Sporadic photos and notes from a Psyche-midwife, cheerleader, anthropologist--aka clinical social worker in therapy practice. Photos are usually mine except for those of historical events/famous people. Music relevant to the daily topic is often included in a web video embedded below the blog. Click on highlighted links in the copy to get to source or supplemental material. For contact information, see my website @ janasvoboda.com or click on the button to the right below. Join in the conversation.
Oh the nerves, the nerves; the mysteries of this machine called man! Oh the little that unhinges it, poor creatures that we are! --Charles Dickens
As promised, though belated, a few tips for managing anxiety-- part one.
1) Don't suffer twice. When we worry about something in our future, (and there's nothing to be done about it) it's a lose-lose situation. If it happens, we get to suffer twice. If it doesn't, we worry for nothing.
2) Mind your stories. A Swedish proverb says: Worry often gives a small thing a big shadow. We can tell ourselves pretty alarming stories that have no real basis in probability. Check for facts. How many times have planes crashed at PDX today? This week? This year? Chances are that same pilot who's already landed the plane safely 8 times this week will also do fine today.
3) Take a breath. When we are fretting, we are often literally holding our breath. We don't breathe out all the used up air, and we end up in a bit of an oxygen deficit-- which does nothing to soothe our anxiety. Try "box breathing"-- take as much time to breath out as in, and make sure to pause for a reasonable time between inhalation and exhalations.
4) Get some distraction action. Since what you feed (your mind) grows, look for healthier places to invest. Listen to some music, taste a lemon, do some art.
5)Fire up a more logical part of your brain. Think of your brain like a power grid. If one part-- say that pesky amydala, which is all about emotion-- is all lit up, chances are the areas that access logic and reason are a bit dimmed down. Shift the resources by engaging in a few minutes of algebra, or even sudoku. Firing up those neurons will take a load off.
(Photo by Marla Dean Svoboda) GOT FEAR? The spectrum of human experience known in the biz as ANXIETY DISORDERS account for much of my office traffic. As noted in previous blogs, there's reason to believe some of what makes a good chunk of our population more jumpy is genetic, and evolutionarily beneficial. People with more anxiety have Great Big Radar-- they are more tuned in to (and reactive to) changes in environment, internal and external.
Anxiety disorders in the DSM-IV, my professional's travel guide, include everything OCD to Post-Traumatic Stress. There's also categories for the generally jumpy (Generalized Anxiety Disorder) to the specifically frightened (phobias). Panic attacks are discrete periods of high anxiety that can be brought on something in particular, such as being in a crowded place or on a bridge, to nothing obvious at all-- worse, because that's a little harder to avoid.
The brain is great at learning what scares it. Danger memories can get hard-wired to provide a quick spill of chemicals that ideally would serve us well-- to get us the hell out of dodge, or help us fight off our attacker. Brain is not particularly selective in what gets filed, which can result in some strange associations we may not even know exist. For example, if you're in a car wreck, Brain may file away not only screeching tires and breaking glass. You might find yourself also getting panicky feelings (the emotional interpretation of all those chemicals coming to fore) when you pass white Hondas, or that particular intersection. That one's easy to connect, but while you might not have noticed what was on the radio, Brain could have, and you may not understand why your heart races every time that Lady Gaga song plays. I had a boss once who was a Viet Nam War Vet. Once during a staff meeting someone decided to make popcorn and started up the air-popper. Next thing we knew, our normally composed boss was under the conference table. Turns out the sounds the machine make are very close to what rear-machine gunfire sound like. Now obviously his logical thinking knew a popcorn machine was no physical threat. But body thought different, and it took a while for him to dial down the adrenaline.
Anxiety is the dizziness of freedom, said Kierkegaard. We are faced with an avalanche of choices, and each choice carries a responsibility and the opportunity to go wrong. Anxiety just wants to know and be able to plan for what's next. That's why a lot of people with the Anxious Gene can look like micro-managing control freaks (and why OCPD is probably just a coping response to an anxiety disorder). It's why we become much more anxious after an event that is not predictable, like the beautiful fall morning in NYC that later became known as 9/11. It's the seductive attraction of fundamentalism-- a simple recipe we can follow so that everything is guaranteed to turn out OK.
Our attempts to make an unpredictable world more comfortable often backfire. Addictions often start as ways to soothe, and we use many means to become comfortably numb, like TV watching. We substitute relationships that feel more manageable for ones that can provide greater intimacy with its resultant greater risk of loss and heartbreak. We practice avoidance through procrastination (consult me for tips-- I should be doing billing right now). We adhere to rules and ritual, sometimes crazy ones, to give an overlay of structure. All things in moderation -- some structure is a great thing, and too much or too little is a bad thing.
CHECK CHECK CHECK: Obsessive Compulsive Disorder is the label given to a anxiety disorders that have two chief characteristics: Obsessions (unwanted thoughts, images, beliefs) and/or compulsions (ritualized or repetitive behaviors). There are several subtypes. In contamination OCD, the sufferer worries about being affected by touching or being exposed to specific (although often many) people or objects, or being infected by germs. The fear is controlled where possible by avoidance (never touching doorknobs, refusing to shake hands, etc). When avoidance is impossible, the sufferer often develops rituals to "cancel out" the contamination. These may be logical though excessive, such as hand washing or use of antibacterial lotions. A person with contamination OCD may wash, scrub or apply chemicals to hands to the point of damaging the skin. Illogical rituals may also be used: retracing steps, saying a particular phrase, and so on. The rituals can be very time consuming and do NOT feel like a choice.
Rituals aren't limited to contamination OCD. Some OCD folks have intense fears something terrible will happen to them or someone they care about if rituals are not followed. Checking disorder, in which a person has intrusive concerns about not completing a protocol, may lead to checking and rechecking to make sure the lights are off, gas isn't leaking from the stove, or similar. Last year driving to the airport I saw a bumper sticker on a car that said "Are you SURE you unplugged the iron?" Like most people, I have a touch enough OCD that it nagged me for a minute or two. For someone who really is affected by OCD, that might have led to a drive back home from over an hour away.
OCD can cause intrusive, usually illogical thoughts that cause distress. They are "ego-dystonic", a fancy way of saying the person doesn't want them. Those affected seek constant reassurance to refute them. In one case many years ago, I worked with a young man who worried he might be gay. He had never been sexually involved with a man, and never wanted to be. He had perfectly satisfying heterosexual relationships. Yet every week he would ask me "Are you SURE I'm not gay?" Reassuring someone with OCD is not effective, and in some ways contributes to the worry. The person with OCD knows their behavior or thinking is illogical. But it is not a choice to them.
"Pure O" OCD is the name given when the primary symptom is intrusive thoughts and/or images. Disturbing sexual or violent pictures and thoughts are common in this type of OCD, but the name is misleading-- there are almost always some compulsions around being used to try to control the behavior. For example, a person may avoid driving because of obsessive thoughts about running someone over.
I read once that the chief difference between the OCD and non-OCD person with egodystonic thoughts is the "stickiness" of their brain. We all think crazy thoughts. But if we don't have OCD, we dismiss them as random. The OCD brain worries them like the place where a lost tooth came out. They just can't leave them be.
The causes of OCD are unclear. There is an obvious genetic component that accounts for at least half of occurrences. While no one gene appears responsible, it's rare to treat someone with true OCD who didn't have one or more direct family members with some sort of significant anxiety disorder. But environment also plays a role. Life stresses, maternal pregnancy factors and even childhood strep infections can be factors. Hormones appear a factor at least in women-- it is common for new mothers (some say around 30%) to struggle with some intrusive thoughts and compulsive behaviors. Of course, stress and anxiety in such situations would be a clear contributing factor: is the baby breathing? Did I feed her enough? But the frequency leads researchers to conclude that hormones may exacerbate the situation. You can see in that case the evolutionary effectiveness of increased vigilance. Worried-over babies are more likely to survive than neglected or ignored babies.
OCD is different from Obsessive Compulsive Personality Disorder. People diagnosed with OCPD don't usually have rituals. Personality disorders are considered more personality types that cause trouble for people rather than isolated disorders. If you're old enough to remember "The Anal Retentive Chef" from Saturday Night Live, you've seen a classic OCPD type-- obsessed with rules and order, inflexible, fussy, perfectionistic. As I mentioned in my first blog about diagnosis, at their most basic most diagnoses describe a particular type of genetic predilection that have both strengths and weaknesses. You probably WANT your chef, your surgeon, the guy that lays your tile to be a bit on the obsessive-compulsive side. That means you will get a job done right. But when either of these slips into the really disordered arena, you get someone impacted so much by rigidity, anxiety, avoidance or time-eating practices they cannot function at all close to their potential. That's when it's time to do something.
Therapy for OCD
The most demonstrably effective treatment for OCD is not pleasant for those who have it. It involves systematic exposure to the triggering events so that the brain can rewire these to be perceived as non-threatening. OCD "boot camps" provide this quickly, though overwhelmingly. A person with contamination OCD might be forced to touch a toilet, for example, then eat something without washing. Generally, in outpatient treatment, exposure is done gradually to desensitize the person.
Medication can also be helpful. SSRIs (antidepressants such as fluxoetine, better known by its brand name of Prozac, or others) seem to help some people. There are risks and benefits to using medication and it appears that they work best when exposure therapy occurs concurrently. Medications of these sort should NEVER be stopped abruptly because serious withdrawal syndromes and rebound effects (worsening of symptoms) may occur.
New treatments using deep-brain stimulation (which involves surgery), transcranial magnetic stimulation (non-invasive) and even good old ECTs are also actively being explored to treat more severe and disabling forms of OCD.
If you're worried now that you have OCD, remember that most people have a little bit of every "disorder". The key factors for figuring out whether it's a problem is how disruptive it is to your life. Who's complaining? How much is it limiting you? If it's a problem for you, there are many options. Most cities (certainly Corvallis) have therapists and psychiatrists who specialize in treatment of OCD. Here are some other resources:
ocdtribe is an online source with chat groups and information by and for OCD sufferers.
The International OCD Foundation, also run by persons with OCD, distributes information, research, and connects folks to treatment.
Dr. Stephen Phillipson has several good articles here at OCD Online.
Lots of successful, famous people have OCD. Click this post's title to see Howie Mandel talk to David Letterman about his.
