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Dr. Mark
Dr. Mark, Psychotherapist
Category: Mental Health
Satisfied Customers: 5105
Experience:  Dr. Mark is a PhD in psychology in private practice
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I dont know if I have anxiety, OCD, depression, or am psychotic

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I don't know if I have anxiety, OCD, depression, or am psychotic but I have been having fearful thoughts of harming family members, anxiety about going crazy and/or hurting someone, and, as I am a practicing Catholic, sometimes have the worst possible thoughts about God and figures in the church. It's been like, what is the worst thing I can think of and there it is. Not constant but this comes and goes. I take my faith seriously so the worst thing I can think of is thoughts about God, Jesus, and Mary. I love my family so what's the worst things I can think of. Losing control and harming them. Not sure what I should do about this. I've been able to work through it for several years but this weekend has been difficult. I hate forcing myself to keep busy just avoid certain thoughts. Please, any advice is greatly appreciated.
Submitted: 3 years ago.
Category: Mental Health
Expert:  Dr. Mark replied 3 years ago.

Hi! I believe I can be of help with this issue.

First, let me say I can imagine how frustrating and worrisome this situation must be for you. You are clearly a loving and caring person and it is very wonderful that you are recognizing that you have to be somewhat patient and work through this problem. Good for you.

I have worked for a long time with people who have had obsessive thoughts or thought patterns. But what's so unusual here is that just yesterday, someone else asked me a question with the exact same problem: obsessive thoughts about Jesus and then it spread to thoughts about her family, awful destructive thoughts. I am relating this to you to let you know how this is not so uncommon. That is the first step in relaxing and the work we're going to do about this below. Because this is a form of OCD. yesterday it was a young woman: A thought comes into her mind and she obsesses on it. This obsessing causes more of these thought "events" to occur. So, let me help you implement the strategies you need to use. If you are not able to control this on your own, you should see a psychologist who is experienced in OCD to help with this. It is not good to let this become too entrenched in your thinking pattern, so you should get help soon if it doesn't abate. The therapist should be practicing some form of Behavioral Therapy for OCD, which is the most effective way to treat this.

Okay, let's start:

You have these thoughts that come into your mind and they scare you. You are CONVICING yourself of something that has no reality other than your inability to stop convincing yourself. It's a vicious circle that is caused by anxiety and increases anxiety. At the end of this posting I’m going to include a technique to use when the anxiety from these thoughts and worries rises. It will give you a little relief so you can use some of the other techniques I will be talking to you about.

You need to know that this is not as uncommon as you think. Intelligent people, both male and female, tend to have these obsessive thoughts. And there is no way to predict or know why each person's subconscious mind chooses one thing to obsess about instead of another. We can theorize about fears driving the subconscious choice of subject, but it's only theorizing at this time. Therefore, I need you to reorient your view of what is going on.


EVERYONE has strange thoughts come into our minds! So what's the difference between all of us and those who have a psychological problem or a mental illness? What we DO with those strange thoughts!

Here's what I mean:

It is very common to have a thought, sentences that come in, about jumping or falling off a subway platform or onto the tracks of a train. Why? Because we've all seen images of this in movies, etc. Same with jumping off balconies or falling. And other such calamities. BUT, most of us let these thoughts just go. We don't hold on to them. We treat them like all the other type of fleeting thoughts we have throughout the day about whole sorts of things. We just let them go and don't attach any importance to them. When someone CAN'T let the thought go, then that could be OCD for example, or some other anxiety disorder. When someone embroiders the thoughts into voices saying they SHOULD jump or into whole elaborate stories about jumping or falling on the tracks, then that could be a sign of schizophrenia or some other thought disorder, for example.

Do you see the difference here? It's not in the thought, the sentences that come into our awareness. It's in what we do with it. So you had thoughts about the religious figures you revere that were thoughts of an awful nature. Okay. That is not so uncommon. But rather than letting the thoughts go like any other stray thoughts, you obsessed on these particular thoughts and they became anxiety triggers for you.

By the way, you may be interested: about 5 months ago I actually treated someone with the problem you describe! His obsession was that whenever he thought about his family members and said to himself that they were okay, that he REALLY meant that he wished them to have awful sicknesses. Thoughts of that nature. What did we work on? What I'm telling you. We worked on changing his view from never having such thoughts as being normal to recognizing that we all have stray thoughts that are horrible or awful. The important skill that most people have is how to just let strange thoughts go the way of any other fleeting thought.

So, that is the key and I hope you will apply it. You may need to do this in therapy. So you may want to try working on this first on your own. Apply the strategy. Every time you have the thought, consciously tell yourself that it is just a stray thought, a strange thought. This is just a stray thought. If it persists, use the technique below and remind yourself it's just a stray thought like everyone has because you still have residual anxiety. Got the technique?

Okay, I wish you the very best!

Here are instructions on a therapeutic protocol called Progressive Muscle Relaxation (PMR). It's really quite easy to do almost anywhere. My patients suffering from anxiety and stray thoughts, when I teach them PMR at first are amazed how simple it is and that it is a psychological protocol. It was first used in the 1920s! Since then, of course, it has been refined and many studies have been done showing its effectiveness. You will practice PMR at first when you don't wake up with an attack so that you will be familiar with it. I want you to practice the PMR at least 5-6 times before acute anxiety. Why? Because when you're in the throes of anxiety, you will only remember to do something you are very familiar with it. So practicing 5-6 times is really a minimum.

I want to stress the importance of breathing as well. Part of the physiology of what is happening to you in anxiety from stray thoughts is that your breathing is getting shallower. This reduces the oxygen in your blood to your brain. That increases the anxiety reaction, which strengthens the attack and you are in a vicious cycle! Not good. So breathing is the primary tool. I have found in my practice that learning breathing techniques can be helpful. But some of my patients are not interested in learning more than one thing at the beginning, so I have found that just reminding you to BREATHE deeply at the same time you are doing PMR is almost as good. If you are willing to take a yoga class and learn breathing techniques, that's the best. But, breathing deeply with your PMR will help.

So, we're ready for learning PMR. I want you to print my instructions below my signature and have a copy in each of the rooms of your home where you may be when you have an attack. And again, you need to practice this easy technique at least 5-6 times as soon as you can. It needs to become as natural to you as breathing. Ah, remember breathing?


INSTRUCTIONS:

  1. After finding a quiet place and several free minutes to practice progressive muscle relaxation, sit or lie down and make yourself comfortable.
  2. Begin by tensing all the muscles in your face. Make a tight grimace, close your eyes as tightly as possible, clench your teeth, even move your ears up if you can. Hold this for the count of eight as you inhale.
  3. Now exhale and relax completely. Let your face go completely lax, as though you were sleeping. Feel the tension seep from your facial muscles, and enjoy the feeling.
  4. Next, completely tense your neck and shoulders, again inhaling and counting to eight. Then exhale and relax.
  5. Continue down your body, repeating the procedure with the following muscle groups:
    • chest
    • abdomen
    • entire right arm
    • right forearm and hand (making a fist)
    • right hand
    • entire left arm
    • left forearm and hand (again, making a fist)
    • left hand
    • buttocks
    • entire right leg
    • lower right leg and foot
    • right foot
    • entire left leg
    • lower left leg and foot
    • left foot
  6. for the shortened version, which includes just four main muscle groups:
    • face
    • neck, shoulders and arms
    • abdomen and chest
    • buttocks, legs and feet

Quickly focusing on each group one after the other, with practice you can relax your body like ‘liquid relaxation’ poured on your head and it flowed down and completely covered you. You can use progressive muscle relaxation to quickly de-stress any time.

What You Need:

  • A comfortable place.
  • Some privacy.
  • A few minutes.

Again:

Customer: replied 3 years ago.

For Dr. Mark:

Thanks Dr. Mark. I have probably made things worse by just trying deal with this on my own rather than get help. It's like "If I don't need get professional help then that means I'm not crazy and don't really have a problem that I can't handle on my own". I actually ordered an anxiety DVD series a couple years ago but only actually used it a couple times.

When you said the sooner you get help the better it elevated my anxiety because I was thinking that, because I've tried dealing with this on my own for so long that I have developed thought patterns that can't be changed. I understand this is the anxiety and irrationality talking but the thought that it isn't is what is scary. The fact that you didn't say "Go to the nearest mental health facility immediately!" when you read my question also helps. I will try the methods you suggest. I will wait for a response before I click "Accept Answer".

Expert:  Dr. Mark replied 3 years ago.
This is an important point to make clear and I'm glad you asked for clarification.

Let's compare it to someone who knows that eating cupcakes makes him gain weight. But he can't resist them whenever he sees them. Well, it's clear that if he doesn't treat this problem, the more he sees them, the harder it will be for treatment to work when he DOES get treatment, right? It's never IMPOSSIBLE, it's just harder. Why?

Because he has now developed it into a pattern. And our brains work based on patterns. So when we establish a pattern, the more we reinforce that pattern, the harder it is to break it. So does that mean he shouldn't try?

Of course not! He needs to learn behavioral techniques to help himself not give in to the temptation of the cupcakes. That is still the treatment he needs. The same with OCD.

There are medications today that are very useful in the treatment of OCD. The main treatment, we psychologists believe, is still Behavioral Therapy with an emphasis on Exposure and Response Prevention.

If you are not seeing a psychologist who is experienced with OCD and Behavioral Therapy, then this is your main strategy to pursue. The self help techniques I proposed to you were assuming that, since you said you already were diagnosed with OCD, that you had treatment for OCD and that these were new symptoms. So the techniques I proposed to you were not to take the place of an overall treatment plan for the OCD that includes these obsessive thoughts.

Do you need to deal with this as an emergency? NO. You need to deal with it as a disorder that you want to treat as soon as you can find someone you feel confident with and comfortable with in working on the disorder.

I wish you the very best!

Please remember to click the green accept button. Feel free to continue the discussion; my goal is to get you the best answers possible. Bonuses are always appreciated! If I can be of further help with any issue, just put "for Dr. Mark" in the front of your new question, and I'll be the one to answer it. All the best, Dr. Mark

Customer: replied 3 years ago.

Dr. Mark,

Sorry it has taken so long to get back to you and accept your answer. You are mistaken in your last post. I never said I was diagnosed with OCD. Nor did I say that these were new symptoms. You must have misread my post. I have brought up to my primary care physician that I had some issues with anxiety and difficulty concentrating at times. He prescribed me meds for the anxiety but I never actually got the prescription filled. I just worked through it. It seems lately that my anxiety has escalated a bit but I am working through it mostly by distracting myself. At times it is very difficult to focus on the task at hand or work thorugh a normal thought process to solve problems at work and at home. If you think my best course or action is to see someone about this then I will pursue it but as I said in my previous post. Sometimes what seems to help me more than anything is the comfort that I have dealt with this on my own without medication or therapy and that it is managable. Once I go to meds or a therapist it becomes a serious problem. There's still that stigma in my head.

Please respond to this last post. I'll wait for your response and will "accept answer". Thank you again for your help Dr.

Expert:  Dr. Mark replied 3 years ago.
Hi. Let's see if we can get me to understand. I originally read when you said that you have OCD that this was diagnosed and being treated. And then when you responded that you probably have made it worse by trying to treat it yourself instead of getting professional help that you weren't being treated. So I drew an image of what the situation is.

Now it seems that the situation is that you have had OCD type symptoms and have been dealing with them yourself, with some success. But they have not gone away. These symptoms are the strange stray thoughts we've discussed in my first answer. You feel anxiety and it is unclear whether the anxiety is a result of the strange thought, or leads to these stray thoughts or they are two parallel problems.

Now, I think, you have tried to communicate to me that you really pride yourself and want to continue in dealing with these problems yourself. You are unsure whether that is wise or not. I look at it this way: give yourself a little more time to work on the techniques I have proposed to you and the book I'll recommend to help in working by yourself, perhaps 2 months or so. If you feel that you are not moving forward then consider at that time seeking a psychologist's help. You know, as a religious person it can be a big spiritual step for you to accept help, to acknowledge the need for help and to accept it.

So here's the book:

Here is the Amazon web page address for the classic workbook for phobias by Edmund Bourne The Anxiety and Phobia Workbook:

http://www.amazon.com/Anxiety-Phobia-Workbook-Fourth/dp/1572244135/ref=sr_1_1?s=books&ie=UTF8&qid=1286170992&sr=1-1

 

So use the technique for the stray thoughts above and the PMR which is in this workbook and the other techniques in the workbook that may be useful to you on its own and see how you do. Okay?


I wish you the very best!

Please remember to click the green accept button. Feel free to continue the discussion; my goal is to get you the best answers possible. Bonuses are always appreciated! If I can be of further help with any issue, just put "for Dr. Mark" in the front of your new question, and I'll be the one to answer it. All the best, Dr. Mark

Dr. Mark, Psychotherapist
Category: Mental Health
Satisfied Customers: 5105
Experience: Dr. Mark is a PhD in psychology in private practice
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