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Dr. Mark
Dr. Mark, Psychotherapist
Category: Mental Health
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Experience:  Dr. Mark is a PhD in psychology in private practice
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I was diagnosed with pure O in February. I was having intense

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I was diagnosed with pure O in February. I was having intense fears that I would harm my family. I was able to overcome this fear with therapy. My fear now however is that I might be schizophrenic. I am a nurse and aware of the symptoms of schizophrenia and my biggest fear is that I may hear a command hallucination. Although I have never heard any voice telling me to do something..... I will sometimes imagine what it would be like to experience a command and in my mind think.....this is god telling you to hurt yourself. Although I am aware it is me thinking that I am scaring myself that maybe I am having a command hallucination even though I know I am making myself think about it....? Is this common with OCD I feel like im loosing it.
Submitted: 1 year ago.
Category: Mental Health
Expert:  Dr. Mark replied 1 year 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. It certainly does sound as though you are dealing here with symptoms of the OCD type disorder that is purely obsessional without compulsive behavior yet. That your obsession has switched from harming loved ones to a self-illness is not so uncommon. Obsessions do change.

I know this is so frustrating that you already successfully worked on the harming obsession in therapy and now you have the problem again. I want you to recognize that the fact you are a nurse is probably one reason why you've fixated on schizophrenia: you clearly know, from what you write, the characteristics of the disorder, so your brain, which is clearly very intelligent, is able to obsess with enough "material" on such a disorder. It's also one of the scariest mental disorder we who don't have can think of, so that also makes it a good candidate for OCD symptoms.

But it does need a return to therapy. The medications for OCD are better today than even a decade ago, but you've had good success with therapy and even if you do choose to try medications, the studies do show that specialized CBT therapy specific to OCD is the first line treatment that enhances effectiveness of meds very much.

You sense in yourself that you are CONVICING yourself of something that has no reality other than your inability to stop thinking about it and obsessing about it. It's a vicious cycle that is caused by anxiety and increases anxiety. You originally started feeling anxiety because of some triggering event that is now forgotten and may have been not a big deal even then, but now the anxiety has settled in to become itself the problem rather than a reaction to a problem. At the end of this posting I’m going to include a technique, PMR, to use when the anxiety from these thoughts and worries rises. You may already be familiar with it from therapy before. It will give you a little relief so you can use some of the other techniques I will be talking to you about. Because that you're writing indicates you're hoping for some self help tools to work on this.

Let me link for you a really good layman's guide to this:

http://www.ocduk.org/sites/default/files/understand-pure-o.pdf.pdf


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. Your mind fastened on hurting loved ones and now self-illness. These are not anything profoundly true, they are just what your mind fastened on. Other people fasten on other things. 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 in order for self help tools to be of help.


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



Here's what I mean:


It is very common to have a thought 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 part of Obsessive Compulsive Disorder for example.


Do you see the difference here? It's not in the thought. It's in what we do with it. So for you, the obsessive thoughts of having a thought disorder like schizophrenia are now habitually coming into your mind. But that's all they are: habit.


By the way, you may be interested: about 10 months ago I treated in my private practice someone with strange thoughts problems. His tended toward being very sad about possible hidden motives in his thoughts. He was obsessed that if he thought about a relative in a fond way that really he must have had a malevolent intent: that somehow by thinking a pleasant thought about his mom, dad, or someone else, he was actually hoping they would get cancer or something like that. It was very debilitating to him. What did we work on? What I'm telling you. We worked on changing his view from being so scared of these thoughts to just letting these stray strange thoughts go the way of any other fleeting thought.


So, that is the key and I hope you will be able to apply it on your own or with help in therapy. 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?

Good. Here's the other part:

We're going to create an acronym. An acronym in case you don't know is when you take the first letters of something. Like EU stands for European Union, right? But whenever you hear or read EU, you know what it means. That's an acronym. So what's our acronym?

This is just a stray thought = TIJAST


When a thought of your maybe having some delusional symptom or hallucinatory symptom or other positive symptom of schizophrenia wanders in you're going to remember TIJAST. But you also are going to remember what TIJAST stands for, okay?

And whenever you get nervous about it and start to worry, you're going to smile and say TIJAST! Because it is a funny word isn't it? TIJAST...this is just a stray thought...

Because we ALL get stray thoughts. The thoughts of suffering themselves have no power and are not a problem. It's the nervousness and fear you feel about having them that causes you a problem. So use the technique: It's only fear, it's not anything else. It's just fear of stray thoughts. It's..........TIJAST.

I also want you to commit yourself to apply the principles in the following videos and books to your worries about anxiety. So that you can be yourself with more confidence. Coach yourself. Be your own life coach! I want you to get really into motivational videos and books. In other words, accept your past fears, accept your past worries and hurts and traumas. Accept them and focus on becoming who you WANT to be now. Here's a simple YouTube search I put together on "motivational speakers":


http://www.youtube.com/results?search_query=motivational+speakers&aq=f



Some like Tony Robbins are the classic big guys. Some are newer. There are now great women speakers as well. Watch them all. Get inspired. Buy a book or two.

This book is by Anthony Robbins. He's one of those speakers who fills up huge auditoriums. For a reason. He's a terrific speaker and writer. The particular book (if you like it, try his others): Awaken the Giant Within.


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 an attack or feeling 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?

My goal is for you to feel like you've gotten Great Service from me and the site. If we need to continue the discussion for that to happen, then please feel free to reply and we'll continue working on this. If the answer has given you the help you need, please remember to give a rating of 5 (Great Service) or 4 (Informative and helpful), or even 3 (Got the job done) button. This will make sure that I am credited for the answer and you are not charged anything more than the deposit you already made by pressing any of these buttons. Bonuses are always appreciated! If I can be of further help with any issue now or in the future, just put "For Dr. Mark" in the front of your new question, and I'll be the one to answer it. All the best, XXXXX XXXXX


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:

My goal is for you to feel like you've gotten Great Service from me and the site. If we need to continue the discussion for that to happen, then please feel free to reply and we'll continue working on this. If the answer has given you the help you need, please remember to give a rating of 5 (Great Service) or 4 (Informative and helpful), or even 3 (Got the job done) button. This will make sure that I am credited for the answer and you are not charged anything more than the deposit you already made by pressing any of these buttons. Bonuses are always appreciated! If I can be of further help with any issue now or in the future, just put "For Dr. Mark" in the front of your new question, and I'll be the one to answer it. All the best, XXXXX XXXXX

Dr. Mark, Psychotherapist
Category: Mental Health
Satisfied Customers: 5111
Experience: Dr. Mark is a PhD in psychology in private practice
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