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Dr. Z
Dr. Z, Psychologist
Category: Mental Health
Satisfied Customers: 5515
Experience:  Psy.D. in Clinical Forensic Psychology with a background in treating severe mental illnesses.
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I have had Pure-O OCD for a long time now, and I have just

Resolved Question:

I have had Pure-O OCD for a long time now, and I have just recently begun the ACT and ERP therapies regarding letting the thoughts bet there, and not reacting to them, and treating them as they are, just a thought. I have made tremendous progress. I was wondering if the magnifying area of holding the thoughts for a long period of time is necessary to do every time, or should i just let the brain flow and allow myself to have these thoughts and not worry about trying to magnify every thought in my head?
Submitted: 1 year ago.
Category: Mental Health
Expert:  Dr. Z replied 1 year ago.

DoctorZ :

Hello I believe I can help you with your concern today

DoctorZ :

I think that is great the ACT and ERP therapy modalities are working so well for you regarding your diagnosis of OCD

DoctorZ :

Typically with ACT and ERP therapies you want to limit your magnification as this can compound your thoughts associated with OCD, which can make them bigger and bigger, thus harder to control.

DoctorZ :

By letting the thoughts flow and accepting that they are there, but being flexible enough to continue with your daily activities and not let those thoughts control you is a central focus of ACT and ERP therapies.

DoctorZ :

So you do not have to magnify every thought related to your OCD, but some thoughts will trigger strong feelings and compulsions and those should be magnified and given more focus to a point in order to examine them and help you differentiate that thoughts are different then feelings, as ACT described.

DoctorZ :

This is a little cheat sheet outline that I give my patient for ACT/ERP therapy if you would like it. It helps remind them of certain basic tenants of these two types and how they work together

DoctorZ :

Also I usually use the term mindfullness for magnifying because magnifying has been used a cognitive distortion in other therapy moralities, so if I accidentally slip up and call it mindfullness, then that is the reason why

DoctorZ :

I also believe by allowing your brain to flow normally with these thoughts will allow you to perceive these thoughts to be harmless and a normal variation of your cognitive process

DoctorZ :

I see that you are offline right now, but when you get back online I would be very interested in continuing this discussion with you and talking about anything further you would like to share regarding your concern, so if you respond in the chat box I will be able to get back to you as soon as possible.

Customer:

hey would you like a basic background story on my pure o that i typed up last night? it entails everything I have been through and the exact nature of my pure o, which is really a strange strange pure o and experiences mostly obsessions that i cannot find in any of the common exceptions sections, however I have experienced every type of disturbing thought considered a "common theme"

Customer:
My OCD began when I was seven years old as a hybrid of both overt and mental compulsions. I still remember to this day my first compulsion, kissing my mother thirteen times before I went to bed and then praying the same prayer every night, repeating each line and asking "God" to live to one hundred and four years old, every night. It escalated as simple compulsions like that until middle school, when it became drastically more intense and significantly more purely obsessionally based. In middle school I was a bit of a social outcast, going through freshmen year, and my obsessions at that point were more focused on counting numbers in the head, repeating the same phrase like "I'm not gay," or sometimes if I thought of say last years schedule of classes, I would have to go through the current years classes. The directive of these compulsions all changed after I became socially affluent my sophomore year. My Pure OCD vanished for a good four months only to return, with the fear underlying the obsessions and rituals being the idea of returning to how I was at a younger age, and me losing my ability to socially interact in the way I had come to exhibit. This turned into a fear of just being afraid I would not act like myself in general, once I concluded I would not return to my older ways. However, because the anxiety would attack my brain, I would most certainly exhibit signs of being socially awkward at times, or the anxiety that would accompany my endeavors would raise thoughts in my head that I actually would lose the ability to be myself since my efforts to were being impeded by the anxiety already. This of course led to a cycle of worrying about being myself, focusing on anxieties in talking to people, namely girls, how I presented myself and felt, and whether the thoughts in my head were thoughts I would think, being myself, or thoughts that myself in a state of "not being myself," would think. This lead to the thoughts, intrusive thoughts, sticking in my head for extended periods of time, as they do, and me believing I was not "myself," for extended periods of time. Also it involved trying to get the just right feeling in order to be myself, for example when I would have an uplifted moment from the obsessional thought induced belief that I was not myself, I would focus on the just right feeling of having my brain rid of any current obsessions, and eventually created a feeling and image in my head that I would associate with being myself, and felt that I was only myself when this was present in my mind with the absence of the intrusive thoughts. This case of being "myself," of course became less and less frequent, and obsessions that I could not talk to people well because I had an elongated feeling intruding my mind that I was not could last weeks, months, and some periods years. One summer my junior year of high school, I managed to recover from the constant thoughts for the three months when I essentially stopped considering them, and created the idea in my head that thoughts could not change who I was, also assisted with Lexapro that I began for the first time. However, at the end of the summer an obsession came to me that although my conclusion may be true, what will stop me from obsessing about these thoughts and having them remain their for a prolonged time. Without a practical response (ritual/compulsion), to answer the question, I again dove into a bad spiral. Without an answer to this question, my obsessions retrogressed with a severe vengeance. I would have obsessions about whether getting over a thought was done with a compulsion or not, and if not that I wasn't validly over the thought. I would have obsessions about how I thought, whether I could say remember things the same way, focus on homework, whether I thought about discretionary opinionated matters correctly, like politics, or whether I was different and had to do these compulsions to function unlike everyone else. These are four simplified and finely extracted obsessions, because the obsessions came at a rate of over a hundred a day, with no relent. I was attending a very prestigious private school in Maine at the time, and had already gotten into college when I started using substances to cope. I was basically asked to leave the school after being caught at a dance drunk, and went away to a mental hospital in Utah for awhile. I came back without any help from a staff that refused to address my problem, and instead insisted on testing for learning disorders, claimed I had some strange one that was inaccurate, and after recommendations by many other psychiatrists, psychologists and other medical professionals my parents ended up suing the institution. Afterward I graduated from the local high school, and went to the University of Tampa, with the same continuing symptoms. There I became addicted to the ADHD medicine I was prescribed, adderall, after being on add meds since first grade. This was because the euphoric feeling gave me the idea of the just right feeling and made me believe it overcame the anxious thoughts and allowed me to be myself, which in hindsight was just focusing on the euphoric feeling instead of the lingering feeling/thought that I was not myself. I also became addicted to Valium, which I was prescribed for the OCD, because it temporarily relieved the anxiety and allowed me to better interpose good thoughts into my mind and believe I was myself over the intrusive thoughts. What I am getting at is the strangeness of these addictions, being addicted to these pills simply because of their ability to let me believe that they allowed me to be myself, therefore making me believe that I basically needed them to be myself. Everytime I would get a prescription refilled, I would go on a binge, believe that it would last even after i stopped taking the meds, which it never did, and repeat the cycle, which went on until May of this year since 2010. During that time, I got basically all A's, and managed to transfer into the Pre-Law program at the XXXXX XXXXX University, where I currently am. However, I had to take a medical leave due to the OCD last year as well, which makes basically two leaves from excellent schools due to this mental disorder.

I am contacting you because recently, last May, I began using methods like mindfulness cognitive behavioral therapy, Exposure Response Prevention, and the other methods. I did this by, for the first time ever, not fighting the thoughts and just allowing them to be there, occasionally magnifying them in my mind but mostly just letting them be there, not responding to them and not giving them must thought. As you can imagine it was extremely difficult at first, however over the last four months I have made an extreme amount of progress. My question to you, after all this, is whether you have any suggestions? I know that not responding to it and accepting the thoughts presence is the key, however I don't go to regular therapy due to the incessant nature of my intrusive thoughts. Since they are so constant, I figure that going to therapy and writing my obsessions or sitting in a room and putting the image of one obsession in my mind would be a waste of money, and that it would be better to just continue the techniques in my everyday life. My question is how successful of a treatment does this look on surface. Most articles I read online and from psychiatrists focus on the in therapy activities, and lightly touch on outside methods like just letting the thoughts be and not actively engaging them. However, I feel that with the incessant nature of my Pure O, the most important aspect would be the outside, so the main question is, is this what I should be doing as far as treatment goes, continuing to accept the thoughts into my mind and going on about my day. It has been extremely effective so far, and I wanted to make sure from a professional opinion that I am not omitting any possibly more helpful
DoctorZ :

Okay, I am back online. Just give me a couple minutes to read what you wrote

Customer:

yah sorry its pretty long

DoctorZ :

No worries, the more detail the better :)

Customer:

its something i wrote to another therapist last night, im really just backing up the fact that im doing the right techniques, I have already had it confirmed by my psychiatrist and therapist back home, i am just looking for other suggestions given you have already confirmed i am on the right path

DoctorZ :

No problem, just give me a little more time to finish reading and then we can discuss

Customer:

ok sounds good thank you

DoctorZ :

Okay I am done, sorry I am slow reader and I wanted to re-read parts to make sure I got it all.

DoctorZ :

So on the surface, yes this seems like a good treatment plan you are on because you are accepting the thoughts as they are and letting them come naturally to you without focusing on them and as a byproduct these thoughts are not having as strong of a hold on you as they did in the past

DoctorZ :

Now though, in the beginning of this therapy modality individuals sometimes lost perspective and their objectivity and it is good to have a a therapist or other metal health professional there to help them still maintain that objectivity that is so valuable with this type of therapy.

DoctorZ :

But it appears that you have a better insight into your OCD thoughts and behaviors then most patients, so you may not need this separate objective voice to help you

Customer:

precisely, although i have to admit, my first obsessionally stricken moment in the last four months really was yesterday when i kept searching to re confirm and re confirm that this method was legitimate even though i already knew it was. This could also be because i took my adderall yesterday for school for the first time in awhile and that tends to make me obsess more. I know that the therapy of letting the thoughts be there and just accepting their presence as thoughts of the mind that have clearly been cultivated to have a higher presence in my mind after being classically conditioned as important, therefore have a higher traffic rate as far as thoughts go in my head, is the correct way. I was just obsessing over this one angst that maybe its not exactly right, of course the uncertainty, which I have before managed to disregard knowing that this is the proper way to desensitize myself to these thoughts, and the only way to get control of them, however I just kept re affirming it over and over again. I am finally putting a halt to it

Customer:

i think i am just hyper sensitive to the idea that it might not be the way to get rid of it because in the past I have come up with ever new compulsions that had appeared, after being immersed in the OCD so long and believing the goal was to rid myself of the thoughts, that they were a non-ocd way to get over the ocd, however they were clearly just compulsion methods to get the thoughts out of my head rather than accept them

Customer:

does this all sound correct

DoctorZ :

The great thing about ACT therapy is to enhance your flexibility with dealing with your obsessional thoughts, so there is no one way to help you through this. There are multiple ways that comfortable for you. It sounds like by focusing on the treatment is causing an obsessional thought and behavior and the more you focus on it, the more it compounds, which is where the difficulty of magnification lies. Remember with ACT therapy you are not focused on lessening your symptoms or trying to find a technique to lessen your symptoms...ACT is designed to accept your thoughts, beliefs, and feelings as they are and as a byproduct of that acceptance these obsessional and compulsion thoughts/behaviors will lessen.

DoctorZ :

So try not to focus on the technique so much as it were, but instead focus on accepting and letting go

Customer:

yes because trying to lessen your symptoms would be controlling

Customer:

that is why i am letting the thoughts be, this was a one time incidence i have had the thought occur many times before and been able to let it be and ignore it

Customer:

and not obsess over it

DoctorZ :

May I ask have you ever tried progressive muscle relaxation in conjunction with ACT/ERP?

Customer:

which is what i should be doing correct, just letting it go and not trying to control it? accepting the fact that the thought is there and occurred and moving along

DoctorZ :

Exactly, you have it right by acknowledging the thought and letting it go. You are still new to this type of therapy, so there are going to be some hiccups along the way, but so far it sounds like you are doing really well with it

Customer:

what do you mean by progressive relaxation, the one where you focus on your head first, then your face, then your neck ext. to your toes and by the end it usually assists in helping one handle the anxiety

Customer:

i once had one of my "therapy compulsions" my senior year of high school where i believed when i flexed my stomach muscles, how it helped me get rid of anxiety meant it helped me get rid of the thoughts, clearly not true but it may have helped with anxiety but probably just focused my mind on something else

DoctorZ :

Yes is a therapeutic tool that is often used to help an individuals relax and makes the process of acceptance and letting go easier, that is why I mentioned it.

DoctorZ :

You are focusing your mind on something else, but it is not designed to be a distraction more of a way to attune your body and mind together

DoctorZ :

I just wanted to mention it to see if it would help you, but if you tried it before and it did not help then you do not have to use it

Customer:

no i never really attempted it to much ill give it a try now thank you

Customer:

i think i avoided it because i didn't want to make it a compulsory responce

DoctorZ :

Let me give you a link for it real quick

DoctorZ :

So did I confirm that you were on the right track with your ACT/ERP therapy?

Customer:

thank you, XXXXX XXXXX absolutely did

Customer:

now i think three medical professionals opinions should suffice, either or im not gonna act on the obsession again

Customer:

i appreciate it very much

DoctorZ :

Well I hope you do not act on that obsession and the ACT therapy helps you to accept and let go.

DoctorZ :

Anytime, I am always happy to help

DoctorZ :

If you have any other questions or concerns please feel free to contact me again at anytime

DoctorZ :

I hope I provided you with excellent service today

DoctorZ :

Is there anything else I can assist you with today?

DoctorZ :

Before you sign off though, I would very much appreciate if you could rate my performance in helping you so that I can get credit for this question. Thank you very much

Dr. Z, Psychologist
Category: Mental Health
Satisfied Customers: 5515
Experience: Psy.D. in Clinical Forensic Psychology with a background in treating severe mental illnesses.
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Dr. Z
Dr. Z
Mental Health Professional
5515 Satisfied Customers
Psy.D. in Clinical Forensic Psychology with a background in treating severe mental illnesses.