Being Mindful...

Mom's Thoughts:

Last week I stumbled across the website for the OCD Center of Los Angeles, and found some very helpful information about Harm OCD.  That website has led me to several different articles about CBT, ERP (Exposure & Response Prevention,) and a couple of other therapy methods I had not heard about before, like DBT (Dialectical Behavior Therapy,) ACT (Acceptance and Commitment Therapy, and Mindfulness Based Cognitive Therapy. 

Actually, my sister happens to be a psychologist in another state, and she had mentioned DBT to me, along with a couple of other therapies that I don't remember.  She is researching these topics for me further, so hopefully will come up with some other ideas.  Most coincidentally, she is attending a professional workshop on Panic Disorder next week and has a bunch of questions ready for the presenter, poor man.  He doesn't know what he's in for!  :)  I'm very grateful to her for her professional and sisterly support!

The one I understood most (perhaps because it is explained at length in the OCD Center of LA's articles) is Mindfulness Based Cognitive Therapy.  However, it seems the general concepts behind them are similar:  they teach the person to stop resisting or trying to control the obsessive or upsetting thoughts and just accept them as passing events in the mind.  Here is what was written about Mindfulness-Based CBT:

One of the most effective CBT developments for the treatment of Obsessive-Compulsive Disorder (OCD) and related conditions is Mindfulness-Based Cognitive-Behavioral Therapy. The primary goal of Mindfulness-Based CBT is to learn to non-judgmentally accept uncomfortable psychological experiences. From a mindfulness perspective, much of our psychological distress is the result of trying to control and eliminate the discomfort of unwanted thoughts, feelings, sensations, and urges. In other words, our discomfort is not the problem - our attempt to control and eliminate our discomfort is the problem. For an individual with OCD or a related anxiety-based condition, the ultimate goal of mindfulness is to develop the ability to more willingly experience their uncomfortable thoughts, feelings, sensations, and urges, without responding with compulsions, avoidance behaviors, reassurance seeking, and/or mental rituals.  To learn more about Mindfulness Based CBT, click here.

Last week, even before reading these articles (after reading more of Dr. March's book, Talking Back to OCD,) I started to think that what my husband and I had been doing to comfort Elizabeth when she was "going crazy" (her words, not mine,) with these upsetting and/or overwhelmingly anxious thoughts was actually part of her compulsion - in other words, we were actively participating in her "reassurance-seeking" compulsion, which is a common compulsion with Harm OCD.   Family members are often bossed around by OCD too, according to Dr. March, and I was finally beginning to see how it applied to us.  The obsessive thoughts are so distressing and guilt-producing that Elizabeth continually asks if something has really happened, if they are hurt or bleeding, if someone else is hurt or dead, or seeks reassurance that she is not a bad person and couldn't have done anything to hurt someone, and so on.  

It seems to me that with Elizabeth's self-harm obsessions she tends to look to me or her dad to prevent her from "going out of control" and hurting herself.  (That seems to be a big fear for those with OCD - a fear of losing control - and knowing Elizabeth, I can see that being the root of a lot of things.)  However, when she's having an "episode" like this, if I step back from my own fear and look at it as objectively as possible, it doesn't really seem she needs this kind of intervention; I truly don't think she would hurt herself, except perhaps by accident.  It really does seem to be a reassurance-seeking compulsion more than than me actually preventing her from harming herself.  It is a very subtle difference in behavioral clues to me.  For example, she might hit her head on the wall over and over, but not hard enough to really hurt herself.  Or she might try to lunge for the stairs, but then pull herself back rather than forcing me to pull her back.  Later when she "comes out of it," she will tell me she really didn't want to hurt herself, but she was very afraid she would.  Afraid she would lose control and do it even though she didn't want to - very much a symptom of OCD.  This is how I know she is not really suicidal.  This greater understanding helps me to be less afraid when I see her in this state.

Now, I'm not going to just leave her alone and say "you'll get over it," of course not!  But now  instead of saying "You don't want to hurt yourself," or "Calm down, everything is OK" or that kind of thing, I am trying instead to say "This is just a passing thought, no more important than any other,"  or "Just allow this thought to be in your head without any judgement or worry about it.  It's just OCD (or Snow White, in Elizabeth's case) putting this in your head to scare you.  Don't judge yourself or the thought at all; let it pass out of your mind."  and tell her even though it's scary, it is the no different from the thoughts in your head about "we had chicken for dinner, or it's snowing, or my blanket is warm, etc." 

I tried this kind of dialogue with her the last couple of evenings when she began to have bad, "Snow White" thoughts or was very anxious.  (Intense "I'm so worried but don't know why" kind of feelings we decided to attribute to Grumpy.  Ha!)  And I'm not sure if it was just a coincidence, but it really seemed to work!  She quickly (within just a few minutes) was able to shake it off and continue on with the night without a relapse.

I don't dare to hope this is the big "cure" for her, but it so far has been a very peaceful weekend for us.  I really really hope that our new knowledge of Mindfulness-Based CBT will lead us to more, similar successes.  If she can get control over those super distressing thoughts and anxiety, I'm hoping she can focus more fully on eliminating OCD in all areas of her life.  Fingers crossed!!