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Dr. Bob is Robert Hsiung, MD,
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Posted by chess on August 25, 2005, at 10:13:43
i have ocd (pure-o) and gad (general anxiety disorder) and panic disorder also
my confusion is that when experiencing anxiety and fearing that i might go crazy or lose control or die or something terrible, the ocd therapy is to accept uncertainty and not avoid or retreat from a situation and say to myself "well, i could go crazy or lose control or die" and not do any reassurance statements or safety behaviors, while the GAD-PD therapy is to reassure oneself that anxiety never leads to a person going crazy or losing control or dying.
my ocd therapist says that i must not reassure myself in any form of self-talk or behavior, while my anxiety therapist says there is nothing wrong with a person reassuring themselves with reassuring self-talk (the reassurance comes from yourself and not from anyone or anything else)
i think that reassuring myself would be okay, especially if it helps me to engage and stay in situations that make me anxious, but then i always wonder if my ocd therapist is right
can anyone relate to my confusion?
Posted by Emily Elizabeth on August 25, 2005, at 17:26:52
In reply to therapy for OCD GAD (help please, i'm confused), posted by chess on August 25, 2005, at 10:13:43
Gosh, that is confusing! I don't think that I really have a good answer for you, but I wanted to ask some follow up questions...
So each T only focuses on one part of your problems? Do they work in the same clinic? Do they know about each other's work?
I guess I am asking b/c it sounds like it would be helpful if the T's could talk to each other and sort this out a little for you. It isn't helpful to feel confused!
BTW, how long have you been in treatment? Is there a set length for the treatment?
Best,
EE
Posted by Emily Elizabeth on August 25, 2005, at 17:30:28
In reply to therapy for OCD GAD (help please, i'm confused), posted by chess on August 25, 2005, at 10:13:43
One more question--how did you get diagnosed w/ OCD-O? That seems like a somewhat unusual diagnosis. (I think) many clinicians would just lump that into part of your GAD. Is there a reason that they thought it would be most helpful to diagnose you OCD-O?
Best,
EE
Posted by chess on August 26, 2005, at 8:47:11
In reply to Re: therapy for OCD GAD (help please, i'm confused), posted by Emily Elizabeth on August 25, 2005, at 17:30:28
i have intrusive thoughts that i get anxious and panic about (harming myself and others or doing something inappropriate etc) but have no checking rituals thus pure-obsessive ocd (pure-o)
my main problem is that i still get over-anxious about things and then i interpret those anxious feelings as possibly going crazy or losing control or something terrible, the difference now from before is that i have anxiety all the time instead of just during a panic attack
> One more question--how did you get diagnosed w/ OCD-O? That seems like a somewhat unusual diagnosis. (I think) many clinicians would just lump that into part of your GAD. Is there a reason that they thought it would be most helpful to diagnose you OCD-O?
>
> Best,
> EE
Posted by Dinah on August 26, 2005, at 11:06:17
In reply to Re: therapy for OCD GAD (help please, i'm confused) » Emily Elizabeth, posted by chess on August 26, 2005, at 8:47:11
I guess this explains my therapist's reluctance for me to have two therapists. Or even a therapist and a backup therapist.
Since you do have two therapists, and I'm assuming are happy with that arrangement?, can you tell them that their advice appears on the surface to be conflicting, and ask them to get together and consult so they can provide a unified front?
Posted by chess on August 26, 2005, at 16:28:41
In reply to Re: therapy for OCD GAD (help please, i'm confuse » chess, posted by Dinah on August 26, 2005, at 11:06:17
they might be both right
the problem isn't with them as much as with me having gad and ocd
ocd and gad therapy seem both the same and different once you identify the problem
with gad once you know the problem it's okay to reassure yourself that you're just feeling anxiety and it's just adrenaline rushes
while with ocd once the problem has been identified then the next step is to accept uncertainty (which means if a thought about dying keeps popping up and causes anxiety then the anxiety-therapist says to reassure yourself that you're just feeling anxiety and are not dying while the ocd therapist would say to accept the thought and consider that you might be dying to habituate to the thought...see the conflict?)
Posted by Dinah on August 26, 2005, at 16:45:22
In reply to Re: therapy for OCD GAD (help please, i'm confuse » Dinah, posted by chess on August 26, 2005, at 16:28:41
Yes, but you're not two separate diagnoses. You're one person with problems with anxiety disorders. And someone who is familiar with the complexities of human beings and how often disorders, particularly anxiety disorders, overlap should be able to balance the pros and cons in such a way as to present a coherent plan of action for you.
With two therapists they might have different ideas. But it's their job to work that out and present you with clarity.
It really isn't unusual to have concurrent anxiety disorders. I remember when I read the list of symptoms for each, I was positive each of them was right. But they finally settled on OCD because my panic attacks were related to my OCD fears, and my generalized anxiety were organized around my the same general concerns that lay beneath my OCD. And my phobias may have been separate in topic, but they were obsessive in scope. Even so, I'm pretty sure I could be diagnosed with a few.
And incidentally, while I used to have a few problems with rituals, for the most part I was pure obsessional.
I don't have the experience or knowledge to know how to weight the different CBT goals, but a professional should.
Posted by chess on August 27, 2005, at 1:57:39
In reply to Re: therapy for OCD GAD (help please, i'm confuse » chess, posted by Dinah on August 26, 2005, at 16:45:22
as a pure-o did you ever have thoughts of harming yourself or someone else?
if you did, how did you handle those thoughts?
did you accept uncertainty and say to yourself that it was possible that you might harm yourself or another, or did you say to yourself "that's just a thought that i know is not going to happen, it's just my ocd"
thanks>
>
Yes, but you're not two separate diagnoses. You're one person with problems with anxiety disorders. And someone who is familiar with the complexities of human beings and how often disorders, particularly anxiety disorders, overlap should be able to balance the pros and cons in such a way as to present a coherent plan of action for you.
>
> With two therapists they might have different ideas. But it's their job to work that out and present you with clarity.
>
> It really isn't unusual to have concurrent anxiety disorders. I remember when I read the list of symptoms for each, I was positive each of them was right. But they finally settled on OCD because my panic attacks were related to my OCD fears, and my generalized anxiety were organized around my the same general concerns that lay beneath my OCD. And my phobias may have been separate in topic, but they were obsessive in scope. Even so, I'm pretty sure I could be diagnosed with a few.
>
> And incidentally, while I used to have a few problems with rituals, for the most part I was pure obsessional.
>
> I don't have the experience or knowledge to know how to weight the different CBT goals, but a professional should.
Posted by Dinah on August 27, 2005, at 6:34:38
In reply to Re: therapy for OCD GAD (help please, i'm confuse » Dinah, posted by chess on August 27, 2005, at 1:57:39
Yes, those thoughts have occurred to me, though they aren't my main obsession (causing harm or disgrace to my family through carelessness). The intellectual reasoning helped but so did some of the little tricks. I particularly liked singing the obsession to a silly tune. That was in "Stop Obsessing". OCD really did respond well to CBT for me.
Posted by goldenslumbers on August 27, 2005, at 8:59:05
In reply to Re: therapy for OCD GAD (help please, i'm confuse » chess, posted by Dinah on August 27, 2005, at 6:34:38
Hi Chess,
How long have you been this way ?
I started worrying about dying about 6 months ago. I have a minor stomach disorder that flairs up every 5 years or so and this time I was convinced it was "the big one"
The stomach medication quickly controlled the flair up but the thought of dying stuck. I have recently started a family and dying took on a whole new meaning. I was terrified, chest pain, dizzyness it was bad.
I tried Effexor but it made me feel really weird so I only lasted 4 months. After quitting that I felt better, the only thing that stayed was the dizzyness. I had read a lot and I now understand anxiety will not kill you. It is the mind reacting to fear and it takes time to reassure yourself that everything is ok.
I am not free from my anxiety. The last few weeks were good but I got run down from lack of sleep and my anxiety returned. The first thing it does is zap my appetite (if you know of a fix for that I would love to hear it).
Now I need to got through the same process again, telling myself this is temporary, i'm OK and my mind is trying to protect me. The more I ignore the physical symptoms the better I feel. Once my appetite returns I'll be good again.
I would love to hear from anyone that has a similar story. I live in a small town and I can't find a therapist.
Thanks
Posted by JenStar on August 27, 2005, at 13:25:42
In reply to therapy for OCD GAD (help please, i'm confused), posted by chess on August 25, 2005, at 10:13:43
hi Chess,
it sounds like the two T's are talking at cross-purposes! What works best for YOU to make the anxiety or obsessive thoughts stop? That might be a cue as to which method to use.I personally like the anxiety-person approach. I tend to blow up things in my mind and make them really scary (ex: I feel a slight twinge in my chest, it must be a heart attack, I'm going to fall down and die, Oh My God!) When I stop and think rationally -- very few chest pains turn into heart attacks, especially like this one, and my doctor told me I don't have heart issues, and I KNOW I have acid reflux disease....then I can calm myself down. So talking to myself seems to help. I mean, if I said, "Hey, I could be having a heart attack..." that doesn't help me feel better.
My doctor did also tell me that it's OK to think the worst, as long as you then figure out whether or not it's going to happen. Such as, "Well, I COULD have a heart attack. What's the worst that could happen? I could call 911, get to the hospital, and probably get treated. People much older than I am are treated successfully. I have aspirin in my purse in case I need it. But based on the types of pains and my history, I know a heart attack is not likely."
So...FIRST I think of the worst, but THEN I talk myself down.
Does that make sense for you? Maybe you could think: OK....maybe I COULD lose control. What would happen then? But most likely you WON'T lose control. Anxiety doesn't do that. You won't die. History tells you that. And so on...you can calm yourself down.
So I'm wondering if the two theories might be linked in a way, or more similar than they first appear?
good luck! I hate anxiety and I hope yours goes away soon!
J
Posted by chess on August 27, 2005, at 17:34:10
In reply to Re: therapy for OCD GAD (help please, i'm confused) » chess, posted by JenStar on August 27, 2005, at 13:25:42
hi JenStar
i tend to agree with you
i think that if the reassurance is REALISTIC and from yourself then it should be okay
getting reassurance from other people or other things (like a rabbit's foot) seems like avoidance to me
so a compromise to reassure myself but also accept uncertainty could be when i feel anxious ... "i'm anxious and afraid that i might lose control right now, but i remind myself that anxiety doesn't lead to loss of control and that i've never lost control in the past, i'm just feeling anxiety, it's possible that i could lose control from having an brain aneurism (sp?) or something but it's very unlikely, i'm okay right now but i also accept that there's uncertainty in life and i just have to live with that and concentrate on what i enjoy doing rather than on what i can't control"
how does that sound? too much?> hi Chess,
> it sounds like the two T's are talking at cross-purposes! What works best for YOU to make the anxiety or obsessive thoughts stop? That might be a cue as to which method to use.
>
> I personally like the anxiety-person approach. I tend to blow up things in my mind and make them really scary (ex: I feel a slight twinge in my chest, it must be a heart attack, I'm going to fall down and die, Oh My God!) When I stop and think rationally -- very few chest pains turn into heart attacks, especially like this one, and my doctor told me I don't have heart issues, and I KNOW I have acid reflux disease....then I can calm myself down. So talking to myself seems to help. I mean, if I said, "Hey, I could be having a heart attack..." that doesn't help me feel better.
>
> My doctor did also tell me that it's OK to think the worst, as long as you then figure out whether or not it's going to happen. Such as, "Well, I COULD have a heart attack. What's the worst that could happen? I could call 911, get to the hospital, and probably get treated. People much older than I am are treated successfully. I have aspirin in my purse in case I need it. But based on the types of pains and my history, I know a heart attack is not likely."
>
> So...FIRST I think of the worst, but THEN I talk myself down.
>
> Does that make sense for you? Maybe you could think: OK....maybe I COULD lose control. What would happen then? But most likely you WON'T lose control. Anxiety doesn't do that. You won't die. History tells you that. And so on...you can calm yourself down.
>
> So I'm wondering if the two theories might be linked in a way, or more similar than they first appear?
>
> good luck! I hate anxiety and I hope yours goes away soon!
> J
>
>
Posted by JenStar on August 27, 2005, at 19:00:48
In reply to Re: therapy for OCD GAD (help please, i'm confused) » JenStar, posted by chess on August 27, 2005, at 17:34:10
hi Chess,
well, to ME that sounds really good! I guess you'll have to see if it works for you, though. :)Actually one thing that worked for me during panic attacks WAS past history. The first time I had a panic attack I thought I was dying of a heart attack. The next few times, I also though this (even though some part of me suspected I was NOT.)
After that, I started to get calmer during the panic attacks. I reminded myself that they always feel the same way, I always get the same horrible symptoms, and I never actually die or have anything really bad happen. I remind myself that I eventually calm down and things get better.
By repeating this in my head over and over, and doing deep breathing, I'm able to calm down more quickly each time. It's sad that I had to undergo multiple panic attacks before I realized that I could handle them!
But each panic attack is still awful, miserable, horrible stuff. I hate them! Especially when they come at night when I'm trying to fall asleep. But at least I know now what they are. The first one was just nightmarish. At least now I have some power of knowledge!
I hope things are going well for you! :)
JenStar
Posted by JenStar on August 27, 2005, at 19:03:37
In reply to Re: therapy for OCD GAD (help please, i'm confused) » JenStar, posted by chess on August 27, 2005, at 17:34:10
hi Chess,
I agree with you about the best reassurance coming from within. It's interesting though, but some people seem to really derive a calming influence from an item or talisman of some kind - for example, a picture of their T, or a special rock, or a stuffed doll/animal. My guess is that they're starting to internalize the comfort that came first from another, and the object acts as a "bridge" to help them make the transition.But I think that if one tries to rely on that "bridge" item forever, it will eventually lose the power unless the person is able to internalize the comfort.
What do you think? Do you ever use a rabbit's foot or other thing like that?
J
Posted by chess on August 27, 2005, at 22:01:19
In reply to Re: therapy for OCD GAD (help please, i'm confused) » chess, posted by JenStar on August 27, 2005, at 19:03:37
jenstar
panic and ocd run in my family
and everyone in my family has some sort of reassuring item (rabbit's foot, picture of mother mary, picture of jesus, bottle of water, etc)
i don't use anything, although i always have some of my meds (lexapro and xanax) in my wallet, but mostly for just in case i need them if i stay over at a friend's house for the night, otherwise i 'd really prefer not to take meds
actually i've been taking less and less xanax, i feel terrible, but the worst part is not knowing if i feel terrible because the anxiety is breaking through because of less xanax or if i'm going through withdrawal from less xanax, i'm guessing it's withdrawal-rebound from the xanax but i don't know for sure, if i knew that the xanax was working for a biochemical problem i have in my brain then i would take it thankfully, but my docs can't tell me whether xanax has made my anxiety worse (because long use lowers a person's threshold to handle anxiety) or if my anxiety has always been bad and xanax is the med that works for it and when i don't take enough i feel bad, if we lived in the time of star trek they could tell me but the brain science is just not there yet unfortunately
thanks and i hope all is well with you
> hi Chess,
> I agree with you about the best reassurance coming from within. It's interesting though, but some people seem to really derive a calming influence from an item or talisman of some kind - for example, a picture of their T, or a special rock, or a stuffed doll/animal. My guess is that they're starting to internalize the comfort that came first from another, and the object acts as a "bridge" to help them make the transition.
>
> But I think that if one tries to rely on that "bridge" item forever, it will eventually lose the power unless the person is able to internalize the comfort.
>
> What do you think? Do you ever use a rabbit's foot or other thing like that?
>
> J
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