Angst

I remember viewing a programme on BBC 4 about the work of the Centre for Anxiety and Trauma a NHS in London. Where a young man and his therapist positioned themselves at Denmark Hill, the nearest station to the Centre, where the clinical psychologist positioned herself in front of the young man as a train approached the station. The young man had the fear that he would push a person in the front of a train. This was an example of a good behavioural experiment where the therapist positioned herself in the actual situation. Therapy is about changing our thinking about things and what we would do. There are two types of thinking - fast or slow or intuition and deliberate - therapy in the consulting room gives you a chance to intellectually or deliberately challenge your thinking. Behavioural experiments especially with the therapist changes our emotional or intuitive thinking. In the actual situation which triggers our thoughts. In my example the train station. I had several visits from my therapist. We learn from doing or not doing in specific contexts. You have developed a false memory. You had the idea that you pushed somebody into a busy road. You planted and pictured this idea in your brain. Each time you revisit this ‘event’ the memory will likely become more vivid. False memories become more vivid while real memories do not. Read about false memories when you search ‘BBC-Science-False Memories’. It will refer you to research on the subject as well as explain the phenomenon.

My mindset is different to yours. I have lived in places which would be intolerable to you. Places without gardens in inner city areas. Friends have had places above betting shops, restaurants and chicken and chips shops. Also I have seen doctors for mental health problems and at times have received money from the DWP. I have even received therapy. I do now live in place with a garden with bees and birds and the trees are now showing leaves. It’s great the fresh smell. The lack of noise. In control of my own space without the unsocial intrusion of neighbours with their noise. The thud of stereos. The rat and mice infestations from neighbours in the terrace. The lack of communal maintenance unless I arrange it and having to deal with the hassle of non payment from co-occupiers. It is pleasant living in a pleasant space. But millions don’t. You say ‘I went and looked at’ supported living places. So you can escape from your self imposed house arrest. Build upon this. You have been very lucky. So what are you going to do. For me I would change my mindset.

Supported living places are not prisons. The facilities on offer do vary. They can include such things are self contained studio flats. They are offered by the statutory sector and charities. Unless you are under a CTO - a Community Treatment Order - you will not be monitored to see if you take prescribed medication. CTOs tend to be used as an alternative to being sectioned under the Mental Health Act. A person in supported living accommodation is not locked in. You would not have to wait until for death for release. They are not places for life imprisonment. They are places where you ability to pay does not affect your residency rights. Where do you live? To repeat Ashley’s question. If you live in the UK I would contact OCD UK on Monday morning to see what alternatives are available in your locality.

Good news. You have the sick/fit note if needed. Arranged for therapy. Did you talk to your GP about reviewing your medicines?

Just answered your other thread with the same title. Does sound as if depression is present. I have or can have depression with OCD. At its worst OCD, depression and panic attacks. I am experiencing some depression at the moment with bad memories and feeling quite irritable. On your other thread you mention that your GP was not particularly helpful. I suggest you try again. Personally, I found Beck’s depression inventory a useful measure of depression. It is quite accessible on the web. I think if you filled it in and then contacted your GP again with the score then this might be helpful. I have found that some GPs are more sympathetic than others regarding mental health matters. Perhaps another GP in the practice might be more helpful. Don’t make a decision about employment whilst in your present state, perhaps a sick/fit note might help, whatever it’s called these days, would provide a respite.

The feeling that you have unlucky clothes, unlucky shoes, unlucky breakfasts, unlucky packed lunches are examples of magical thinking. Thinking that a choice that you make affects the luck you will have during the day. When there is no causal relation between these lucky/unlucky things and having good luck. Lots of people get this - lucky underwear for the interview for example. Because in the past something good happened when you wore that piece of underwear. There are lucky charms and lucky rabbits’ feet. And a whole set of superstitions that bring bad luck if you break the rule. Different cultures have different superstitions. You appear to have a whole host of things that you must not wear or must not eat in the morning. When I was in the waiting room waiting for therapy there was a list of superstitions pinned up on the wall with the advice to break the superstitions. I remember times when I had similar thinking for example I must walk down one side of the street or something bad will happen. I disobeyed the order. Or I must buy a product to be lucky. I disobeyed. The general rule is these situations is to disobey - do the opposite.

Your upsetting thoughts are about the future - will I be able to cope, what will happen to my family, the effectiveness of my medication will reduce to zero, I see negative things in the future. In these circumstances I would focus on my breathing, perhaps mindfulness might help. Your fears are ‘what ifs’. You need to quieten your mind. What do you do to calm and soothe your mind?

Sometimes our plight becomes so bad that a GP refers you to a CMHT where you will receive a diagnosis or set of diagnoses. In this case the GP in the UK has a gatekeeper role in that he or she uses their professional judgement to refer a patient to specialists. In certain other health systems in Europe it is easier to refer yourself to specialist units. Sorry this may be contentious but it is to with budgets and availability of specialist staff. The access to psychological or talking treatments in England bypasses the gatekeeper role of the GP in order to spread the availability of psychological treatments. Unfortunately, even if you are referred as an adult or child to a specialist unit there are even longer waiting lists than access to psychological/talking therapies in England. My plight was bad.

Everybody has false memories which can be good or bad. Memories consist of networks of neurons which contain visual, sound, smell, and touch sensations. You are talking about episodic or autobiographical memory where our brain registers our experiences in the world. But our memories can be false. Imagine that you believe something was true When you go back to review this memory you start with a self planted image -it tends to be imagery in these cases. When go back to your memory search you will start with the planted image and develop in your brain more and more vivid imagery. Memories are not like videos. The BBC Science site has a good explanation of this phenomenon. Put into a search engine BBC - Science - False Memory. The site will explain the phenomenon and refer you to scientific sources explaining the phenomenon. Whether you have OCD or do not have OCD everybody has false memories. People report a problem when the false memory is a bad one. There is a danger of becoming obsessive about it. So do not ‘search’ your memory. False memories can become more vivid but when we experience real memories they tend to become less vivid and intense with the passage of time. Switch your mind to positive imagery when you have the urge to ‘search’ for a particular memory. Or deliberately recall a positive memory.

What is your diagnosis? CBT is a multi pronged thing a major CBT approach for depression is called Behavioural Activation for Depression and this differs from CBT for hoarding, or CBT for psychosis. For my therapy for OCD, depression and hoarding I had different monitoring questionnaires for each condition. Frequently for OCD and for hoarding family therapy is used as well as CBT. CBT is about individual cognition and where other individuals are concerned such as families other therapies act as a supplement. In the UK family therapy is recommended in conjunction with CBT for certain presentations of OCD and hoarding.

It seems to me that you have a compulsion about the fear of having a compulsion. I would follow what constitutes a sensible course of action. One way of following a sensible course of action is to follow the behaviour of a person whom you consider to be a sensible person in a particular domain such as cyber security. In this case your husband. I would not say that OCD has some good points, rather I would say that sound judgement is good and unsound judgement is bad.

The fact that your scores on the depression and anxiety scales became low so low that treatment was suspended is a similar point to the point Howard is making. OCD, anxiety and depression are measured by questionnaires. We all have degrees of anxiety and depression. Those of us with clinical problems of anxiety and depression have abnormal levels of anxiety and depression. The standard OCD questionnaire for OCD, and the variants of this scale, measure the degree of OCD that you have. Good therapy for OCD will regularly measure the degree of OCDness that you possess. Those of us with OCD are not so alien, so off the scale, that our experiences are completely unknown and unexperienced by the general public.

Religions are full of omens. I once passed a funeral parlour and a thought cropped up in my brain that my mother would die soon. Such thoughts are common. You had the thought of being murdered - a memory of a conversation with your wife lodged in your brain - and that memory surfaced when seeing a show. If you are alert to something then your perception becomes biased and you see signs of significance in many places. Because you are on a mental alert for something. It is a form of something called confirmation bias. There is a lot of talk on the forum about rumination. But remember the psychological discussion about rumination starts with a debate about the mental features of depression. Rumination is one of the core features of depression and can occur with OCD. In depression discourse, rumination is not called a compulsion. And, as far as I can see, there is no difference between the mulling over of things in depression and in cases of OCD. Magical thinking, believing things that can have no validity in empirical reality is a feature of human thought which is reflected in superstitions. And superstitions vary from culture to culture. In British culture they include walking under a ladder, an erect umbrella inside a house, shoes on a table. I would go further, many religions have magical thinking associated with their belief system for example human beings have to be sacrificed to placate the Sun God. I deliberately chose an example from an old religion so as not to upset people.

Let it go.

One of my favourite novels is David Lodge’s ‘Therapy’. It is a novel with some comic themes. The main character has undertaken all sorts of therapies including cognitive therapy but becomes very interested in existentialism, the existentialism of Kierkegaard. The novel explores the character’s search for meaning within this brand of existential thought. Sometimes novels and biographies can provide insight into our feelings. I think humour can be very uplifting. Another existentialist, Sartre, if I remember correctly believes in projects that involve in doing something that you find meaningful. You were doing this - productive activities, socialising, exercising, meditating. Do things that are meaningful to you.

Yes it is a form of Theory AB - looking for evidence. For me, cognitive therapy gave me the intellectual foundation for change but for emotional learning so as not to feel compelled to to do compulsions you need to do the behavioural work for example walking out of a house without checking things, or walking past a school playground, or handling a hammer, showering without bleach, brushing your teeth for two minutes not two hours and so forth. This is generally done in stages. As I see it there are two types of learning cognitive and behavioural. You do the cognitive learning about alternative ways of thinking and then the behavioural work about changing your behaviour in the world.

Basically Theory A is your worst fears are true and Theory B is that you have OCD or anxiety. You look at the evidence. It is concerned to map out how you think - cognition - you use it to build up a picture of how your mind works. Two very popular books Break Free From OCD and Overcoming OCD go through the theory. In therapy we worked out my thinking worked we built up a picture of my thinking using a wall charts. Somewhere I have the charts that we built up in therapy. Doing cognitive therapy gives you the confidence to test whether your fears are true. You don’t just magically stop believing something because you can conceive that it’s an obsession. You need to see an alternative way of thinking. You just don’t suddenly stop a compulsion on command. You have to at least acknowledge that the obsession may have no or little basis in reality and be willing to test whether your belief is true. You ease your way into stopping compulsions. Really recommend that you get the book. Break Free From OCD.

There are disagreements about cognitive therapy on the forum. I advocate Theory A and Theory B as used in the British centres of excellence for the treatment of OCD and anxiety but have been told that they are inappropriate. Beck’s notion of Automatic Negative Thoughts has also been criticised. In the UK not all mental disorders and illnesses are treated by CBT. In the case of depression several approaches have equal validity according to NICE. There are neurodivergent people on the forum. I do not think CBT is the recommended treatment for this condition. People with neurodivergence and OCD need to be treated in a different way to those that do not have neurodivergence, Many people take medication as well as have CBT therapy including SSRIs and antipsychotics. Presumably, therefore, there is something neurological as well as cognitive involved in OCD. NICE recommends in certain cases forms of medication. At all times I think that we should follow evidence based treatment based on the NICE guidelines. To my mind, there are some rather idiosyncratic notions of what constitutes cognitive therapy on the forum. We are experts by experience. When offering our support we should put it in the context of our experience.

Hi Ironborn You say in your post ‘but this time I really went into the laws and found out that……’ You say ‘2 years ago when I had this topic I looked her her up on Facebook….’ To me, it seems like you are checking things. Checking things is kind of reassurance in that you are checking that things are all right. I found that when checking doors, taps, the gas and such like that I did not reassure myself when checking but got myself into a cycle of checking. My advice when this theme crops up again is not to check. Leave the whole thing alone.

Hi ChrisP You are doing well in a sad and difficult situation. Cleaning and sorting stuff so your ill sister can have some comfort. And getting hot water. These things will make it easier for nurses and carers to help your ill sister. It must have been a shock to discover the state of the house. It is probable that your sisters had not had many visitors in these years. Plus you’re dealing with the death of your father and the dementia of your mother. You have done a good job. There should be support from the cancer charities and Hoarding UK have a list of organisations that can help. Do you have Power of Attorney for your mother? Perhaps you need a good therapist as well. Carers need care too. So are there carers organisations for your neighbour? They provide mutual support.

When I was a young boy I used to engage in ‘maladaptive daydreaming’. The phenomenon was not recognised then - if you put into a search engine ‘maladaptive daydreaming’ and ‘The Guardian’ you will see three articles about it. It will soon by recognised by the psychiatric establishment. I did it to escape from abuse and constraint. A fantasy world with narratives and vividness. It is maladaptive if it takes too much time. It is reckoned to be more common than OCD and as an experience has growth since the Covid Years. A comic book and film ‘Billy Liar’ explores the vivid fantasies of a young man who wants relief from his mundane life. I suppose the question to ask is whether you find the imagery disturbing? Whether you feel compelled to reproduce the imagery. Maladaptive daydreaming conjures up positive feelings and is quite immersive you blot out the environment. I personally have not run a movie or action sequence in my head and at the same time perceived the environment.

Let us wait for a reply from Wonderflower. For clarification. A measure of obsession is the amount of time one spends doing something. OCD also involves compulsions. Whether one feels compelled to reproduce the imagery in order to check its veracity, for example. We do not have this information. Unwelcome images and mental videos can be related to phobias, post traumatic stress and a whole range of other things. We might tentatively suggest a person has something but a brief list of perceptual experiences do not a diagnosis make. A feature of OCD is the desire for certainty. We need to be open minded. Perhaps the poster has OCD, perhaps the poster does not. It is up to the poster and their therapist and GP to deliver a diagnosis.

I assume that an ‘intrusive image’ equates with an unwelcome or unpleasant image. I don’t know what you mean by ‘first person’. In grammar it is I and me and we and us. What does it mean with regard to images? We can conjure up images of things and place them in the present environmental context. It has certainly occurred to me. Often in the case of phobias people will misperceive a dreaded object in the shadows. You are describing visual perception. What makes you believe it’s OCD?

I use DuckDuckGo and Apple products because I don’t want to be tracked. The function of tracking is for google and others including social media is to sell advertising. That is why they are so rich. Taking ads from newspapers and ITV. Your profile is also sold to companies which aim to affect elections as revealed by the Cambridge Analytical scandal. With targeted biased posts. I am a member of Liberty the civil rights group. In many countries, perhaps most, I would not want this known to the state. Who knows what might happen in the future! I am a Quaker in the wars I would not want my details to be known. The Quakers revolutionised mental heath care and set up businesses such as Cadbury, Rowntree and Clarkes and had remarkably good personnel policies including very good housing for their employees.

‘When I start to grab ahold of a particular topic that is bothering me and really try to fight it….’ Don’t fight it. You a giving the thoughts too much significance. Let the thoughts spread into and out of consciousness. Do not cut off the conversations but switch your mind to other conversations in the real world. Rather than type on a key board a text message or comment on a social media platform have a real conversation on the phone or video call or in person. This will enable to switch your mind by having a second party involved - you will listen to their remarks and the cadences of their voice. Feeling compelled to do things like test, check and ruminate are compulsions. Compulsion is an abstract noun and a scientific category - OCD, as it were, compels you to do things. But it is you who is doing the compelling. You yourself are obsessing about something. You think your thoughts are important and significant and reveal something about you. That is why I have found cognitive therapy to be successful for me, The therapy being Theory A or B or Beck’s approach of seeing negative automatic thoughts as meaningless nonsense. To let go to have to accept that the thoughts have no significance.