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Guest Tricia

Cornerstone of cognitive therapy.

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Could it be that we are doing conpulsions without being aware of it? And could that prevent erp from having full effect? (for example, if we ruminate)

Absolutely. It takes education and experience to be able to identify all the compulsions you do.

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Perhaps a fundamental may be lack of conviction that the OCD is exaggerating the threat?

This could be where the CBT would be beneficial. It seems maybe Tricia you remain totally convinced in the validity of the contamination and that is why your anxiety does not reduce?

Edited by taurean

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I think that is my problem, the fact that what i fear is a real threat(dog,cat,foxes etc, faeces)so that is why my anxiety doesn't come down either.

I realize it is a small threat,but i totally believe that it may of caused my sons'illness(well one factor anyway)

I don't know why though i hoard things,and find it so hard to throw anything away!I am just so scared that i am throwing something of value away.

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Overestimation of threat is a very common cognitive distortion. It's at the root of much that makes up OCD, especially with contamination themes. The actual threat present is miniscule but your mind makes you believe it is not only huge but critical and in need of dealing with immediately. Again, not performing compulsions is the key to changing your mind about the threat present.

Hoarding is a whole other issue. You have to start throwing things out so you get used to not having things. Not easy I know.

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I think that is my problem, the fact that what i fear is a real threat(dog,cat,foxes etc, faeces)so that is why my anxiety doesn't come down either.

I realize it is a small threat,but i totally believe that it may of caused my sons'illness(well one factor anyway)

I don't know why though i hoard things,and find it so hard to throw anything away!I am just so scared that i am throwing something of value away.

Hi Daisy.

That sounds right.

There us a seeding event - son's illness.

There is a belief contamination may partly have been responsible for his illness.

I see the possibility for a therapist focusing on that in CBT.

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Hoarding is separate.

Fear of throwing away something of value - I would think that can be addressed.

My sister who was a hoarder and had OCD had to ditch a lot of stuff to have the loft converted.

She managed to do it. So it can be done.

Edited by taurean

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Guest Tricia

No, I'm not saying they're completely wrong. The graded exposure system was what I was taught and seemed to work quite well for the people in my ERP group. To tell you the truth, I can see the constant exposure scenario working for some people. The one fly in the ointment is the individual's ability to put up with the anxiety created. I think that is one problem that isn't talked about very much. Some people have a very low tolerance for anxiety.

I have read in David Veale's book about people having a low frustration tolerance. i disagree with this in my case and with so many people I know with OCD. I'd say it's the opposite. I can cope with a great deal of anxiety, but not at the level I experienced (during therapy) for the length of time I endured it. Several months proved too much.

Tricia.....do your compulsions free you from anxiety?

Why doesn't your underwear become contaminated/contaminate?

Yes, Caramoole, my compulsions free me from a great deal of anxiety, except when I have to face certain chores. (I am very afraid of soil and really struggle to peel vegetables)

My underwear does become contaminated, but it's not the same as sleeves and trousers that I constantly panicked had touched contaminated things (I was forever changing clothes and having to wash them - by hand). I am a terrible prude (I'm sure the neighbours would disagree with that, when they catch glimpses of me!) otherwise I'd opt for totally naked.

Also, any outer clothes I or the family wear I wash outside dressed in my underwear, so the less I wear the less time I have to spend outside. My house is not warm, but outside this time of year is really unbearable, undressed as I am.

Could it be that we are doing conpulsions without being aware of it? And could that prevent erp from having full effect? (for example, if we ruminate)

It is quite possible that we are at times unaware, but I know I wasn't during my therapy.

I think that is my problem, the fact that what i fear is a real threat(dog,cat,foxes etc, faeces)so that is why my anxiety doesn't come down either.

I realize it is a small threat,but i totally believe that it may of caused my sons'illness(well one factor anyway)

I don't know why though i hoard things,and find it so hard to throw anything away!I am just so scared that i am throwing something of value away.

Daisy, it often seems that therapy actually works better when we fear an illness etc., but of course it's not always the case. My friend, who shares your exact concerns, has said that during her cognitive therapy, she explained to her therapist, that although she may see no harm comes to her or her children after exposure, she will then wonder how many months or years before it does lead to their being ill. I think you see it this way, too. I also know you worry about what may have caused your son's problems. My friend also hoards (as do I) and many specialists feel this makes a person with OCD harder to treat.

Perhaps a fundamental may be lack of conviction that the OCD is exaggerating the threat?

This could be where the CBT would be beneficial. It seems maybe Tricia you remain totally convinced in the validity of the contamination and that is why your anxiety does not reduce?

I'm unsure, Roy. My psychologist tried this approach. I do know that what I fear is around us all and that, if I let my guard down, it will enter the house. This is a fact. However, what I need to work on (and so far have been unable to) is reason with myself as to why it matters, when I don't feel that any harm will occur from exposure to it.

Overestimation of threat is a very common cognitive distortion. It's at the root of much that makes up OCD, especially with contamination themes. The actual threat present is miniscule but your mind makes you believe it is not only huge but critical and in need of dealing with immediately. Again, not performing compulsions is the key to changing your mind about the threat present.

Hoarding is a whole other issue. You have to start throwing things out so you get used to not having things. Not easy I know.

PB, I don't overestimate the threat. In fact, I don't even see it as a threat. As I said to Roy, I know the contaminant I fear is around and I am certainly not overestimating that. I have to find a way to convince myself that I can live with it. Not performing compulsions and even living with dogs (which I fear) did nothing for me.

Edited by Tricia

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Tricia

"I'm unsure, Roy. My psychologist tried this approach. I do know that what I fear is around us all and that, if I let my guard down, it will enter the house. This is a fact. However, what I need to work on (and so far have been unable to) is reason with myself as to why it matters, when I don't feel that any harm will occur from exposure to it." (I took a simple way to quote). This is the key is it not?

You mentioned soil - what else is a contaminant from outside that you don't like?

I had a look through the chapter on contamination in my mindfulness workbook for OCD. It makes it easy to follow why the contamination in a number of ways becomes such an issue to the sufferer.

But it is interesting that you state although you have a real dislike of the contamination, you don't feel it may cause harm. The standard position appears to be that it will cause harm, as in your comment in response to Daisy's answer.

Perhaps the answer lies somewhere between the intense dislike - probably even inability to tolerate - and the lack of any feeling of potential harm. If the therapist could focus on the first and see if something could be worked on with that, maybe that would help?

Edited by taurean

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Just adding in a bit into the thread about my own troubles, this negative free association thing is a real bug-bear for me at the moment.

E.g. A therapist will sometime check out with the patient the health of "free associations" - they tell him to name something, then ask him to name the next thing that comes into his head arsing from that and so on. This gives an idea of the pattern of the patients thinking.

In mine this is very negative and is running automatically from a starting point of an OCD thought, as the brain engages its power totally non-beneficially to find a link to something else that contains distress of a violent nature. It then ,looks to label that as a "bookmark" if you like, to bring up when it likes. Naturally I don't wish either the connection or the bookmark. It is really debilitating and stressful.

It was number 4 in my hierarchy of trigger issues to address, and not a great problem before, but in fact because I have been cutting down on exposure to other issues it has pushed itself up to no 1 and been really playing up.

It's a tough cookie to take on the chin because a connection can be made in just a second or two before there is any chance to try and focus away onto something else.

Folks please don't use any upsetting words or phrases in reply as I am not coping at all with them - It's just the concept not actual examples I would be grateful for any suggestions on tackling.

Edited by taurean

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In mine this is very negative and is running automatically from a starting point of an OCD thought, as the brain engages its power totally non-beneficially to find a link to something else that contains distress of a violent nature. It then ,looks to label that as a "bookmark" if you like, to bring up when it likes. Naturally I don't wish either the connection or the bookmark. It is really debilitating and stressful.

I don't know if I'm missing something or not understanding properly (so forgive me) but I see this sort of connection as much the same as most peoples OCD thoughts

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I think you are missing something Caramoole.

It's a connection between things that wouldn't have a connection if it wasn't making one and applying a label of distress. .

Like when I operate really well my focus is purely in the present and in the immediacy. If an intrusion comes up its just that intrusion with the meaning being given to it in its own immediacy.That can be difficult enough in itself to tackle, but there is no link to anything else.

In this other scenario there is an intrusion. Then the brain searches for a connection to something else compleley disconnected and not especially related and seeks to put a marker on that to trigger the distress now and also when that second situation place or person comes in to focus at some point.So before that secondary thing place or person had no distress against it and therefore no trigger factor.

So its looking to accumulate a load of new triggers by seeding these into other connections. Its absolutely horrible.

Edited by taurean

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Free associations are considered to be a test for positivity.

So if I was given the word party the next word chosen could be birthday, then coming of age 18, etc... positive conenctions.

So if i got an intrusive thought - and I make a negative connection to a place with a very minimal connection to that intrusion that the brain finds - and then the brain associates that instrusion to the second place - then its possible when I think of that second place my mind will connect back to the first intrusion because the brain has forged an unwanted connection.

With one intrusion in one environment at least you are dealing with one thing at a time.

Edited by taurean

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Okay.....I do understand but it's not disimilar to any intrusive thought making a false connection. A bit like thinking of a sweet shop might forge a connection for someone with children and then paedophilia.

They're all very distressing but falsely connected with the intrusive thought. I suppose the work is about accepting that whatever connections they're meaningless, intrusive thoughts and connections

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Okay.....I do understand but it's not disimilar to any intrusive thought making a false connection. A bit like thinking of a sweet shop might forge a connection for someone with children and then paedophilia.

They're all very distressing but falsely connected with the intrusive thought. I suppose the work is about accepting that whatever connections they're meaningless, intrusive thoughts and connections

I would agree with that but it would be nice to be able to ease it away from doing this.

It could be doing it - moved it up from 4 to 1 in the hierarchy - because I've restricted its food chain by easing down on current exposure to other areas it likes to utilise. It is a clever foe.

I rather think in a strong phase - where me and not OCD is the dominant party - I have some strength of mind to keep focusing in the present and on the one thing.

Edited by taurean

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PB, I don't overestimate the threat. In fact, I don't even see it as a threat. As I said to Roy, I know the contaminant I fear is around and I am certainly not overestimating that. I have to find a way to convince myself that I can live with it. Not performing compulsions and even living with dogs (which I fear) did nothing for me.

You must think things like dirt are a threat otherwise why would you stay away from them? They must be threatening to you at some level. If there was no perceived threat there you could roll around in the dirt and be fine with it.

I realize you aren't overestimating the fact there is dirt. I'm saying you're overestimating the threat that dirt represents.

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Guest Orwell1984

Hi Tricia, is it more 'disgust' at the contaminant/possibility of contamination rather than 'sense of harm'?

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Guest Tricia

Thank you, Orwell, I will look at those links. You are right, it is disgust, that's the basis of it, but it then leads to terror when faced with it.

You must think things like dirt are a threat otherwise why would you stay away from them? They must be threatening to you at some level. If there was no perceived threat there you could roll around in the dirt and be fine with it.

I realize you aren't overestimating the fact there is dirt. I'm saying you're overestimating the threat that dirt represents.

I really appreciate how hard it must be for anyone to understand the levels I go to if I don't fear a consequence, but I don't. I do not feel threatened as such, I don't believe dirt, or faeces, will harm me at all. It is sheer disgust and that feeling is so overwhelming it triggers fear.

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Guest Tricia

I would agree with that but it would be nice to be able to ease it away from doing this.

It could be doing it - moved it up from 4 to 1 in the hierarchy - because I've restricted its food chain by easing down on current exposure to other areas it likes to utilise. It is a clever foe.

I rather think in a strong phase - where me and not OCD is the dominant party - I have some strength of mind to keep focusing in the present and on the one thing.

Roy, I truly don't know what to advise, but I just wanted to say this. I empathize with what you are going through and would not change my symptom for yours. I've been there and I found it very hard to deal with.

In a previous message you wrote the following:

"You mentioned soil - what else is a contaminant from outside that you don't like?

I had a look through the chapter on contamination in my mindfulness workbook for OCD. It makes it easy to follow why the contamination in a number of ways becomes such an issue to the sufferer.

But it is interesting that you state although you have a real dislike of the contamination, you don't feel it may cause harm. The standard position appears to be that it will cause harm, as in your comment in response to Daisy's answer.

Perhaps the answer lies somewhere between the intense dislike - probably even inability to tolerate - and the lack of any feeling of potential harm. If the therapist could focus on the first and see if something could be worked on with that, maybe that would help?"

Roy, my main fear is animal faeces and so soil is a big problem for me. I can honestly say harm is not an issue at all. Orwell is right with disgust, but the fear that then leads to is great. No therapist has so far known quite what to say about that.
Edited by Tricia

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Guest Tricia

Fascinating articles, Orwell. Thank you, again.

This paragraph from ScienceDirect may explain a great deal:

"In concert with previous research, the present findings support the systematic focus on disgust in the treatment of contamination-related OCD. In one such study, McKay (2006) found that OCD patients with primary contamination fear habituated to disgust more slowly and to a lesser degree than OCD patients with other symptoms"

​I have a friend with OCD who recently told me her two-year-old nephew is disgusted by his own bodily functions. No one has ever chastised him over toilet training, this comes purely from within his own mind. I hope to goodness he can be helped because he is becoming constipated due to his fear. What cognitive therapy would work for a two-year-old?

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Roy, I truly don't know what to advise, but I just wanted to say this. I empathize with what you are going through and would not change my symptom for yours. I've been there and I found it very hard to deal with.

In a previous message you wrote the following:

"You mentioned soil - what else is a contaminant from outside that you don't like?

I had a look through the chapter on contamination in my mindfulness workbook for OCD. It makes it easy to follow why the contamination in a number of ways becomes such an issue to the sufferer.

But it is interesting that you state although you have a real dislike of the contamination, you don't feel it may cause harm. The standard position appears to be that it will cause harm, as in your comment in response to Daisy's answer.

Perhaps the answer lies somewhere between the intense dislike - probably even inability to tolerate - and the lack of any feeling of potential harm. If the therapist could focus on the first and see if something could be worked on with that, maybe that would help?"

Roy, my main fear is animal faeces and so soil is a big problem for me. I can honestly say harm is not an issue at all. Orwell is right with disgust, but the fear that then leads to is great. No therapist has so far known quite what to say about that.

That is interesting.

I would love to think there would be a way round this

I have had a cats a lot of my life so my gardens and home have been "contaminated" by my own, and other cats, plus bird poo foxes and whatever.

I have not considered this to be a real threat - I know we discussed this once - nor have I personally felt revulsion or disgust - just anger involving not properly trained cats.

I can understand that the therapists are a bit thrown - they struggle to understand the intensity of my thought loops.

Maybe however there could be some way of tackling that revulsion and the resultant fear. The consequent compulsions are very restrictive and difficult I can imagine, so if there was a way it would be very helpful.

If the problem was say a phobia about spiders, there would certainly be revulsion and fear would there not? Standard therapy of course for that is a gradual exposure to spiders until the sufferer has no revulsion - they can handle a spider - and no fear.

Maybe you could consider how that revulsion and fear dealt with in that way might differ from yours, and see if some varied approach might tackle it?

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I do not feel threatened as such, I don't believe dirt, or faeces, will harm me at all. It is sheer disgust and that feeling is so overwhelming it triggers fear.
Perhaps the answer lies somewhere between the intense dislike - probably even inability to tolerate - and the lack of any feeling of potential harm

As Roy suggests perhaps it is the fear of the emotion itself that is the problem.

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