I am proud to announce the opening of the Manhattan Center for Cognitive-Behavioral Therapy, located at 276 Fifth Avenue, 9th Floor. The Manhattan Center for CBT will provide psychological services by experts in this type of therapy. The Center has a sliding fee scale, with different rates available (based on the years of experience of the therapist). For further information, see the website link above, or call us at (646) 863-4225.
A Compulsive Need to Confess
One rarely discussed symptom of OCD is an overwhelming urge to confess “sins,” even when the transgressions are very slight. Typically this will arise in the context of a marriage or romantic relationship. At first, what is confessed may not seem so minor. However if this problem is not addressed, the confessed acts often become quite trivial. For example, let’s say that a man with OCD feels attracted to a co-worker. If he suffers from this form of OCD, he might feel very anxious, telling himself that he has to tell his girlfriend about this situation so as not to risk damage their relationship. If he does, in fact, tell his girlfriend, she might react by saying, “oh, okay. Just don’t act on it — no big deal.” Then, the man with OCD will feel relieved. This completes a cycle of anxiety for this man — he engages in the compulsion, and immediately feels relief from anxiety. Doesn’t sound too terrible, right? However, the problem is that this pattern often does not stop. Next week he might be confessing more minor things, like having wondered whether a female acquaintance likes him, or even having thought his 9th grade homeroom teacher was attractive (many years ago). While these latter two situations might seem less important to most observers, they provoke just as much anxiety for the OCD sufferer. It is often a downward spiral that can reach the point where spouses/boyfriends/girlfriends can become frustrated at having to listen to meaningless confessions every day. Ironically, this can strain a relationship more than if the OCD sufferer had not mentioned anything.
The key for people suffering from this symptom of OCD is the recognition of the role anxiety plays. Do they want to confess because it’s the right thing to do, or because they’ll feel relieved? Do they want to confess despite having been told by their partner that it is not necessary or helpful? Working with a therapist trained in exposure and response prevention can be a helpful way to change the way one deals with anxiety in these situations.
Posted in Uncategorized.
Antidepressant news – recommended reading
On January 29th there appeared a well researched and well written piece in Newsweek on the effectiveness of antidepressants. The article, by Sharon Begley, explains some important aspects of the process by which pharmaceutical agents are brought to market and come to be prescribed.
The article explains about the relevance of the placebo effect in clinical trials, and explains that for antidepressant medications, much of the improvement they produce can be attributed to the placebo effect. The placebo effect is the extent to which our experiences and expectations that a drug will work actually help us improve. For example, let’s say that you get frequent headaches, and find that aspirin gets rid of them pretty effectively. Then one day your prankster roommate replaces your aspirin with breath mints… but your headache still goes away after you take one! Some would explain this via the placebo effect – you expected it to work, and so it did. The placebo effect is a mysterious and very important part of medical research; so much so that it is a focus of significant ongoing research at medical institutions around the world (e.g., at UCLA and at Harvard Medical School.)
Scientists have known about the placebo effect for many decades, and account for it in research often by using what are called placebo-controlled studies — i.e., studies where half the patients receive the drug under investigation, and the other half receive a placebo. Thus they can look at the difference in improvement between the two groups, and conclude that any difference is likely due to the true effect of the drug.
Begley’s Newsweek article not only may surprise you in its description of how strong the placebo effect is for antidepressant medications, but in its description of how such medications are approved by the FDA. She describes how the FDA, at present, does not have a mechanism by which trials with negative results (showing that a drug was ineffective) are accounted for in its pharmaceutical approval process. That means that a drug shown to be no better than placebo in six studies, but shown to be somewhat effective in two others, can be approved for widespread use.
Read the article, and be an informed consumer!
Posted in Posts.
Reassurance
One way to recognize OCD is to look for excessive efforts to get reassurance. This can take many forms, and in my experience often comes up as questions asked to a spouse. “Did you check the locks on the door?” “I’m feeling a little ill, do you think I have lupus?” A recent interview with Dr. Wayne Goodman correctly suggests that the best way a spouse can respond to such questions, in cases of OCD, is to try to avoid providing that reassurance that only strengthens the compulsive tendency. Sometimes arguments over such requests for reassurance can become problematic for couples. In that case, consultation with an OCD specialist is appropriate.
Posted in Posts.
Is your therapy actually helping?
A previous posting on this blog discussed the recent controversy over “effective” psychotherapy. A more recent article in the LA Times outlines the two sides of the debate. Regardless of what you think about this controversy, one important message to take away is that it’s important to consider whether your therapy is helpful. That may sound obvious, but whatever the reasons you sought therapy to begin with, it can be helpful to periodically ask yourself whether you feel that things are tangibly changing for you. If not, have a frank discussion with your therapist — a good therapist will share your desire for tangible meaningful change, and would welcome such a discussion.
Posted in Posts.
Science and Psychotherapy
Most people closely associate medicine and science, but how many of us think of psychotherapy and science as being related? Maybe we don’t, but we should. A recent research article that has received significant media attention has drawn attention to this issue.
Psychotherapy for OCD
For people suffering from OCD, it can be hard to find help. Being an informed consumer can make all the difference.
It is common for people who think they might have OCD to say, “I’d better see someone,” and go to see a psychotherapist. So far, so good. However, there are different types of therapy for OCD, and evidence suggests that some work better than others. Many people who seek help for obsessions or compulsions with a psychotherapist find that sometimes, after months or years of therapy, their symptoms are still a problem. There can be many possible reasons for this.
Continued…
Posted in Posts.
How to Find a Therapist
Finding a therapist can be a confusing task. Where to start? Should you ask your doctor? Look on the internet? Ask a friend? Ask your insurance company?
These are all reasonable ideas on the face of them. However, some strategies may be more practical for you than others. Let’s look at each of the above options.
Continued…
Posted in Posts.
Contamination in OCD
Are you a germophobe? People have phobias of all sorts of things — heights, insects, blood, needles, dogs, you name it. However, people with a fear of germs typically do not have a phobia. Often, this is the contamination subtype of OCD. This will often manifest in tendencies to avoid people, places, or things that are thought to be contaminated. Sometimes the contamination is of a specific disease like HIV or hepatitis, or just general “germs.” Other times the contamination can be more vaguely defined. In its extreme forms, contamination OCD can result in people feeling that their homes are too contaminated to continue living in. How do you know if your fear of contamination is a big problem, or just a quirk? Here are some tips — you should consider seeking help if: the contamination can spread from one thing to another and then anotherattempts to rid yourself or your surroundings of contamination of caused you to be late to work, school, or other engagementscontamination fears have affected your sex life or your romantic relationship(s)efforts to prevent/contain contamination have significantly lengthened your daily routinestime spent washing, disinfecting, or otherwise cleaning has become excessive, or is thought to be excessive by others
Posted in Posts.
OCD research update
This past week saw the annual meeting of the Association of Behavioral and Cognitive Therapies, or ABCT. This is the largest American organization of cognitive-behavioral researchers and therapists. Every year, the latest research is presented on cognitive-behavioral therapies for various types of problems, ranging from anxiety to depression to psychosis. This year one of the important projects discussed was the Brown Longitudinal OCD Study. This research study focused on the long-term changes seen in people with OCD who sought help for their symptoms. The study is one of the largest of its kind.
One of the interesting findings to come from this study are estimates of how many people with OCD have tried various forms of treatment. Continued…