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OCD Treatment: OCD vs. Me. How do I Tell the Difference?

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Question: Because many of my OCD rituals are related to my professional identity, I’m worried that changing my rituals will somehow change those parts of me that I like (e.g., my personal goals and ambitions). Should I be concerned about this? Early Onset OCD in Kids & Teens (Pediatric OCD) Many people worry that by fighting their OCD, they will lose essential parts of themselves. This is particularly true for adults with obsessive compulsive disorder, who have had to deal with OCD for most of their lives. Because OCD often begins early in childhood and can have a chronic course, it can be difficult to separate yourself from your OCD symptoms. In many pediatric OCD cases, kids with OCD exhibit symptoms by age 10. Shockingly, in certain cases, even toddlers can show clinical signs of obsessive-compulsive disorder. There are...

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Fear, Doubt, Uncertainty, ERP, & the Monster Under the Bed

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Everyone I know has, at some point, had to deal with the monster under the bed. Some do it with grace. Others falter. I’ve always been clumsy. I can vividly recall many terrified nights from my childhood, when I would lie rigidly in my bed, utterly paralyzed by fear. Afraid to make the slightest movement, to breathe, to call out for my parents…lest I be detected by IT. The pounding of my heart would be so loud in my ears, and my breathing so ragged, that I could swear the entire house could hear me. And yet…no one came to help. The moment would stretch out like taffy. At some point, my raw fear would ever so subtly decline, freeing me up to end the stalemate in one of several ways. Some nights, I would call out for help....

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Social Anxiety Treatment: CBT & Intentional Mistake Practice (an example)

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When I was a kid, one form of mischief that was briefly popular in my neighborhood was crank calling strangers. Usually, the bravest kid in the group would pick up the phone, and with the encouragement of all the other kids in the room, would dial a random telephone number. A brief, very Bart Simpson-esque conversation would then ensue. Usually it would go something like this: Kid: Hello, ma’am. I am conducting a brief survey for the Grocer’s Association. Do you have a minute to answer a quick question? Stranger: Of course. How can I help you? Kid: I was wondering if you have Sara Lee in the freezer. Stranger: Why, yes I do. Kid: Well then let her out!!! We would then bust out in laughter and hang up the phone, leaving the recipient of our phone call...

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Therapy as Science: You + Your Therapist + Scientific Method

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I consider myself a scientist.  I wear this hat officially when conducting research, but I also wear it every time I sit with a patient.  In my research, my science is pretty self-evident: I identify a research question, develop falsifiable hypotheses, and then collect quantifiable data to see whether or not the phenomenon I’m studying behaves the way I think it does. A very similar process unfolds when I work with you in my clinic.  However, from your vantage point, you might not realize it right away.  Nevertheless, we are two collaborative empiricists. Most often, you will define the “research question”.  Usually, this is the very reason that you’re coming to see me.  Sometimes the questions we think we’re asking are not necessarily the ones we should be asking.  For example, questions like, “Why is this happening to me?”...

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The Power of Being Selfish: Selfishness as a Key to Mental Health

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I’m about to tell you something that your mother might not approve of…so for those of you sensitive souls out there, you might want to click on something less controversial. Here it is: It’s okay (and sometimes even essential!) to be a little bit selfish. Conventional wisdom, and our parents, often tell us that it’s not okay to be selfish.  If you want to be an effective parent, you must learn to put your kids’ needs before your own.  Likewise, to be a good spouse, you must learn to  honor your partner’s needs.  These are truths, and if you aren’t living these truths in your daily life, it is likely that your relationships have suffered. However… As with anything, these truths must not be taken to extremes. I found myself thinking about this idea over the weekend as I...

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Specific phobias: symptoms & CBT treatment (reader question)

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Question: Basically, I wanted to know from an expert, what can a phobia do to a person? How does it affect them mentally? Also I see that you’ve got a new treatment philosophy — is there any way you can talk me through it? One of the goals of cognitive behavioral therapy (CBT) is to learn to better understand the interrelationships among thoughts, feelings, and behaviors.  Once you understand how these things are connected, it gives you a lot of power to implement change. Most people who seek therapy do so because they are experiencing an emotion they don’t want to have.  In the case of depression, the person might feel sad.  In the case of a phobia, the person might feel scared.  People often have trouble modifying these feelings directly because emotions tend to be somewhat involuntary.  If...

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