Freedom from Obsessive Compulsive Disorder: A Personalized Recovery Program for Living with Uncertainty, Updated Edition - Softcover

Grayson, Jonathan

Softcover

ISBN 10: 042527389X ISBN 13: 9780425273890

Publisher: Berkley, 2014

Synopsis

Nearly six million Americans suffer from the symptoms of obsessive-compulsive disorder, which can manifest itself in many ways: paralyzing fear of contamination; unmanageable “checking” rituals; excessive concern with order, symmetry, and counting; and others.
 
Freedom from Obsessive-Compulsive Disorder provides Dr. Jonathan Grayson’s revolutionary and compassionate program for finally breaking the cycle of overwhelming fear and endless rituals, including: 
 

• Self-assessment tests that guide readers in identifying their specific type of OCD and help track their progress in treatment
• Case studies from Dr. Grayson’s revolutionary and profoundly successful treatment program
• Blueprints for programs tailored to particular manifestations of OCD
• Previously unexplored manifestations of OCD such as obsessive staring, Relationship OCD (R-OCD), obsessive intolerance of environmental sounds and chewing sounds
• Therapy scripts to help individuals develop their own therapeutic voice, to motivate themselves to succeed
• New therapies used in conjunction with exposure techniques
• “Trigger sheets” for identifying and planning for obstacles that arise in treatment
• Information on building a support group
• And much more

Demystifying the process of OCD assessment and treatment, this indispensable book helps sufferers make sense of their own compulsions through frank, unflinching self-evaluation, and provides not only the knowledge of how to change—but the courage to do it.
 

About this title

About the Author:

Jonathan B. Grayson, Ph.D. is a licensed psychologist (PSY26643), director of the Grayson Center and Adjunct Clinical Assistant Professor of Psychiatry & the Behavioral Sciences at the University of Southern California where he lectures and supervises residents.  Dr Grayson has been specializing in the treatment of obsessive compulsive disorder (OCD) for more than 35 years and is a nationally recognized expert and author of Freedom from Obsessive Compulsive Disorder: a Personalized Recovery Program for Living with Uncertainty, a self-help guide for sufferers. In 2010, the International OCD Foundation awarded Dr. Grayson the Patty Perkins Lifetime Achievement Award for his devotion and contributions to the treatment of those with OCD. In October of 2010, the Association of Behavioral and Cognitive Therapies gave his book, Freedom from Obsessive Compulsive Disorder, the Self Help Book of Merit Award, recognizing his book as providing sufferers with the highest level of information about the best practices treatment for OCD. Dr. Grayson has presented workshops and written numerous articles and book chapters for both professional and lay audiences, including two manual/ videotape sets made for the International OCD Foundation (The GOAL Handbook: Running a Successful Support Group for OCD and How to Recognize and Respond to Obsessive-Compulsive Disorder in School Age Children). His work and expertise has been featured in national media including, People Magazine, The Oprah Winfrey Show and Nightline. He serves on both the Scientific Advisory Board and the Speakers Bureau of the International OCD Foundation. In 1981, along with Gayle Frankel (the former president of the Philadelphia Affiliate of the OC Foundation), he started the first support group in the country for OCD. In 2015, helped to form and donate his time to a free GOAL support group in LA. Finally, he has the distinction of being the first and possibly the only professional to run a yearly OCD camping trip.

Excerpt. © Reprinted by permission. All rights reserved.:

Acknowledgments

Introduction

I was standing in an open field, looking back into the forest and brush, watching the others struggle their way out. It was raining. I had purposely taken everyone off trail through trees and undergrowth so densely packed that forward movement was a slow process of stepping over and through bushes and being on guard for branches snapping back from whoever was in front of you. Melanie, the fourth person to emerge into the freedom of the clearing, shouted, “I’m having a great time!” The photographer documenting our trip for People magazine snapped a picture. Seeing Melanie’s joy, it was hard to connect this woman with the one I’d met seven months earlier at my former center, The Anxiety and Agoraphobia Treatment Center in Philadelphia.

When I met Melanie at our first session, she was an extreme suicide risk— all medications in her home, even aspirin, had to be locked in a safe. Her parents wouldn’t permit her to carry more than two dollars at a time, fearing that access to more money would enable her to commit suicide with over-the-counter medications. She was an attractive and articulate twenty-nine-year-old with a fifteen-year history of both obsessive-compulsive disorder (OCD) and body dysmorphic disorder (BDD). Her OCD focused on issues of perfection. When taking notes during class, if there were any cross-outs, stray marks, folds, or creases in her notebook, she would feel compelled to discard the page. Similarly, she wouldn’t tolerate any such marks in her textbooks and would cope with such “imperfections” by not using the text. Though she found school a nightmare of anxiety, Melanie did well in the courses she managed to complete. But many of her attempts to go to school resulted in anxiety and depression severe enough to require psychiatric hospitalization.

Melanie also felt as though she was horribly ugly—so repulsive that she believed it was a burden for those around her to tolerate her presence. This is what it feels like to have BDD, a form of OCD in which sufferers can’t stand their own appearance. She spent endless hours agonizing over her hair and makeup, trying to get ready to go out, but often wouldn’t be able to leave the house. For more than fifteen years, she had no memory of ever being free from her anxiety and despair.

Yet here she was on a camping trip. And not just any trip, but one that I’ve been running almost every year for more than two decades as a therapeutic journey for OCD sufferers. Even non-sufferers might find it difficult to spend a weekend sleeping in tents, using latrines without the benefit of running water, and taking torturous hikes through the mud and muck. For the OCD sufferers I treat, especially those with contamination fears, the accomplishment of making it through such an experience is often nothing less than a tremendous breakthrough in their recovery.

This camping trip is just one of the approaches I’ve found to be of use in working with OCD sufferers during the last twenty-five years. Earlier in my career, as a faculty member in the Department of Psychiatry at Temple University’s School of Medicine, I was part of a research team studying the treatment of OCD. Though our research excelled at delineating the mechanics of treatment—our results and findings regarding the behavioral techniques known as exposure and response prevention are still the core of today’s treatment for OCD—I felt the need to go beyond the actual treatment process.

I wanted to address issues our research was ignoring, such as relapse prevention. So in 1981, with an OCD sufferer named Gayle Frankel (who was then the current president of the Philadelphia Affiliate of the Obsessive-Compulsive Foundation), I started the first OCD support group in the country. Called GOAL (Giving Obsessive-compulsives Another Lifestyle), our group was more than a place for sufferers to share their stories. Its purpose from the beginning was to help sufferers understand their OCD and to make and maintain treatment gains.

Helping people understand their OCD is the key to my treatment approach. One of the greatest problems for those of you who suffer from this disorder is the disparity between your inner world and the outside. For all of us, the person we show the world is not exactly who we are; we all have our private thoughts, opinions, and secrets. But, for you, the gulf between your private and public selves is greater. No matter which aspects of your OCD everyone else sees, you and I know it is only the tip of the iceberg. You understand the pain and frustration of being locked in a strange world in which you know that your thoughts and behaviors make no sense. It is as if you have simultaneously lost your mind and, at the same time, are so sane that you are a witness to the loss. You are an expert at knowing what OCD feels like, but fully understanding your plight is another story.

You may have heard many explanations for your OCD—it’s a chemical imbalance, it’s a learned behavior. These are explanations, but they are no better than saying a car works because it has an engine. Knowing that a car has an engine doesn’t tell you how to fix a car that’s not running. For you to fully understand your OCD, a meaningful explanation needs to be more than logical and scientific. It must address your feelings and experience and answer questions such as: I’m staring at the stove and can see that it is off. Why don’t I know that it is off? If an explanation touches you, and you can’t help exclaiming, “That’s me!” then you understand.

If you suffer from OCD, you have probably seen many different professionals, tried numerous medications, and read any number of books dealing with anxiety and OCD. This book, however, is different. It is not simply a cookbook explaining how to recover from OCD, because overcoming OCD requires more than simply following instructions. Treatment without understanding is like painting by numbers; there will be some improvement and symptom reduction, but you want more.

To go beyond symptom reduction and stop OCD from controlling your life, I believe you’ll do better as a master artist. The “master artist” has the understanding to create and fashion his or her own work. This book offers the self-guided version of the treatment program used at my center, where helping sufferers understand their OCD is the crucial first step to recovery, because they can’t truly agree to therapy if they don’t understand their OCD and the treatment process.

Your success depends upon your becoming an equal partner in designing your recovery program. As you’ll find in this book, with understanding you won’t follow a treatment protocol, you’ll design your own. Copies of the forms, worksheets, and other materials found in this book are also available for free download from www.FreedomFromOCD.com.

Part 1 of this book, Understanding Obsessive-Compulsive Disorder, will help you to truly understand your OCD experience. You will begin to answer the questions that plague you—for example: How can I not know what I know? Why can’t I stop ritualizing? In making sense of your OCD, you will begin to realize that this disorder doesn’t set you apart from the rest of humanity. You will come to recognize that the difference between you and non-sufferers is a matter of degree, not unlike the differences between social and problem drinkers. In the case of drinking, getting drunk isn’t the problem; it is how often and how much it interferes with your life. For OCD, it is not rituals, seemingly irrational thoughts, or anxiety that differentiates the sufferer from the non-sufferer, but how much these interfere with your daily life. This section will also address the role of medication in recovery and the cognitive behavioral techniques that you will use in your OCD program.

In Part 2, The Foundation of Your Program, I will demystify the process of OCD assessment and treatment, allowing you to design a recovery program for yourself that you can understand and believe in. Then I will guide you through the initial steps of assessing your OCD.

Your newfound understanding will be transformed into practical knowledge as you use the tools and instructions I provide to further assess your OCD and prepare the materials you will need in your self-guided recovery program. The most important of these will be the “scripts” you will be creating to keep up your motivation, fight discouragement, and overcome difficult hurdles. These scripts will help you address one of the greatest difficulties in carrying out a self-guided OCD treatment program: the absence of a therapist to provide you with support specifically targeted and appropriate to your needs of the moment. Although a book can’t replace an experienced therapist, sample therapist scripts are provided, along with directions that will enable you to adapt them to your own needs or to create your own. These scripts will appear throughout the book. Ideally, your recovery program should be a collaboration between you and an experienced OCD therapist. This book is meant to be used as an adjunct to therapy or at times when you can’t find a therapist.

Part 3, Personalizing Your Program: Treatment Guidelines for Your Specific OCD Concerns, is the heart of this book and focuses upon the different manifestations of OCD. Each poses special challenges that need to be addressed when designing a recovery program, particularly if most of your OCD symptoms seem to fall into a single category, such as obsessions focusing on contamination or violent thoughts. The chapters in Part 3 will provide guidance for modifying and individualizing your recovery program through examples, adjusted treatment guidelines, and scripts.

Even when your obsessive concerns seem to have a single focus, they may affect your life in more ways than you realize. For example, if you have contamination concerns, you may find that, in addition to washing your hands, you check the environment for contaminants and mentally ruminate about what you have or have not touched. Or if violent thoughts are your focus, you may spend your time both trying to figure out what it means that you have such thoughts and trying to find ways to prevent the thoughts from coming into your mind. Because of this, you will discover advice throughout Part 3 that you will want to incorporate into your recovery program.

Part 4, Recovery and Beyond, will help you complete your recovery. Working alone on your recovery can be hard. I provide you with guidelines for using family and/or friends as helpful supports during treatment. However, sometimes you will want help from someone who knows exactly how you feel. For this purpose, I also provide instructions for setting up an effective GOAL support group.

Your recovery program doesn’t end when you feel you have overcome your symptoms. Maintaining your gains is a process that requires continued effort. In the last chapter, you will discover why “slips” are normal and how, when you prepare for them, they don’t have to lead to a complete relapse.

The good news is that, while OCD can be a devastating and debilitating psychological disorder, surprisingly it is one of the most treatable. Current research holds that 70 percent of those suffering from OCD will significantly benefit from a treatment involving exposure and response prevention (the treatment of choice for OCD). This should be a time of hope and optimism for finding treatment.

The key, though, is finding therapists who are truly experienced in treating OCD, who know how to properly use exposure and response prevention instead of offering traditional talk therapies or nothing more than medication. When Melanie, my camping trip client, first came to me, I found that her psychiatrist had been underprescribing the SSRI (Selective Serotonin Reuptake Inhibitor) antidepressant she had been taking. When this was rectified, she went from being an extreme suicide risk to a moderate one. Her OCD and BDD, though identified early in her previous therapies, had never been properly treated. Her course of treatment with me included exposure and response prevention, and seven months later she was camping and having a great time. One year after that trip, Melanie was no longer controlled by OCD, BDD, and depression; had completed two semesters of school with ease; had spoken at the annual national conference of the Obsessive-Compulsive Foundation about her recovery; and had gone on her second OCD camping trip.

Too often I am faced with seeing another Melanie—someone who has needlessly suffered for years. Freedom from Obsessive-Compulsive Disorder is my solution. I believe that OCD, when properly understood, is not a disorder of hopeless torment but one that can be overcome. Conquering OCD is hard work, but not as hard as what OCD sufferers already go through every day. So, I invite you, like my campers, to find the hope and courage to journey with me to a better place.

 

Chapter 1

A few years ago, I was in a doughnut shop, waiting to be served. A well-dressed woman was sitting at the counter next to me. When her server—Jared, according to his name tag—brought her doughnuts, she had a special request. “Would it be okay if I pay you after I eat?” she asked. “I’m not going to run out or anything, but I just washed my hands, and if I go into my purse to touch money, they will be dirty and I’ll have to wash them again.”

“Do you realize how dirty money is?” she continued. “Money is handled by so many people that anything could be on it. That’s why they don’t allow cashiers to both handle money and serve food. In fact . . .” She went on for quite some time, ignoring or pretending not to notice Jared’s expression, which silently said, What is wrong with you? Fine, pay later—just let me get back to work.

The answer to Jared’s unspoken question was obsessive-compulsive disorder (OCD). And the woman in the doughnut shop—to my trained eye, an OCD sufferer—is not alone. I am often struck by how many people I pass on any given day—driving my car on the highway, walking through a mall, sitting in a movie theater—who likely have OCD as well. Statistically, for every forty of the thousands of faces I see, one is suffering or will suffer from OCD. When I was in graduate school in the late seventies, I was taught that OCD was a rare and hopeless disorder that only affected about .05 percent of the population (1 in 2,000). However, in the early eighties, I quickly realized that these figures had to be wrong. At that time, I was working at Temple University’s School of Medicine with Dr. Edna Foa, who was on the first of her many National Institute of Mental Health (NIMH) grants that researched and pioneered today’s treatment of OCD. Everyone I discussed my work with seemed to know of someone who exhibited OCD symptoms (significant symptoms, like those of the woman in the doughnut shop, not the little habits and rituals all of humanity engages in on a daily basis). I wondered, How could OCD be simultaneously rare and yet so common that everyone knows someone with it? Since then, worldwide studies have found lifetime prevalence rates for OCD to vary between 2 and 3 percent—about one in every ...

About this edition

• Publisher: Berkley
• Publication date: 2014
• ISBN 10: 042527389X
• ISBN 13: 9780425273890
• Binding: Paperback
• Number of pages: 384