​Everyone has ‘intrusive’ thoughts that are odd and even disturbing, inappropriate, or taboo, at times (Grayson, 2014). Individuals without obsessive-compulsive disorder (OCD) recognize that intrusive thoughts, or thoughts we are not consciously producing that just pop into our heads, are not anything to be alarmed by and don’t need to be interpreted as potentially dangerous. They might think to themselves, “well that was a strange thought” and move on with their day. However, someone with OCD will be inclined to react to an intrusive thought with fear, panic, and shame and interpret the thoughts as potentially meaningful and dangerous. They might alternatively say “Oh my, that is awful, I need to get that out of my head, would I act on this thought? Why am I having this terrible thought? I must be a monster.” They then may assume that having this terrible thought MUST mean that they will act on the thought and that every thought will lead to action, and therefore they must do something to prevent the terrible thing from happening (i.e., compulsive behavior). 

As referenced in a previous blog written by Johanna Younce, MA (see OCD and “Unacceptable” Intrusive Thoughts - You are Not Alone - OakHeart, Center for Counseling (oakheartcenter.com)), a study conducted on 777 students from 6 continents (13 different countries), found that 94 percent of people without OCD have the same of intrusive and unwanted thoughts, images and/or impulses that someone with OCD has (Moulding et al., 2014). So why is it that individuals with OCD have such a strong reaction to these intrusive thoughts when someone without OCD does not react really at all? 

Well, OCD is sometimes referred to as a thought phobia. In other words, individuals with OCD believe that their thoughts are very powerful and they fear having certain thoughts due to the belief that every thought is significant. Most of us tend to believe that thinking positively will result in positive outcomes and thinking negatively will result in negative outcomes. However, we do not think this in a literal sense. We believe that negative thinking isn’t great for our well-being. Conversely, someone with OCD might believe that negative, intrusive and disturbing thoughts (that are highly normative) will likely result in negative outcomes. In this sense, individuals with OCD tend to believe that whatever thought comes to mind will result in action or result in very real consequences. I think we all sometimes wish our thoughts were that powerful. Wishing for a billion dollars would then result in financial prosperity. Wishing for world peace would result in world peace. Unfortunately, individuals with OCD don’t just believe positive thoughts will result in positive outcomes. They also believe the alternative. I think we can all recognize that this belief would be challenging and quite distressing. If every intrusive thought that pops into someone’s head could lead to an actual outcome in the world, our world would be a scary place! For example, when we are running late and the car in front of us fails to see that the light turned green, many people likely experience anger followed by intrusive thoughts about the person in that car. Individuals with OCD tend to believe, because they had that bad thought, there is an increased likelihood that the person in the car ahead will actually experience harm.

Thought-action fusion reflects the distorted thinking described above that is often characteristic of OCD: This distortion suggests, because I think it, it must be so (Grayson, 2014). Because we think many ridiculous thoughts throughout the day, this psychological phenomenon causes significant distress in individuals with OCD. For this reason, the most effective treatment for OCD is exposure and response prevention (ERP), which entails exposing someone to a scary thought (ones that they are already having) and then refraining from trying to undo the thought via a compulsion. 

Studies have been conducted to understand the neurobiology of thought-action fusion. Researchers have identified areas of the brain that are likely involved, including the inferior orbitofrontal gyrus, several prefrontal cortex regions, the insula, and the globus pallidus (Lee et al., 2021). Lee and colleagues (2021) found that the superior and middle frontal gyri (dlPFC), medial prefrontal cortex (PFC), and inferior parietal lobule were correlated with OCD symptoms. A recent meta-analysis showed that all of these regions were associated with OCD in functional imaging studies (Rasgon et al., 2017). For instance, individuals with OCD were found to have abnormalities in the insula (associated with disgust) and the unacceptable thought dimension of the dorsolateral and dorsomedial prefrontal cortex (PFC; associated with cognitive control; Rasgon et al., 2017; as cited in Lee et al., 2021). This neurobiology of thought-action fusion exhibits that OCD is a medical/ biological condition and therefore requires treatment that will assist with training the brain, which is the goal of exposure and response prevention treatment. 

ERP treatment aims to help you either reduce the frequency of intrusive thoughts or learn to recognize that most thoughts are just thoughts without much or any meaning. By intentionally provoking or “sitting with” your scary or distressing thoughts in exposure-based therapy, you can start to learn that intrusive thoughts do not lead to action and that thought-action fusion is simply a thinking error. This is a major goal of treatment. An additional goal in treatment is to realize that a thought is just a thought; it means nothing without intentional action. For instance, one exercise that I sometimes have my patients participate in is to have the thought “stand up” for one minute. I then tell them, “now actually stand up.” To actually stand up, requires intention. Intended action requires more than a thought. The goal of treatment is to see that you are more than your thoughts. We are here to help you too start to believe this. 

If you are interested in counseling, call OakHeart at 630-570-0050 or 779-201-6440 or email us at [email protected]. We have counselors, psychologists, and social workers available to help you at one of our locations in North Aurora, IL, Sycamore, IL, and/or via Telehealth Online Therapy Services serving Kane County, DeKalb County, Dupage County, and beyond.

References

Abramowitz, J. S., Deacon, B. J., & Whiteside, S. P. H. (2019). Exposure therapy for anxiety: Principles and practice (2nd Ed.). The Guilford Press.

Foa, E. B., Steketee, G. S., & Rothbaum, B. O. (1989). Behavioral/cognitive conceptualizations of posttraumatic stress disorder. Behavior Therapy, 20, 155–176. https://doi.org/10.1016/S0005-7894(89)80067-X

Grayson, J. G. (2014). Freedom from Obsessive-Compulsive Disorder: A personalized recovery program for living with uncertainty. Berkley Books.

Krypotos, A-M., Effting, M., Kindt, M., & Beckers, T. (2015). Avoidance learning: A review of theoretical models and recent developments. Frontiers of Behavioral Neuroscience, 9(189), 1-16. https://doi.org/10.3389/fnbeh.2015.00189   

Lee, S. W., Cha, H., Jang, T. Y., Kim, E., Song, H., Chang, Y., & Lee., S. J. (2021). The neural correlates of positive versus negative thought-action fusion in healthy young adults. Clinical Psychopharmacology and Neuroscience, 19(4): 628-639.  https://doi.org/10.9758/cpn.2021.19.4.628

Moulding, R., Coles, M. E., Abramowitz, J. S., Alcolado. G. M., et al. (2014). Part 2. They scare because we care: The relationship between obsessive intrusive thoughts and appraisals and control strategies across 15 cities. Journal of Obsessive-Compulsive and Related Disorders, 3(3), 280-291. https://doi.org/10.1016/j.jocrd.2014.02.006

Rasgon, A., Lee, W.H., Leibu, E., Laird, A., Glahn, D., Goodman, W., et al. (2017). Neural correlates of affective and non-affective cognition in obsessive compulsive disorder: a meta-analysis of functional imaging studies. Eur Psychiatry, 46, 25–32. https://doi.org/10.1016/j.eurpsy.2017.08.001.

Resick, P. A., Monson, C. M., & Chard, K. M. (2014). Cognitive processing therapy: Veteran/military version: Therapist’s manual. Department of Veterans Affairs.

Treatment for an anxiety disorder generally involves two components:

1. Taking small steps towards facing a fear, psychologically and/ or behaviorally.
2. Taking the same small steps over and over again until you can take another step.

​In theory, if you keep taking small steps, eventually, you get to the final step and overcome your fear. Why would you need to repeatedly take the same step over and over again to get used to it? Well, simply stated, that is the only way we learn that we can do something difficult as human beings. If we do not think we can do something difficult, we need to go do that thing over and over again until we feel like we are actually capable of doing it and have collected enough instances of success to be confident in our abilities. Treating an anxiety disorder, in this sense, is similar to training as an athlete. How many baskets does an NBA player have to make to feel confident? Many. 

Exposure therapy, a therapy that entails facing and overcoming fears that are interfering with your happiness and success in life, is therefore effective because it entails repeatedly taking small steps towards overcoming your fears. Your therapist will explain a part of this process as habituation, or getting used to or desensitized to unhelpful or unrealistic anxiety (as cited in Abramowitz et al., 2019, p. 17). Habituation involves anxiety reduction/ getting used to anxiety both within and between sessions. In other words, during sessions, you will work on sitting with anxiety but in between sessions you will repeat the exercises for successful habituation.  

Why can’t you just complete the work in one session per week? Because habituation or desensitizing is a process that takes several repetitions and a large amount of time (Abramowitz et al., 2019). You would never go to the gym and expect results after only one gym session. Similarly, modifying your brain will take repetition. As mentioned in the previous blog in this series (see The Role of Avoidance Learning in the Development of Anxiety-Based Disorders, OCD, and PTSD), fear is promoted through operant conditioning, or the encouraging or discouraging of behavior by using reinforcement or reward. Therefore, unconditioning a fear requires habituation or many repeated exposures to the conditioned stimulus (the now feared situation that you did not fear before) presented without the unconditioned stimulus (feared outcome taking place) until fear starts to diminish. For example, if someone is afraid of riding a bike because they fell off of it previously, successfully riding the bike many times will eventually lead to habituation, or getting used to riding the bike again and confident you can continue doing so. 

With respect to neurobiology, during habituation (and eventually elimination of a fear), an area of the brain called the medial prefrontal cortex or the mPFC blocks output in what is called the amygdala, the part of the brain that regulates fear (Kwapis & Wood, 2014). The mPFC is responsible for decision making (Euston et al., 2012). More specifically, during exposure work, neurons, or cells in a portion of the medial prefrontal cortex called the infralimbic cortex (as cited in Kwapis & Wood, 2014) undergo changes that reduce activation in the amygdala (as cited in Kwapis & Wood, 2014). In other words, cells in our brain help us get used to being exposed to a fear (that originally activates the amygdala) and eventually our rational brain realizes that we no longer need to be afraid because a situation is not inherently dangerous. 

Psychologically, one additional component of habituation is learning that our anxiety will not last forever, as we start to learn that the feared stimuli is not actually dangerous. It has been theorized that fear extinction, or complete elimination of a fear, first requires habituation. In other words, getting used to the fear and seeing that it is not as dangerous or intolerable as once believed, allows you to form new associations and to stop avoiding the originally feared situation, object, thoughts, etc. Due to habituation, exposure therapy remains a highly effective intervention for treating anxiety disorders. 
 
If you are interested in counseling, call OakHeart at 630-570-0050 or 779-201-6440 or email us at [email protected]. We have counselors, psychologists, and social workers available to help you at one of our locations in North Aurora, IL, Sycamore, IL, and/or via Telehealth Online Therapy Services serving Kane County, DeKalb County, Dupage County, and beyond.

References

Abramowitz, J. S., Deacon, B. J., & Whiteside, S. P. H. (2019). Exposure therapy for anxiety: Principles and practice (2nd Ed.). The Guilford Press.
Euston, D. R., Gruber, A. J., & McNaughton, B. L. (2012). The role of medial prefrontal cortex in memory and decision making. Neuron, 76(6), 1057-1070. 
Foa, E. B., Steketee, G. S., & Rothbaum, B. O. (1989). Behavioral/cognitive conceptualizations of posttraumatic stress disorder. Behavior Therapy, 20, 155–176. https://doi.org/10.1016/S0005-7894(89)80067-X
Grayson, J. G. (2014). Freedom from Obsessive-Compulsive Disorder: A personalized recovery program for living with uncertainty. Berkley Books.
Krypotos, A-M., Effting, M., Kindt, M., & Beckers, T. (2015). Avoidance learning: A review of theoretical models and recent developments. Frontiers of Behavioral Neuroscience, 9(189), 1-16. https://doi.org/10.3389/fnbeh.2015.00189   
Kwapis, J. L., & Wood, M. A. (2014). Epigenetic mechanisms of fear conditioning: Implications for treating post-traumatic stress disorder. Trends in Neuroscience, 37(12), 706-720. 
Resick, P. A., Monson, C. M., & Chard, K. M. (2014). Cognitive processing therapy: Veteran/military version: Therapist’s manual. Department of Veterans Affairs.

​The development of anxiety-based disorders, OCD, and PTSD, as understood at this time, involves complex interactions between genetic and environmental, behavioral, and psychological factors. In this blog, I will discuss a leading theory on one major behavioral/ psychological contribution to the development of and maintenance of these disorders: Avoidance. Unfortunately, avoidance generally prevents overcoming a fear response. Why? Because you can’t see that a feared situation, thought, or memory is actually not harmful until you repeatedly encounter that thing and see that it is not harmful. 

Specifically, the avoidance learning theory on the development of fear suggests that fear responses develop through two processes. First, fear development is based on forming an association between two stimuli: A neutral thing and a scary or unpleasant thing (as cited in Krypotos et al., 2015). This is often referred to as classical conditioning. For instance, at an early age, we learn to associate a stove (neutral thing) with being hot (an aversive and scary stimuli), after we accidentally touch the stove or are warned by our parents that it will burn us. Therefore, we learn to avoid touching hot stoves and we develop a healthy fear of putting our hands on the burners when the stove is on. Similarly, unrealistic or anxiety-disordered fear associations develop when a previously neutral stimulus gets paired with an aversive or anxiety-provoking stimulus. For instance, if a dog is startled by the loud sound of a garbage truck every time the garbage gets picked up, the dog might start to fear garbage trucks, trucks/ cars in general, or even the garbage can. Although we know the garbage truck is not actually a dangerous stimuli, the repeated pairing of a previously neutral/ safe stimulus (garbage truck/ can) and aversive stimulus (loud noise) will generate a conditioned stimulus (truck/ can) and a conditioned response (fear). In the event that the garbage truck was actually dangerous, it would be adaptive for the dog to avoid seeing or being near the garbage truck or garbage can. However, because the garbage truck is not actually dangerous, the dog has now developed a maladaptive anxiety response and false narrative about garbage trucks being dangerous. 

After this maladaptive anxiety response is formed, disordered anxiety will be further maintained by avoidance, often termed operant conditioning. For instance, if the dog starts to run and hide every time the garbage truck arrives, he will not only maintain the fear but also strengthen the fear. Every time he hides, he is confirming that something about the garbage truck is dangerous and he feels a sense of relief while hiding under the bed. This process is often termed operant conditioning, or the encouraging or discouraging of behavior by using reinforcement or reward. In this way, operant conditioning plays a role in the maintenance of anxiety disorders. When something is pleasant, it is reinforcing/ feels good, and therefore the behavior continues. Conversely, when something is unpleasant/ feels bad, that thing will be avoided so the behavior discontinues. When the dog runs and hides, he feels a reduction in negative emotion (which is pleasant) and therefore the behavior is reinforced and the fear is maintained. 

Thus, the avoidance learning theory suggests that anxiety disorders are developed through classical conditioning and are maintained through operant conditioning. After one fear-provoking situation, our brains can trick us into believing something is dangerous, when it actually is not, and then avoidance fuels and strengthens unhelpful and unrealistic anxiety responses and beliefs over time. 

Understanding this theory is important for your treatment. Why? Because the most effective interventions we have to date for the treatment of anxiety-based disorders, OCD, and PTSD involve breaking these associations using exposure-based interventions and thought challenging strategies. Thus, there is good news! If avoidance maintains these disorders, then challenging it and reducing avoidance will serve as effective treatment for overcoming your fears. 

If you are interested in counseling, call OakHeart at 630-570-0050 or 779-201-6440 or email us at [email protected]. We have counselors, psychologists, and social workers available to help you at one of our locations in North Aurora, IL, Sycamore, IL, and/or via Telehealth Online Therapy Services serving Kane County, DeKalb County, Dupage County, and beyond.

References
Abramowitz, J. S., Deacon, B. J., & Whiteside, S. P. H. (2019). Exposure therapy for anxiety: Principles and practice (2nd Ed.). The Guilford Press.
Foa, E. B., Steketee, G. S., & Rothbaum, B. O. (1989). Behavioral/cognitive conceptualizations of posttraumatic stress disorder. Behavior Therapy, 20, 155–176. https://doi.org/10.1016/S0005-7894(89)80067-X
Grayson, J. G. (2014). Freedom from Obsessive-Compulsive Disorder: A personalized recovery program for living with uncertainty. Berkley Books.
Krypotos, A-M., Effting, M., Kindt, M., & Beckers, T. (2015). Avoidance learning: A review of theoretical models and recent developments. Frontiers of Behavioral Neuroscience, 9(189), 1-16. https://doi.org/10.3389/fnbeh.2015.00189   
Resick, P. A., Monson, C. M., & Chard, K. M. (2014). Cognitive processing therapy: Veteran/military version: Therapist’s manual. Department of Veterans Affairs.

You may have seen the viral TikTok trends about oranges and birds only to wonder what that has to do with the strength of your relationship. “Orange peel theory” and “bird theory” are both real life examples of the famous research study by relationship expert,
John Gottman. After observing thousands of couples in his lab, he found that the couples with the greatest long-term success had one major thing in common: how they responded to bids for connection. A bid for connection can be something as simple as asking your partner to peel an orange or look at the interesting bird outside but often they are an indicator of much deeper aspects of the relationship like shared values, dreams, and desires.

What Gottman noticed is that couples who were happiest (and stayed together) responded consistently to bids for connection from their partner and responded with genuine interest and curiosity. This showed each partner’s willingness to learn and understand more about their partner during regular day-to-day interactions. He called this “turning towards” the bid for connection. Couples who were less satisfied with their relationship often ignored bids (“turning away”) or responded with disinterest or even hostility (“turning against”).

In his research, Gottman discovered that “master couples” (those who stayed together and were satisfied in their relationship) responded by turning towards their partner 86% of the time while “disaster couples” (those who experienced high conflict and eventually ended their relationship) turned towards the bid only 33% of the time. This research was groundbreaking because it highlighted that the majority of the work in the relationship happens in small, everyday moments. Not extravagant date nights, vacations or gifts but asking your partner whether they had a good day at work and actually listening to their response.

It may seem simple and straightforward to respond when your partner asks a question or tries to engage you in a conversation. However, bids for connection require emotional attunement and vulnerability on both sides. Let’s look at some examples of turning against, turning away and turning towards. 

Turning Against

Becca: Hey, I’m thinking about looking for a new job. You know how unhappy I’ve been at this one.

Alex: Oh jeez, not again! I swear you can’t stay at a job for more than six months. Do you know how stressful it is for me when you’re constantly switching jobs?

In this example, Becca is receiving the message that her partner is not a safe person to discuss her dreams and concerns with. She will likely internalize the concept that showing vulnerability is stressful to her partner and she should keep these thoughts to herself which prevents Alex from understanding his partner. Not only will Becca refrain from making bids for connection in the future but it’s likely she will make decisions without informing her partner which can lead to even more conflict.

While Alex is able to clearly assert his needs in the situation (a desire for stability), the hostility he used to communicate will likely keep Becca from fully understanding his fears and create defensiveness instead. Because Becca will probably respond to Alex with a focus on defending herself, the original issue (looking for a new job) will remain unaddressed and both parties will leave the interaction feeling misunderstood.

Turning Away

Becca: Hey, I’m thinking about looking for a new job. You know how unhappy I’ve been at this one.

Alex: Uh-huh… did you remember to get mustard at the store this week?

In this example, Becca is not receiving hostility but the concerns about her current job are being ignored. While this might not create a conflict in the moment the way that “turning against” can, this type of response will lead to a build-up in resentment. Over time, Becca will internalize that her needs are irrelevant and her attempts at building intimacy are not worthwhile.

Alex may not realize that he is ignoring an important interaction because he is distracted. We all experience moments where our partner is trying to connect with us and we have our attention elsewhere. This is where Gottman suggests utilizing a “repair bid” or a follow-up question from the partner who initially ignored the bid. Repair bids are an attempt to turn towards our partner when we missed the first request for connection and go a long way in reducing resentment over time.

Turning Towards

Becca: Hey, I’m thinking about looking for a new job. You know how unhappy I’ve been at this one.

Alex: I know this job hasn’t turned out the way you’ve hoped. What kind of new jobs are you considering? 

It’s important to highlight a few aspects of what makes Alex’s response a good one:

• Validation: Alex starts out by validating his partner’s feelings about her current job. Not only is he providing reassurance that it’s okay she doesn't enjoy her current job but that she is safe to share negative emotions with him
• Emotional Attunement: Learning that Becca is unhappy at work is not a surprise to Alex. He implies that the couple has had conversations about this topic previously and Alex is fully attuned to his partner’s feelings about her workplace.
• Positive Regard: Alex’s response is illustrating that things Becca has shared in the past are important to him. When we show our partners that their fears, anxieties and concerns are valuable to us, it furthers that sense of safety and encourages them to share more frequently. 
• Curiosity: Rather than problem solving or trying to make suggestions for how Becca could be happier at her current job, Alex asks her an open-ended question. This shows a genuine curiosity for learning more about what Becca wants and also allows Alex to gather more information about where his partner is at in their own process. 
• Openness: It is very likely that Alex has his own feelings about his partner switching jobs but he utilizes an open and non-judgmental response to give the couple a chance to have a constructive conversation. Often couples worry that if they don’t voice all of their concerns right away, they won’t get the chance. In practice, the opposite is true. As we can see here, Alex is holding off on passing judgment and allowing Becca to share which in turn will make her more open to hearing his concerns further into the conversation.

Once we start to notice how we are responding to our partner’s bids for connection, we can begin turning towards them with more intention. Your partner might say, “Hey, did you see that bright red cardinal?” when they actually mean “Hey, are you paying attention to things that are interesting to me? Do my experiences matter to you? Do you see me and enjoy who I really am?” Learning to respond to these questions at the heart of the bid will strengthen the foundation of the relationship and ultimately lead to a happier, longer-lasting bond for both partners.

If you are interested in couples counseling, call OakHeart at 630-570-0050 or 779-201-6440 or email us at [email protected]. We have counselors, psychologists, and social workers available to help you at one of our locations in North Aurora, IL, Sycamore, IL, and/or via Telehealth Online Therapy Services serving Kane County, DeKalb County, Dupage County, and beyond.

When you think of the holiday season, I bet you automatically think of things such as holiday parties, ugly sweater contests, eggnog, making gingerbread houses, driving around to see all the holiday lights, and family celebrations. However, this is not always the case for everyone. For some, what should be a time of celebration, is a time of increased depression, and wanting to isolate in the safety of their own home ignoring the fa-la-la-la fun, which can feel like you are on the island of misfit toys. 

According to the National Alliance on Mental Illness (NAMI), 64% of people with an existing mental illness report that the holidays make their condition worse. It is no secret that the holiday craziness of cooking, buying and wrapping presents, keeping children entertained, decorating your home, and cleaning up after family gatherings can exacerbate depressive symptoms, and make us feel more overwhelmed and exhausted. This can lead to some individuals feeling immense amounts of guilt for feeling low. While no one goes into the holiday season hoping to feel like a Scrooge, sometimes life situations, family members, or general mental health can trigger the Christmas Blues. 

If your family is similar to the Griswald’s and drives you crazy, or triggers bad memories that make us want to do anything to steer clear of attending the family holiday party. So how do you deal with a triggering family member? Well here are some helpful tips and tools. 

• Strong boundaries.
• Remember you can only control yourself
• Give yourself a time limit of how long you want to stay
• You do not owe anyone an explanation should you decide to leave early
• You can always say no and politely decline to attend the family event

Alternatively, suppose you have good family relationships but cannot spend the holidays with them. In that case, that can also trigger an individual to have increased depressive symptoms, isolate themselves, and exacerbate feelings of loneliness. Below are some helpful tools for this individual to manage a holiday season away from loved ones.

• Getting out of the house, even if that is for a walk around the neighborhood or to go to your local coffee shop for a coffee; a change in scenery can be helpful for mental health. 
• Instead of going to the local mall that's 10 minutes away make it an experience and go check out a mall you've rarely or never been to, again this goes back to the previous bullet point of change of usual scenery and can also leave you feeling invigorated for going to new places.
• Volunteer your time, this also goes for volunteering your time at a local pet shelter. You will have the company of others (or animals) and leave feeling fulfilled and happy.
• Make sure you video chat with long-distance loved ones to keep a semblance of connectivity with them while miles apart.
• Connect with friends and co-workers around you, even if it's for dinner, or spending time at one another's house watching holiday movies. 

We may feel very Grinch-y this holiday season, but remember you are not the Grinch who lives a lonely life on the top of the mountainside, however, current holiday circumstances can make you feel like you are.

But remember whether you are grieving the loss of a loved one this holiday, experiencing unhealthy family dynamics, or feelings an increase in depressive symptoms. Yes, you may find yourself longing for the happier holiday traditions of the past—making the present feel even more miserable.  But it is important to remember that with each year, holiday plans, traditions, and experiences will change; yes, this is normal for change to occur. With that said, create your holiday traditions.

• You can treat yourself to a gift you’ve been longing for and enjoy it! (remember if it is not about the cost of the gift, inexpensive is just as enjoyable) 
• If finances are tight this year, find free or low-cost experiences such as driving around and looking at holiday lights, going ice skating, or walking around the Christkindlmarket Market while sipping hot cocoa. 
• Treating your local police and fire department to treats or cookies this holiday season, seeing their gratitude will automatically make you feel happy. 

Most importantly, for those of us who live in an area such as the Midwest where there is sparse amounts of sunlight during the winter months. To put into perspective, holiday depression impacts approximately 1.5% of Floridians as compared to the approximate 10% in northern/midwestern states.

So we need to make sure that we are taking extra steps to help ourselves manage throughout the holiday and winter seasons. This means; making sure you are taking better care of your body (eating healthy, quality sleep, keeping up with hygiene, increasing water intake, etc.).  It's important to try and get as much sunlight as possible, so if possible make sure you take time to get outside in the middle of the day when the sun is brightest, or take vitamin D supplements. You can also get a sunlamp. While light therapy is not a cure, it has been shown to help reduce some symptoms of depression. 
​
If symptoms of depression continue to worsen and/or intensify please do not hesitate to seek our support here at OakHeart.

Have you ever found yourself feeling overwhelmed by tasks, responsibilities, and expectations?  Do you find yourself procrastinating until the last possible minute…even if you had a whole day to get it accomplished?  Does the task (when you remember to take care of it) feel like there are just too many steps?  This is the tip of the iceberg known as overwhelm, especially in the neurodiverse community.

Each person has different tolerances for being overwhelmed and different factors that can contribute For some, feelings of being overwhelmed may stem from physical stimuli (too loud, too many people, uncomfortable clothes, etc.). For others it may be the sheer amount of steps required and feeling like it will take “forever”.

While many people with ADHD find that they make decisions very well during times of crisis, they may struggle in making similar decisions without the crisis present to push them along. 

Signs of Overwhelm:

• Freeze/Paralysis: you cannot function and have a strong urge to sit/lay down, however this is accompanied by feelings of guilt/anxiety/anger that you are not finishing tasks
• Mentally Scattered: feeling your thoughts move very fast and/or disjointed, difficulty finishing any tasks and more commonly jumping from task to task with anxious energy
• Frequently Staring Into Space: or “spacing out”
• Angry: Getting easily angered and lashing out.

Coping with Overwhelm:

• Step Away: give yourself permission to take a break or leave this situation
• Take a Breath: inhale and exhale, use an app to help or just breathe as deeply as you can and then let it all out, do this a few times
• Move: stand up and walk around, movement helps us regulate ourselves
• Consider Noise and Light: if sensory issues (too loud, too quiet, annoying noises, too bright) are making things worse, go somewhere quiet, listen to music you like, put in headphones, put on sunglasses, go somewhere dim

Getting Tasks Done:

• Use AI: try using online tools to break down tasks into smaller pieces
• Goblin Tools: this free website is fantastic for someone with ADHD (because that’s who it’s built for) and breaks down tasks, formalizes wording, helps with determining tone of written communication, helps estimate time, compiles “brain dump” into tasks, and helps you figure out what to make for a meal with the ingredients you already have  https://goblin.tools/ 
• ChatGPT: this is also useful for breaking down tasks, but can be a place of distraction and requires an established login  https://chat.openai.com/auth/login 
• Body Doubling: asking someone else to work on something the same time you are, especially if they can be in the same room with you
• Delegating: can you ask someone else to take this on to get it off your plate?
• Accountability Buddy: telling someone that you are going to do the task(s) and asking them to check in with you the same day (in a few hours or at the end of the day)
• HALT: Are you hungry, angry, lonely, or tired?  Try addressing these before tackling more.
• Music: Try listening to enjoyable music.
• Write: writing things down helps us to remember
• Gameify: Make it a game or competition
• Deadline: Establish a deadline with someone else, that helps with feeling urgency needed to complete the task

Not all of these things work for everyone at every time, but these can be a good starting point. You are not able to be productive all of the time and you do not need to expect yourself to be.  Try things to work with your brain, instead of trying to do things the same way.  Different is not bad, just different and you are not alone.  

If you are looking for more, I recommend checking out this article on ADHD paralysis on ADDitude Magazine: https://www.additudemag.com/slideshows/analysis-paralysis-and-adhd-trouble-making-decisions/

​If you are interested in counseling, call OakHeart at 630-570-0050 or 779-201-6440 or email us at [email protected]. We have counselors, psychologists, and social workers available to help you at one of our locations in North Aurora, IL, Sycamore, IL, and/or via Telehealth Online Therapy Services serving Kane County, DeKalb County, Dupage County, and beyond.

What is a Body-Focused Repetitive Behavior (BFRB)?

Body-Focused Repetitive Behaviors (BFRBs) include any repetitive self-grooming behaviors such as biting, pulling, picking, chewing, or scraping one’s own hair, lips, cheeks, skin, or nails that can lead to physical damage to the body. Often, the individual will make multiple attempts to stop or decrease the behavior but fail to do so. BFRB's fall in a category of disorders called the "Obsessive-Compulsive and Related Disorders."

The most common BFRBs are hair pulling (trichotillomania), skin picking (excoriation), nail biting (onychophagia) and cheek biting. There is no one cause for BFRBs; however, there is likely some genetic predisposition which is then triggered by some environmental components. They are "among the most poorly understood, underdiagnosed, and untreated group of mental health disorders" (bfrb.org). Ultimately, there are a vast array of reasons why an individual may engage in BFRB's. Research suggests that some individuals with BFRB's are attempting to improve/correct an imperfection or physical appearance while others may be engaging in BFRB's to regulate intense emotions. Other's may be using BFRB's in response to an intense urge or "tension" without any clear rationale for why. It is important to note, that the goal for an individual with a BFRB is not to self-harm. 

What is Trichotillomania?

According to the fifth edition of the Diagnostic and Statistical Manual (DSM-5-TR) trichotillomania is a "recurrent pulling out of one’s hair" that results in hair loss. The individual must have made repeated attempts to decrease or stop their hair pulling. The hair pulling causes significant distress or impairment in social, occupational or other important areas of functioning.

There is no clear consensus on what causes trichotillomania. Some individuals will first struggle with trichotillomania at a very young age while others may start during adolescence. Both men and women can struggle with trichotillomania; however, typically 65%-80% of individuals with trichotillomania are female. Males may be statistically underrepresented as they have more areas to pull from and may be more likely to hide their hair pulling. 

Individuals who struggle with trichotillomania will typically pull from the scalp, eyebrows, and eyelashes, but they may also pull from other areas such as pubic hair or other areas of their body. There are times when individuals are aware of the hair pulling and are engaging focused pulling (e.g., to make something symmetrical) whereas some of the pulling is more automatic (pulling the hair when they are bored). Focused pulling may encompass rituals such as looking for hair of a specific color/texture (e.g., looking for the one gray hair or the one off colored hair to them). This type of pulling can result in long amounts of time spent on these activities. Individuals with BFRB's may also use tools/implements such as tweezers or mirrors as part of their hair-pulling ritual. The way in which they pull may also become an important part of their ritual. For example, they may attempt to ensure that the hair bulb comes is removed along with the hair strand.

There are many identified antecedents to pulling including being bored, experiencing a strong sense of tension (either immediately before pulling out the hair or when attempting to resist the urge to pull), stress or anxiety, or various sensations such as a tactile sensation of something note feeling "right." (e.g., course hair). Some individuals may feel gratification, pleasure, or a sense of relief when they pull the hair. Individuals will report that before they pull that it will feel like an “itch” or a tingly sensation at the scalp that will be alleviated once the hair has been pulled. Pain typically is not accompanied by the hair pulling. 

Once the hair is pulled individuals will sometimes visually examine the hair or manipulate it. They may run the hair around their face or roll the hair between their fingers. Some may find it soothing to pull the hair between their teeth, biting the hair into multiple pieces or will swallow the hair. However, some individuals will just pull the hair and dispose of it.

Treatment Focus

The Comprehensive Behavioral (ComB) Model identifies the environmental, motoric, sensory, cognitive and affective antecedents and reinforcing consequences. This model is the most well known to combat BFRBs. Here is a very brief summary of the model:

What ComB Does

Identifies a range of antecedents of BFRBs
Identifies a range of consequences of BFRBs
Identifies a range of behavioral sequences of BFRBs
Guides individual assessment of BFRBs
Guides treatment plan development targeting BFRBs
Guides treatment modification as required

ComB has 4 Phases. 

Phase 1: Assessment and Functional Analysis
Phase 2: Identify Potential Target Modalities
Phase 3: Identify and Choose Treatment Strategies, Implementation of Chosen Interventions
Phase 4: Evaluation, Modification, Relapse Prevention

Potential Interventions

Sensory: distraction, substitution, extinction, medication
Cognitive: cognitive restructuring, coping-skills
Affective: relaxation, emotive imagery, exposure, medication
Motor Habits/Awareness: awareness training, response prevention, competing response training 
Place and Other Environmental Factors: stimulus control, contingency management

References

American Psychiatric Association Publishing. (2022). Trichotillomania (Hair-Pulling Disorder). Diagnostic and statistical manual of mental disorders: DSM-5-TR (pp. 282–285).
​
Body-focused repetitive behavior: BFRB: BFRB awareness. TLC Foundation for Body-Focused Repetitive Behaviors. (n.d.). https://www.bfrb.org/your-journey/what-is-a-bfrb#:~:text=Body%2Dfocused%20repetitive%20behaviors%20(BFRBs,stop%20or%20decrease%20the%20behavior. 

Over the last several years, many people have been hesitant to engage in therapy via telehealth. Why? Because it is a new concept and some fear that it will lead to feeling disconnected from their provider and their treatment goals. Others may fear that their therapy will be less effective if conducted via telehealth. However, I have been providing telehealth mental health services since prior to the pandemic. Not only have I felt equally connected to my patients, but also I have witnessed equally effective and focused treatment via the telehealth modality. This is, in part, because I provide evidence-based, often manualized care. What exactly does that mean? It means that I am often using a structured guide or tool, such as a manual, worksheet, or specific activity/exercise, to ensure that your treatment is effective and supported by research, no matter where you are sitting. Here at Oakheart we value using evidence-based approaches for this reason. When providing evidence-based care via telehealth, treatment has remained highly effective for several reasons and many of my patients have reported the following benefits of completing their treatment virtually. 

Time and emotional energy: Patients save time commuting to sessions and therefore they do not need to reserve as much time for sessions if they are conducted via telehealth. If you can carve out exactly 1 hour for your mental health every week, you can engage in effective therapy. After sessions, you can quickly return to your busy life. 

As noted earlier, evidence based and/ or manualized treatment can be completed anywhere. Most of the time, you will have copies of the worksheets or handouts I am referencing or we will be working on skills application, thought challenging, or homework planning together in sessions. I will ask you to complete many assignments and most practicing will take place outside of the session. In part, this is because each session is only one hour of each week and permanent psychological, behavioral, and neurological changes are only possible if some of the other 168 hours in the week are utilized for practicing skills learned in treatment. 

If you are participating in exposure-based treatment with me, we will sometimes use the treatment time for completing exposure work, much of which is more effective outside of an office space. Exposure work consists of gradually and repeatedly approaching feared situations, thoughts, memories, sensations, etc. in order to overcome the fear. Many feared situations are present outside of my office space. Therefore, telehealth has allowed me to help my patients with an exposure that required situations in their home or in another space beyond my office. I believe this is why telehealth has actually been a better option for many of my patients with anxiety disorders or OCD, as I have been able to more effectively assist with the exposures. 
 
Service access: I work with patients who reside all over Illinois. As long as you are in the state of Illinois, you can access any telehealth provider in Illinois. As a specialist in trauma disorders, anxiety disorders, and OCD, I am able to access so many patients who need specialized care who typically would not be able to work with me due to the location barrier. 

Flexibility: Wherever you can carve out an hour that aligns with your provider’s availability, you can schedule your session. Telehealth has allowed me to be much more flexible as a provider as well, as I can also work remotely, as needed. Also, when someone needs a session more immediately, I am often able to find a time for them to be seen quickly. 

Effectiveness: Many patients worry that treatment will be less effective if completed via telehealth. However, my experiences as a provider and research suggests that evidence-based treatments remain highly effective via telehealth, including cognitive behavioral therapy for anxiety disorders (Karpov et al. 2023) and depression (Komariah et al, 2022), exposure and response prevention treatment for OCD (Feusner et al., 2022; Rees et al., 2016), and cognitive behavioral therapy for PTSD (Bisson et al, 2022). 

In sum, if you are considering telehealth services at Oakheart or with another practice or hospital, your hesitation about this new modality is remarkably valid. However, it appears that telehealth may be the best fit for many patients and that the research corroborates my hypotheses in its effectiveness. It is my commitment as an evidence-based provider to ensure that the modality of treatment I am using will not compromise the care of my patients and I believe that telehealth will remain a fantastic option for effective and expansive mental health services for all individuals in need. 

​If you are interested in counseling, call OakHeart at 630-570-0050 or 779-201-6440 or email us at [email protected]. We have counselors, psychologists, and social workers available to help you at one of our locations in North Aurora, IL, Sycamore, IL, and/or via Telehealth Online Therapy Services serving Kane County, DeKalb County, Dupage County, and beyond.

References

Bisson, J. I., Ariti, C., Cullen, K., Kitchiner. N., Lewis, C., Roberts, N. P., Simon, N., Smallman, K., Addison, K., Bell, V., Brookes-Howell, L., Cosgrove, S., Ehlers, A., Fitzsimmons, D., Foscarini-Craggs, P. Harris, S. R. S., Kelson, M., Lovell, K., McKenna, M., McNamara, R., Nollette, C., Pickles, T., & Williams-Thomas, R. (2022). Guided, internet based, cognitive behavioural therapy for post-traumatic stress disorder: Pragmatic, multicentre, randomised controlled non-inferiority trial (RAPID). BMJ,  2022; 377, e069405. doi:10.1136/bmj-2021-069405
Feusner, J. D., Farrell, N. R., Kreyling, J., McGrath, P. B., Rhode, A. R., Faneuff, T., Lonsway, S., Mohideen, R., Jurich, J. E., Trusky, L., & Smith, S. M. (2022). Online video teletherapy treatment of obsessive-compulsive disorder using exposure and response prevention: Clinical outcomes from a retrospective longitudinal observational study. Journal of Medical Internet Research, 24(5), e36431. doi: 10.2196/36431

Karpov, B., Lipsanen, J.O., Ritola, V., Rosenström, T., Saarni, S., Pihlaja, S., Stenberg, J., Laizane, P., Joffe, G. The overall anxiety severity and impairment scale as an outcome measure in internet-delivered cognitive behavioral therapy for anxiety disorders: observational study. (2023). J Med Internet Res, 25, e45362. doi: 10.2196/45362

Komariah, M., Amirah, S., Faisal, E. G., Prayogo, S. A., Maulana, S., Platini, H., Suryani, S., Yosep, I., & Arifin, H. (2022). Efficacy of internet-based cognitive behavioral therapy for depression and anxiety among global population during the COVID-19 Pandemic: A Systematic review and meta-analysis of a randomized controlled trial study. Healthcare (Basel). 30;10(7), 1224. doi: 10.3390/healthcare10071224

Rees, C. S., Anderson, R. A., Kane, R. T., & Finlay-Jones, A. L.(2016). Online obsessive-compulsive disorder treatment: Preliminary results of the “OCD? Not Me!” self-guided internet-based cognitive behavioral therapy program for young people. JMIR Ment Health, 3(3), e29. doi: 10.2196/mental.5363

September is a month dedicated to suicide awareness and prevention, and this week of the 10 - 16th in particular has been designated as National Suicide Prevention week. I like to associate the word prevention with proactivity - meaning, in order for people to stop attempting and dying by suicide, they need to be first empowered to obtain and/or maintain an increased quality of life. Getting ahead of a suicidal crisis also means that other people, places, and things need to be set in motion before the crisis has an opportunity to occur. I believe that suicide attempts and deaths by suicide do not happen in a vacuum - I think it’s helpful and OK to explore and ask why they occur - and l also believe that no person is to blame for someone’s death by suicide. Suicide prevention is complex and possible. 

So, what does it mean to be empowered to keep living, and to empower someone to stay alive? According to Oxford, empowerment can be defined as “the process of becoming stronger and more confident, especially in controlling one's life and claiming one's rights.” To me, this sounds a lot like an individual growing in self-esteem and self-compassion and having their personhood acknowledged and respected by others. Below are some practical ways I think together we can work toward creating a world with fewer and fewer deaths by suicide - check it out:

​If it’d be helpful, I’d invite you to print out this chart and pick a handful of these items to implement into your weeks moving forward to help create a world where more and more people are empowered to keep living, and living well. Suicide prevention is complex and possible. 

​If you are interested in counseling, call OakHeart at 630-570-0050 or 779-201-6440 or email us at [email protected]. We have counselors, psychologists, and social workers available to help you at one of our locations in North Aurora, IL, Sycamore, IL, and/or via Telehealth Online Therapy Services serving Kane County, DeKalb County, Dupage County, and beyond.

Back-to-school time is upon us once again and it can be easy to get caught up in the hustle and bustle of the season. Below are some quick tips to help keep your mental health in check while adjusting to a new school year. 

1. Get Sleep: It's easy to let sleep slide when you're cramming for exams or spending time with friends; however, not getting enough sleep can take its toll on your mental health. Having a good sleep hygiene plan can increase your chances of being able to fall and stay asleep allowing your brain time to rest and restore itself for another day.  
2. Be Mindful: A new school year can come with new challenges that can easily become overwhelming if we don't pay attention to what's going on. Practicing mindfulness can allow you to focus on being in the present and can be as simple as taking a few deep breaths to recenter yourself or taking a hike in a new park while taking in the sights and sounds of nature. 
3. Have Fun: Engaging in new or existing hobbies is a great way to increase your social support and help maintain your mental health. This is a great time to seek out opportunities provided on campus to engage in clubs, sports, or hobbies. 

If reading the information provided above resonated with you and you may be a good fit for one of my specializations reach out. I’d like to connect and find out more about how I can support you on your journey.

​If you are interested in counseling, call OakHeart at 630-570-0050 or 779-201-6440 or email us at [email protected]. We have counselors, psychologists, and social workers available to help you at one of our locations in North Aurora, IL, Sycamore, IL, and/or via Telehealth Online Therapy Services serving Kane County, DeKalb County, Dupage County, and beyond.