“The chains of habit are generally too small to be felt until they are too strong to be broken.” ~ Samuel Johnson
Over the past many months I have had a number of Healthy Mind – Healthy Future readers request that I again run the two-part interview I had late last summer with Jonathan Lukas, MFT, Director of the OCD Treatment Center of Santa Barbara.  Mr. Lukas is not only an expert Cognitive Behavioral Therapist specializing the in the treatment of Obsessive-Compulsive Disorder and anxiety disorders in general, but has also had his own long and arduous journey overcoming the challenges of OCD.
Obsessive-Compulsive Disorder, OCD, is an anxiety disorder characterized by repeated, persistent, unwanted thoughts, images or impulses (obsessions) that produce uneasiness, fear, worry or apprehension.  These lead to performing repetitive behaviors (compulsions) that one feels driven to perform in an attempt to reduce the associated anxiety.  These symptoms can become alienating, time consuming and produce severe emotional distress.  OCD sufferers generally recognize their obsessions and compulsions as unreasonable, and may try to ignore or stop them.  However, these attempts only increase distress and anxiety until ultimately one is ‘compelled’ to perform compulsive acts in an effort to ease their stressful feelings.  Despite their driven efforts, performing these so-called “rituals” provides only temporary relief.  The thoughts of obsessive-compulsive behavior keep returning and leads to even more ritualistic behavior which is the vicious cycle that is obsessive-compulsive disorder.

OCD affects individuals across all age groups.  Symptoms of the disorder typically begin slowly, and tend to vary in severity throughout life, generally worsening during times of stress.  In the United States alone one in fifty adults suffers from OCD.  That makes it the fourth most common mental disorder in this country, and is diagnosed nearly as often as diabetes and asthma.

It is widely accepted that Cognitive Behavioral Therapy (CBT), in combination with psychiatric medication, is more effective than either option alone.  The specific technique used in CBT is called exposure and ritual prevention (also known as “exposure and response prevention”) or ERP.  This technique involves gradually learning to tolerate the anxiety associated with not performing the ritual behavior.  With ERP the person fairly quickly adjusts to the anxiety-producing situation and discovers that their anxiety level has dropped considerably.
Dr. Miller:  What was it that made you decide to specialize in the diagnosis and treatment of Obsessive-Compulsive Disorder?

Mr. Lukas:  Since the age of eight I have battled severe intrusive thoughts, obsessions, related to health fears and premature death from specific diseases.  I began to obsess about having AIDS and terminal cancer from the age of 12.  Other obsessions included accidently running over a pedestrian with my car, being in a plane crash, contamination fears, and cleanliness obsessions.  In response to the obsessions I engaged in years of extremely rigid compulsive behaviors to try and reduce the intensity and distress from the obsessions.  My rituals were both overt; hand-washing, blinking, tapping, stepping, light switches, door locks, and mental, such as prayer rituals, thought neutralizing, and mental counting.  When I finally found the treatment I needed, I was working with Doctor Richard Rosen, a psychiatrist, who was killed in a plane crash during my treatment at UCLA.  Things he said to me throughout my treatment had really affected me.  He reminded me that I have to make the decision to “get busy living” and soon or my life would continue to progress into devastating and crippling OCD.  He pushed me to face my fears and I believe that his words and his death sparked something in me to work hard to get better and to help others who were going through a similar “tragic life experience.”
Dr. Miller:  If OCD is a chronic brain disorder, how do you manage your symptoms so that they do not return to pre-treatment levels?

Mr. Lukas:  Managing the symptoms of OCD starts with an understanding that life is unpredictable, at times stressful, and that some days are better than others.  With knowledge and insight about my own propensity to feel higher levels of anxiety than someone without OCD, I approach each and every day with acceptance that just because I have OCD, I don’t have to engage my thoughts in ways that will feed the OCD.  I know so much more about my own ability to tolerate anxiety-provoking thoughts and I never fall into the trap of feeding the OCD with compulsions.  For example, in the past I would feel tremendous anxiety when I felt a pain in my stomach area because my mind would take me instantly to, “what if I have stomach cancer?”   The thought would keep swirling around my mind until I felt the need to push and prod to feel for tumors.  I would ask reassurance-seeking questions about my appearance such as, “Do I look like I’m losing weight?”  I would spend hours every day on the computer researching cancer symptoms until I was convinced that I had stomach cancer.  The anxiety I felt obsessing about cancer followed me around throughout the day and even invaded my dreams.

These days, I still occasionally get pains in my stomach and even a “what if” question sometimes pops into my mind.  The difference is that I now approach the anxiety in a different way.  First of all, I resist pushing and prodding because that not only irritates the pain but it also feeds the validity of that thought.  Instead I remind myself that I have a tendency to be highly tuned into bodily sensations and that a pain in the belly area is not a reason to panic.  I take a few deep breaths, remind myself that any action I take to try to reduce that frightening thought will only cause my anxiety to increase over time, and finally I tell myself that I know better than to give OCD what it wants.

Instead I am now able to realistically look at an intrusive thought as nothing more than a false alarm that is going off in my brain.  If I run around in a panic and try to reduce my anxiety by going to the computer, to WebMD, or immediately call the doctor for a CT Scan or MRI, I am putting myself in a position to let OCD back in.  I can now tell myself to sit with the anxiety, accept the probability that I don’t have stomach cancer, accept the small possibility that I might have a tumor and then remember that I am alive today so get busy with “real life” and move on.  I am able to look at other possible reasons why I might be anxious about health issues, such as daily life stressors that exacerbate my anxiety and remember that it’s not really cancer I am worried about.  In reality, life stressors have a way of attacking us where we are most vulnerable.  Some people obsess about health issues; others obsess about germs and contamination, thoughts of harming others, the need for perfection, and on and on.   It’s always important to identify that OCD waxes and wanes in relation to external and internal stressors in our lives.  But rather than sit around and stew in your obsessions, get up and get busy.  Refocus on more important things like eating a healthy breakfast, getting dressed, going outside and getting exercise, and living.  The obsessions will not just go away because you stop ritualizing, but you will be taking an important step in facing the obsessions with a much healthier alternative to compulsive behaviors and this will serve you well in the fight against OCD.  Remember that obsessions are often irrational thoughts that feel frighteningly real but are nothing more than faulty messages that cause us to feel anxiety.   And because anxiety attacks us physically, i.e., rapid heartbeat, tightness in chest and throat, cold, clammy hands, and short, shallow breathing, it causes us to feel that we actually are in danger.  We are not!  Remember to breathe through this, take a moment to identify that the anxiety is coming from a tightly wound fight or flight response and nothing more.  I am much better these days at acceptance of this bodily response and no longer need to give OCD the fuel it needs to survive.

Dr. Miller:  How does a parent help their child or teen face their anxieties?  Parents have often shared with me that the almost perpetual reassurance they try to provide does not seem to help, and actually can make it worse.

Mr. Lukas:  First of all, I know the challenges faced as a parent who has a child or adolescent, or even a young adult who is struggling with OCD.  I spend a lot of time working with parents, significant others, and siblings, helping them to understand how OCD affects the sufferer.  I remind them that sometimes our own anxiety overwhelms us when a loved one is so unhappy, so anxious, and so overwhelmed by constant anxiety from intrusive thoughts and the physical and emotional toll it takes to engage in time consuming rituals.

I remind them that OCD is actually a very treatable disorder but it takes a new understanding by not only the sufferer but the family as well.  We experience anxiety when we feel like we have no control over a situation, a thought, an impulse and that leads us to feel that fight or flight response, which we either listen to and respond to or accept as nothing more than a bothersome thought that will go away on its own.

Parents never want to see their child suffering so our natural instinct is to respond to their anxiety.  We answer their questions by giving them reassurance so that they may feel better quickly and in turn we feel better.  When our children are continuously seeking reassurance that no harm will come to them and we feed that reassurance seeking, we are actually unintentionally feeding that OCD.  Instead I work with the family to first remind them that anxiety is not dangerous, but actually just a reaction to a perception that we are losing control and that’s just scary.  In life, the truth is that we have very little control over so many areas of life but we must learn to accept “the possibility vs. probability” of those things that we know we have no control over, such as flying in an airplane.  Talking to a loved one about their obsessions, listening to them, reminding them that we all feel anxiety is a good start.  Then it’s important to get educated about helpful strategies such as reminding your loved one that thoughts have no power unless you give them power.  Instead of answering a “what if” question in the hopes of reducing their anxiety, remember to ask yourself, Will this help my child fight the OCD or will it just give them short term relief?

It takes courage for parents to step up to the “OCD Monster” but it is exactly what will help their child step up to the challenge of facing their obsessions.  Something as basic as, “Jonny remember how we learned that obsessions are nothing more than misinterpretations of thoughts that feel scary or uncomfortable, but you know we all experience these intense thoughts sometimes.  Remember that those thoughts cannot hurt you and in fact if you are willing to try and not give into the thoughts, over time they will not feel so intense.  We are here to help you fight the OCD, but we don’t want to feed the OCD by continually giving you an answer that might make you feel better.  Instead we will hang in their together and call these thoughts and behaviors what they are, OCD”.   I work with my clients and their families to help them see that OCD is like a school bully.  If you keep running from them, avoiding life’s activities, engaging in time-consuming rituals, you will only make the bully stronger and cause them to come at you more and more, and then the OCD is getting exactly what it wants.

On the other hand, if you stand up to the OCD bully and resist the rituals, face those fears, understand that some days will be harder than others, and do the best you can to be consistent in calling out OCD whenever it comes after you, there will likely be a successful reduction in anxiety and intrusive thoughts over time.  When we stop doing rituals, both mental and overt, we see a process of habituation where the anxiety comes down over time and the obsessions actually lose their power and their intensity, thus showing the OCD sufferer that if you take away OCD’s ability to make you engage it, you will discover how much stronger you are than the OCD.

Next week I will continue my interview with Mr. Lukas from late last summer focusing on the treatment and management of OCD. 

Jon Lukas, MFT can be reached for a confidential consultation either by phone at (805) 453-2347 or via e-mail at jcl5050@cox.net