I feel fortunate to have been able to recently attend the 24th annual International OCD Foundation conference in San Francisco, California. This conference gives treating professionals (such as psychologists) as well as children, teens and adults who struggle with OCD, the most up-to date information on effective and evidenced-based treatments for OCD and other anxiety disorders.

Pediatric obsessive compulsive disorder is a fairly common neuropsychiatric condition that can cause significant problems for children and teens, as well as their parents and families in many areas of their life. According to an OCD-fact sheet included in this article, 1 in 200 children have obsessive compulsive disorder. As noted on this sheet, this would look like 4-5 children in an average elementary school and 20 teenagers in a large high-school. Recent research, included in an article by *Marien, Storch, Geffken and Murphy (2013), indicates a 1.3-4% prevalence rate of OCD among children and adolescents.

There are many misconceptions about obsessive-compulsive disorder. Some people state “I am so OCD”, or “you are so OCD” meaning that the individual is overly organized and/or somewhat rigid. These statements miss the truth and reality of what OCD is and how it effects those who really suffer from it.

OCD is usually considered an anxiety disorder with two components: obsessions and compulsions.

Obsessions are unwanted, intrusive and repetitive thought, images or impulses that result in intense anxiety, and/or distress.

Compulsions are actions that are meant to decrease the above noted anxiety. They are generally repeated behaviors and/or mental actions.

For example a child or adolescent may have repetitive and intrusive thoughts about germs…germs causing death to himself/herself and/or his/her loved ones. This may lead to excessive washing to rid the self of germs, and or avoidance of places and items which the child/teen may feel are more likely to be contaminated with germs. Marni L. Jacobs (**Chapter 4-Recognizing Obsessive Compulsive Disorder, in Understanding OCD a guide for parents and professionals, Lewin and Storch 2017) identifies several themes that are present in pediatric OCD. These include: Aggressive obsessions, Checking behaviors, Contamination concerns, Counting symptoms, “Just right” obsessions and need for symmetry or exactness, Ordering/organizing/arranging symptoms, Religious obsessions/scrupulosity, Repeating rituals, Sexual obsessions, Somatic obsessions and Magical thinking/superstitious fears. Though there can be variations in the intensity of the thoughts and obsessions, the thoughts and obsessions tend to interfere with functioning in home, social and school environments. Avoidance of anxiety is typically also involved in the maintenance of OCD symptoms.

Parents and family members of those with OCD may feel confused and at a loss of how to help their child/teen with OCD. In an effort to help their child or teen they may become involved in the obsessions and/or compulsions of their child/adolescent. The conference I attended discussed the hopefulness of treatment for those who suffer. **Storch and Lewin (2017) state, “Two types of effective treatment have been established. These include a form of psychotherapy called cognitive behavioral therapy (CBT) with exposure and response prevention (ERP) as well as a group of medicines called serotonin reuptake inhibitors (SRI’s).” (**Understanding OCD: A guide for parents and professionals, Lewin and Storch, 2017). Lewin and Storch’s book is a great resource for parents who have questions about treatment(s) they may be considering for their child or teen.

CBT/ERP is a specific treatment that includes helping the child or teen slowly go toward their anxiety in a hierarchical fashion and with skills and support. It includes practice in not engaging in their compulsive behavior(s). Children and teenagers are also taught how to accept their anxiety provoking thoughts, label and/or externalize them, talk back to them, and not act on them in the same way. Generally the parent(s) are included in this treatment. They are taught how to best help, which may be different than how they previously responded, in order for their child/teen to improve and better manage their anxiety and symptoms. For example, a trained therapist can help a parent(s) who has become a part of a ritual, slowly disengage from this role. Also, because it is sometimes difficult for a child/teen to engage in CBT/ERP a psychologist/therapist may at times help the parents develop a behavioral reward system for home-based exposure practice. A treatment provider who is trained in CBT and ERP can be helpful to the child/teen and the family. There are also treatment programs (inpatient and intensive outpatient) that utilize CBT/ERP.

On a separate note, as part of the IOCD conference I was able to watch the premier of an amazing movie called “Unstuck: An OCD Movie”. It followed the lives and treatment of brave young people with various types of OCD. It offered a window into the struggles, the treatment and the hope in recovery for children and teens with OCD. The film demonstrated the individuality as well as some common bonds of those with this struggle. Additionally, I loved that the youth were able to address the myths of how people in the general population see OCD and talk instead of what OCD really looks like and feels like. It also demonstrated how CBT/ERP helped with positive functioning.

For your information I have included the (1)***OCD Fact Sheet that can be found on the IOCD website, (2) Two trailers for “Unstuck: An OCD Movie”, and (3)*** A link for the IOCD website, iocdf.org, for more information about Obsessive Compulsive Disorder.

*Intensive Family-Based Cognitive-Behavioral Therapy for Pediatric Obsessive-Compulsive Disorder: Applications for Treatment of Medication Partial-or Nonresponders. Marien, Storch, Geffken and Murphy

Click here to view the book “Understanding OCD A Guide For Parents and Professionals” (Edited by Adam B. Lewin and Eric A. Storch).

Click here to visit the iocdf.org website

Click here to download the “OCD in Children and Teenagers” Fact Sheet

The new year is often a time where we reflect on the past and take time to set goals for the future. I grew up setting goals at the new year and still do, every year. There’s a sense of accomplishment and excitement that comes with predicting the successes and growth that one will obtain in the upcoming year. In this sense, goals are defined as the end-result of a person’s endeavor. However, at the beginning of this new year, I have found myself contemplating the importance of values. Harris describes values as “your hearts deepest desires for how you want to behave as a human being.” Values are continuous and ever-present, while goals are accomplished and final. When I think of the difference between values and goals, I often imagine a journey to a destination, such as a hike. The end view on the peak is the goal -it’s a destination or end-result. I then think of values as the direction I am headed, or the trail that I am on. You can be heading East daily. East is not a destination but it is a metric that we use to consistently modify our path. Some examples of values are compassion, good work ethic, social relations, spirituality, physical health, learning and more. Goals might then be obtaining a service position, getting a promotion, making a new friend, finishing a spiritual book, competing in a triathlon, completing a class, etc.

Why do we set goals? Because we want that feeling of self-improvement, accomplishment and happiness. However, I’m sure none of us would argue that the real leg-work in accomplishing goals comes when we are day-in and day-out making consistent efforts towards said goals. It turns out, happiness and fulfillment comes from that same leg-work that most of us find not so exciting about the upcoming year. In other words, it is common for us, as humans, to want the prize without the effort; while all the while, it is the effort that actually provides those feelings of self-improvement, accomplishment and happiness (the feelings that we mistakenly think come from the end-result of attaining our goals).

There is a strong body of literature that supports this values approach. Research conducted by Whippman (2016) concluded that value-based living is closer to producing happiness as a by-product than “pursuing happiness” as a goal. In fact, she stated that those who pursue happiness as a goal are often less happy than those who focus on strengthening relationships day-to-day, working a consistent job and other “value-based” activities. “Value-based” is another term for behaviors that we perform daily that align with our underlying values (Hayes et. al.). In the case where you value strong relationships, the “value-based” behavior would look like daily activities that align with the value, such as checking in with a friend or family member to see how they are doing, making time to spend with a relative, sitting next to a family member to read, etc.

Becoming clear on what our values are is always a great idea. It provides a gentle reminder of what path or direction it is we want to go. It reminds us, so that in moments of decision making (example: what to do with free time, what to do when faced with a dilemma, etc.) we can make decisions that ultimately provide more long-term fulfillment and happiness. It is also the key to accomplishing goals, but more importantly it is the key to being content and fulfilled while doing so. At the beginning of this new year, I figure it’s as good a time as any to remind myself of my values.

How do you find, set and live by values? There a couple of guidelines that I’ve found useful listed below.

• Explore values. There are many values to choose from and find within yourself. Remember, “values are your hearts deepest desires for how you want to behave as a human being (Harris)” Don’t feel limited or drawn to values that seem more “correct” or valued by others (see the “Defining Your Values” attachment, where it says “A Quick Look at Your Values –page 1”). When you’ve explored adequately, choose the 4-6 values you feel most aligned with or would like to incorporate into your life. Choosing this many does not limit your values, but provides a select few to focus on.
• Identify “value-based” behaviors. Once you’ve chosen 4-6 values, think about what behaviors would align with those values. For example, if one of your values is creativity, what are some ways you know to engage in creativity? This might be writing, art, playing instruments, taking a walk and finding images or meaning in your surroundings, etc.
• Openly/non-judgmentally think of things that get in the way of the behaviors just identified. This step, if done with the purpose of understanding yourself better, can help problem solve for future instances where you might not feel motivated and important values seem to take the “back seat” to less important values (example: creativity taking the “back seat” to fitness).

Making goals and not achieving them or acting in ways that we regret is never enjoyable. Through research, professional experience with clients and personal experience, I have learned that exploring and introducing a more value-based life is best done with honesty towards ourselves and a nonjudgmental exploration of what it is that we each truly value (Neff & Dahm). Readdressing and revisiting our values is not just a great idea at the New Year, but whenever we would like to improve and realign our life with what we truly want.

This article was written by Tess Collett, CSW and Ph.D. in Training. Tess has been working at CHATS since June 2016.

Sources:

Fletcher, L., & Hayes, S. C. (2005). Relational Frame Theory, Acceptance and Commitment Therapy, and a functional analytic definition of mindfulness. Journal of Rational Emotive and Cognitive Behavioral Therapy

Harris, R. (2010). The confidence gap: A guide to overcoming fear and self-doubt. Penguin Group Australia. Boston, Massachusetts.

Hayes, S. C., Luoma, J. B., Bond, F. W., Masuda, A. & Lillis, J. (2005). Acceptance and commitment therapy: Model, process and outcomes. Behavior Research and Therapy 44, p 1-24.

Layous, K., Lyubomirsky, S. (in press). University of California, The How, Why, What, When, and Who of Happiness: Mechanisms Underlying the Success of Positive Activity Interventions

Neff, K. D., & Dahm, K. A. (2012) Self-Compassion: What it is, what it does, and how it relates to mindfulness. University of Texas at Austin, appear in in M. Robinson, B. Meier & B. Ostafin (Eds.) Mindfulness and Self-Regulation. New York: Springer

Suttie, J. (2016) Is the search for happiness making us anxious? Retrieved from http://greatergood.berkeley.edu/article/item/is_the_search_for_happiness_making_us_anxious

Whippman, R. (2016) America the Anxious: How Our Pursuit of Happiness is Creating a Nation of Nervous Wrecks. St. Martin’s Press New York

Although I’m not much of a winter girl, (even though I’m from Utah!) I do love the Holidays. I’m guessing the things I love about the Holidays are similar to what you may love about this time of year: lights on the houses, wreaths on the doors, trees glowing from the windows, scents of cinnamon, pine, and peppermint, Holiday tunes on the radio and in the stores, time with loved ones, watching the stillness of the first snow fall, and of course, the delicious food. Something else I enjoy are the many opportunities to give to others-family, friends, neighbors, coworkers, and strangers.

I think one of the reasons we enjoy giving to others is because it feels good. More specifically we tend to feel positive, happy, and uplifted when we give to others. Giving to and serving others has been identified by research as being a happiness habit that people can engage in to cultivate more lasting happiness and satisfaction. In one study, significant increases in happiness were reported for research participants who performed five acts of kindness one day a week for six weeks (Lyubomirksy et. al., 2005). In another study, individuals who were given a $10 gift card, but chose to use it in a way where they gave it to another person, but also spent time with the receiver felt the happiest compared to other individuals who either gave it away or used it on themselves while spending time with someone else (Dunn et. al., 2011).

Research completed by Dunn and Norton (2013) found that acts of giving are most effective or have the largest impact on our happiness when the following criteria are met: 1) the giving is a choice 2) you connect with the person(s) you’re helping 3) you see and/or learn about the impact your giving will have. Giving is a choice means that you were not pressured nor did you feel obligated to give. Creating a connection means you spent some time with the recipient(s) of the gift (e.g. giving your time to help someone move, helping your neighbor shovel their driveway, tutored children learning to read). Seeing the impact means you took some time to find out what your gift will go toward (e.g. read about how your online donation will be used, asked what the money you were donating would go toward).

There are many ways to give to others. And in case you need some help getting started, below are some ideas keeping the three criteria outlined above in mind:

1) Volunteer to teach your talents to others (e.g. sewing, crocheting, woodwork, ceramics, etc.).

2) Donate food to a food bank/homeless shelter and help serve a meal to the patrons.

3) Pay it forward in the drive-thru line.

4) Donate money to your child’s school. Ask what the money will be used for.

5) Small acts of kindness are great too! Hold the door for someone. Give up your seat on the bus/train/while waiting to be seated at a restaurant. Help a friend with a chore. Make breakfast for your partner.

Happy Holidays from all of us at CHATS!!

This article was written by Tessa Salisbury, Ph.D. Dr. Tessa has been working at CHATS since December 2015. She feels blessed and grateful to be there.

My 11-year old daughter, nicknamed Bee, is passionate about dance.  She isn’t necessarily good or bad or talented or untalented at dance; she simply loves to do it.  She has taken ballet for seven years now and always begs for more intensive instruction.  Recently, at her ballet school, an audition was held for a “professional ballet track for girls ages 8 to 11. My daughter was thrilled with the news and begged to be able to “try out”.  We arrived for the audition early and I was surprised to already see a pretty long line of girls.  As she happily went into the audition room the line continued to grow longer and longer. As a mother, I began to become concerned for Bee, that her dream may not be fulfilled.  An inner battle ensued between wanting her to do well and be placed in the class, wanting her to do well and not choose to go into the class (mostly because of the time commitment), and wanting to grab her little hand and go home to avoid the competition and scrutiny. The mom sitting next to me, possibly sensing my struggle started talking to me about the benefits of ballet to both body and soul.  She discussed how much ballet had added to the lives of each one of her daughters in terms of balance, wisdom and self-awareness.  She related that she recently had discovered that in the German language there is no word for “confident”.  The closest word to “confident” in German, she said, was “Selbstbewusstsein”, which translated means “to be self aware” or “an awareness of self”.  This wise woman implied that it was more important to be self-aware than to be confident.  Knowing our purpose in our own behaviors, as well as our deeper beliefs, feelings and aspirations can help us even when faced with disappointments and possible failures. Taking risks, with an awareness of our goals and values, is important in and of itself. Coming to know our-selves, our flaws and our strengths can come from taking these healthy risks. I thought a lot about her comments. I recalled a quote by Aristotle that reads, “Knowing yourself is the beginning of all wisdom.” Crisp and Turner (2010) defined self-awareness as “a psychological state in which people are aware of their traits, feelings, and behavior”.  Alternately, it can be defined as the “realization of oneself as an individual entity”.Being self-aware means seeing clearly our own personality, reactions or responses, behavioral and relationship patterns, desires, reasons we feel think and behave in certain ways, motivations and core beliefs. I see self-awareness as a state of radical self-honesty regarding our own values, our priorities, and who we really are in both positive and negative terms.  It is our individual awareness of our self that guides us into making positive necessary changes in our own life in order to become ever closer to the person we really want to be. Self-awareness also helps us understand other people, and other people’s perceptions of us. “It is more useful to be aware of a single shortcoming in ourselves than it is to be aware of a thousand in somebody else.”  (His Holiness the 14^th Dalai Lama). We can go toward self-awareness in many and various ways, including:

• Purposeful Mindful thinking
• Mindfulness practices
• Journaling
• Examining our choices
• Determining and acting on our values
• Being open to considering both our mistakes and our triumphs.
• Looking and assessing consistent patterns which appear in our thoughts, feelings, behaviors and relationships.
• Slowing down and considering the “why” in our own behaviors, thoughts and emotions.
• Considering honestly the reasons behind potential gaps between our intentions/priorities and our behaviors.
• Going toward healthy, growth-enhancing desires and promptings.
• Spending time in nature and tuning into our senses.

Self-awareness is not self-consciousness.  There is some evidence that extreme private self-awareness may lead to self-consciousness, which can be positive in that such people are more aware of their thoughts and feelings and are more likely to stick to their personal values, but they also may suffer from increased stress and more anxiety (Mullen, B. & Suls, J., 1982) In my own self-awareness, I am conscious that the launching of this website and this blog feels both like an exciting new adventure and alternately like a bit of a risk to me, kind of like my daughter’s audition.  I continue to love my work and love the privacy and anonymity that my office affords. I make every effort to make my office feel safe and warm and private for each of my clients.  That will continue.  No clinical information regarding any client will ever be shared in this “internet/blog” forum.  One of my goals is that this website and blog will have the same safe, warm feeling as my office.  I hope it will.  However, I am not altogether confident with the forum of the cyber stage. Yet, Even though this stage feels slightly uncomfortable to me, like Bee, I think I will go forward and dance anyway, keeping my goals and priorities in the forefront of my mind. My colleagues and I are excited by the chance to share things that we have learned and experienced as helpful in the years we have been psychologists. I am sure we will have some small missteps along the way, but we hope to be able to give information that will be helpful, relevant, informative and entertaining.  The blog is not meant as treatment or therapy. Rather it will be stories, interesting concepts and research reviews that are focused on positive change, growth and understanding. We are going to work on updating the blog approximately once a month.  Our first series of blogs will focus on concepts around anxiety disorders. Until then, hold in mind that, “Self-awareness is an act of self-kindness”, Reuben Lowe Whatever life presents us with, it would be well for each of us to slow down and have compassion for ourselves and others, come to know, accept and work in positive ways with our true selves, and of course go toward the dance even if it feels a little uncomfortable. Crisp, R.J.  and Turner, R. N. (2010).  Essential social psychology. London: Sage Publications. Mullen, B. & Suls, J. (1982). Know thyself: Stressful life changes and the ameliorative effect of private self-consciousness.  Journal of Experimental Social Psychology. 18, 43-55.