Acceptance and Commitment Therapy for post-partum OCD: The transition to parenthood is difficult

Acceptance and Commitment Therapy for post-partum OCD: The transition to parenthood is difficult

For Providers, For the Public, Team Members

When you have OCD, the transition to parenthood isn’t always easy. It can be particularly difficult when you suffer from post-partum OCD, which involves having obsessive fears about harming your baby because of an overwhelming sense of responsibility and duty toward your child. Fortunately, there are effective treatment options available, including Acceptance and Commitment Therapy (ACT), that can help you heal from your OCD symptoms and prepare for the challenges of being a parent. 

Obsessive Compulsive Disorder 

OCD, or obsessive compulsive disorder, can be defined as an anxiety disorder characterized by recurrent obsessions (unwanted thoughts) and compulsions (actions that one feels compelled to do). OCD typically manifests in early adulthood with many people having their first episode by the time they are 20 years old. It has been estimated that up to 1% of the population will experience a chronic form of the disorder over their lifetime. 

OCD can be treated effectively with a combination of medications and psychotherapy. Exposure and response prevention therapy is effective for those whose symptoms have not responded well to medication alone. One component of exposure and response prevention therapy involves imaginal exposure, which entails writing out scenarios you fear may happen then reading them aloud until you no longer feel anxious about them. Exposure therapies also help patients identify triggers so that they can avoid things that make them anxious, such as going into public bathrooms or touching anything someone else may have touched before. 

Obsessive Compulsive Disorder after pregnancy 

The transition to parenthood can be fraught with challenges, including feeling out of control or experiencing intrusive thoughts. For some, this can lead to Obsessive Compulsive Disorder (OCD) symptoms, which may include obsessions (unwanted thoughts) and compulsions (repeated behaviors). One treatment that has been shown effective in managing these symptoms is Exposure and Response Prevention (ERP). ERP involves exposure to the unwanted thoughts without performing a compulsive behavior. If done consistently over time, this helps break the cycle of ritualized thinking and leads to a decrease in obsessive thoughts. In post-partum OCD , sufferers experience both obsessions about harming their baby and compulsions such as counting, reciting prayers, repeating words silently, or doing deep breathing exercises. Treatment usually begins with  sessions that teach patients how to identify when they are having an obsession and coping techniques to manage it. Next comes systematic desensitization through ERP; therapists gradually increase exposure time for mental exercises designed to help patients cope with their fears. 

My Symptoms During Pregnancy 

During my pregnancy, I developed obsessive compulsive disorder (OCD) that revolved around intrusive thoughts about harming my baby. These intrusive thoughts were persistent and uncontrollable, causing me significant distress and anguish. Once I delivered my son, these thoughts worsened and became more extreme. When he was 2 months old, I began having visions of choking him or smothering him with a pillow. After receiving a diagnosis from a psychiatrist at, I was prescribed an anti-depressant called Lexapro. It did not seem to help much so we added the new anti-depressant Seroquel in addition to Lexapro. While there has been some improvement in my symptoms, they are still bothering me everyday. Acceptance and commitment therapy has helped tremendously by teaching me how to live with them rather than fighting against them all the time. Now when I have distressing thoughts, I notice but try not to dwell on them. 

What Helped Me Through Pregnancy 

I was in a very dark place during my pregnancy. I had a lot of obsessions that consumed me, including thoughts about hurting the baby. I felt like I couldn’t cope with the pregnancy because of these thoughts, but luckily my therapist told me about Acceptance and Commitment Therapy (ACT). This therapy has taught me to accept my thoughts without judgment while still moving forward in life. ACT helped me find peace with my thoughts and not let them hold me back. Now I’m able to have more confidence in myself as a mom, knowing that I can take care of my child even though I have intrusive thoughts sometimes. 

Depression, Anxiety and Sleeping Problems After Having A Baby 

If you’re struggling with depression, anxiety, sleeping problems or any other mental health issue after the birth of your baby, it’s important to know that these feelings are normal. Postpartum OCD is a relatively new diagnosis in the DSM-5, but this doesn’t mean you’re alone. It’s not uncommon for new mothers to struggle with intrusive thoughts that their baby will be harmed or die. These may cause obsessive compulsive rituals like checking on the child over and over again, locking doors repeatedly or even compulsively washing hands. For some women, these obsessions can become so severe that they start to make decisions based on whether they think they’ll help prevent harm from happening. If you are looking for a referral or help with symptoms like these, please contact us at Better Living Center for Behavioral Health. 

Trichotillomania: What is problematic hair-pulling?

Trichotillomania: What is problematic hair-pulling?

For Providers, For the Public

Trichotillomania (TTM) is currently classified as an impulse-control disorder. TTM entails the phenomenon of repetitive hair pulling that results in hair loss. The diagnostic criteria for TTM include: an increased level of tension immediately before hair pulling or during attempts to avoid pulling and a feeling of relief, pleasure, or gratification in response to hair pulling. Trichotillomania must also cause the individual distress or impairment in occupational, social, or other areas of functioning. Hair is most often pulled, one hair at a time, either from the scalp, lashes, or eyebrows. Hair pulling from the pubic area is also common.

Pulling is generally executed by way of the fingers; however, tools such as tweezers, brushes, or combs may be used as well. TTM suffers will often partake in post-pulling actions that involve handling the pulled hair using the mouth, hands, or face. The hair can be chewed or ingested as well. Ingesting hair may also lead to a number of significant health issues. TTM is considered to be more common among females, although it is not certain whether this sex difference results from an actual variance in the occurrence of the disorder, represents a female treatment-seeking bias, or simply reflects higher acceptability in society of hair loss in men.  

At the Better Living Center for Behavioral Health we treat patients with trichotillomania with evidence-based treatments including Habit Reversal. Habit reversal helps the individual break down the series of actions that lead to hair pulling and engage in alternative behaviors to reduce hair pulling. If you would like to learn more about treatment of trichotillomania or other Body Focused Repetitive Behaviors (BFRBs) please contact us at 972-332-8733.

 

References:

Woods, D. W., Flessner, C., Franklin, M. E., Wetterneck, C. T., Walther, M. R., Anderson, E. R., & Cardona, D. (2006). Understanding and treating trichotillomania: What we know and what we don’t know. Psychiatric Clinics of North America, 29(2), 487-501. doi:10.1016/j.psc.2006.02.009

Differences in Early and Late Onset OCD

Differences in Early and Late Onset OCD

For Providers, For the Public

Pinto et al. (2006) defined OCD as “a neuropsychiatric condition characterized by recurrent intrusive thoughts (obsessions) and repetitive behaviors that the individual feels driven to perform (compulsions)” (pg.1 ).  The researchers sought to investigate predictors of remission/relapse among those treated for OCD.

Over five years, 293 adults were monitored and researchers measured their OCD symptoms. Researchers found those with early and late onset symptoms experience an increase in symptoms over time without effective treatment. Additional findings show a considerable amount of time between symptom onset and first initiation of treatment. Individuals in the study reported an average of 17 years from initial symptom experience to treatment initiation and 11 of delay from meeting diagnostic criteria for OCD until treatment initiation. Many clients reported spending a number of years misdiagnosed before initiating appropriate treatment for OCD.  

Researchers found the average onset for early onset OCD was 11-12 years old, while late onset OCD was 25-26 years-of-age. The first clinical symptom(s), obsessions and compulsions, 53% of participants indicated an obsession and 47% experiencing a compulsion. Interviews also found aggressive content obsessions, hoarding obsessions and compulsions as primary themes in distress. Contamination was shown as the most frequently reported subcategory for obsessions. Those with earlier onset symptoms also experienced higher rates of panic symptoms and disordered (Pinto et al., 2006).

Written by Perry Leynor, MA, LPC Associate supervised by Paula Maloney, LPC Supervisor.

Pinto, A., Mancebo, M. C., Eisen, J. L., Pagano, M. E., & Rasmussen, S. A. (2006). The Brown Longitudinal obsessive COMPULSIVE Study. The Journal of Clinical Psychiatry, 67(05), 703-711. https://doi:10.4088/jcp.v67n0503

Identifying and Treating Race-based Trauma

Identifying and Treating Race-based Trauma

For Providers, For the Public

Statistics indicate the United States of America (USA) is becoming more diverse and a nation of plurality. Despite statistics, USA has consistently struggled with its ability to respect, accept, and include diverse populations. Individuals of color experience direct and indirect health care disparities such as unequal access to material, social, and educational resources on a prevalent and consistent basis. They are often not able to afford health insurance, in addition, experience racist behaviors and discrimination amongst healthcare providers.

Racial and ethnic discrimination can cause negative psychological consequences that cause race-related stress and could eventually cause race-based trauma (Hemmings & Evans 2018). These psychological issues encompass feelings of helplessness, paranoia, anxiety, fear, medical health issues, numbing to their emotions, denigration of one’s sociocultural in-groups, and the onset of PTSD.

One solution is improving the health of individuals of color. Healthcare professionals would need to make better efforts to address racism when working with minorities. Research shows facilitating multiculturally competent care would require awareness of race, racism, discrimination, and how these factors contribute to subpar healthcare practices (Hemming & Evans 2018). Multicultural training within the mental health field also needs to be improved. A solution would be more effective training and treatment models for counselors to be better prepared to establish a therapeutic relationship with a person of color.

Written by Victoria Fontenot – Behavior Therapist. To seek care with us – please call 972-332-8733.

Hemmings, C & Evans, A. M. (2018). Identifying and treating race-based trauma in counseling. Journal of Multicultural Counseling and Development, (4), 20-37. https://doi:10.1002/jmcd.12090

Offering Your Anxious Clients the Standard of Care

Offering Your Anxious Clients the Standard of Care

For Providers, For the Public

                              Offering Your Anxious Clients the ‘Gold Standard’ of Care

         Exposure therapy has long been supported as the ‘gold standard’ treatment for anxiety disorders. Despite strong empirical support for the effectiveness of exposure therapy, many therapists underutilize exposure therapy in the treatment of anxiety and related disorders.

Studies examining why clinicians tend to underutilize exposure therapy indicate several important factors.

These factors include:

  • Lack of appropriate training or supervision to learn these methods.
  • Holding negative or inaccurate perceptions about exposure therapy and when it is contraindicated.
  • Clinician belief that clients will reject the treatment, drop out of treatment, or that exposure therapy may cause harm to clients by asking them to engage with aversive experiences.

In summary, clinicians tend to underutilize the ‘gold standard’ of treatments for anxiety and related disorders because they tend to have little training or experience with it. A key factor in alleviating these issues is offering more training and consultation on utilization of exposure-based treatments.

If you would like to learn more about using exposure therapy in your practice:

  • Sign up for our blog, below.
  • Contact us at 972-332-8733 to join our consultation group or to set up individual case consultation.

     by Perry Leynor, LPC Associate under the supervision of Paula Maloney, LPC-S.    

Meyer, J. M., Farrell, N. R., Kemp, J. J., Blakey, S. M., & Deacon, B. J. (2014). Why do clinicians exclude anxious clients from exposure therapy? Behaviour Research and Therapy, 54, 49-53. https://doi:10.1016/j.brat.2014.01.004

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