Laura L. Smith is a clinical psychologist and former President of the New Mexico Psychological Association. She has presented workshops and classes to national and international audiences, including the University of New Mexico adult continuing education program (Osher). She wrote Anxiety For Dummies and Depression For Dummies.

Introduction 1

About This Book 2

Foolish Assumptions 2

Icons Used in This Book 3

Beyond the Book 3

Where to Go from Here 3

Part 1: The Ins and Outs of Ocd 5

Chapter 1: Facing Obsessive-Compulsive Disorder (OCD) 7

What Is OCD? 8

Suffering shame 9

Wrestling with risk 9

Dealing with doubt 10

Counting the Costs of OCD 10

OCD and the Media 11

Pandemic panic 11

Disgusting filth 12

Exploring Treatment Options for OCD 13

Changing the way you think with CBT 14

Thinking about thinking: Metacognitive therapy 14

Approaching OCD mindfully 15

Modifying behavior through ERP 15

Controlling OCD with medications 16

Sending signals deep into the brain 17

Helping People with OCD 17

Chapter 2: Understanding What OCD Is All About 19

Seeing the Two Sides of OCD 20

Obsessing about obsessions 20

Considering compulsions 22

Coming to Terms with OCD 24

The OCD worry cycle 24

Thinking and believing 26

Inspecting impulses 27

Categorizing the Types of OCD 28

Doubts, fears, and uncertainties 29

Contamination, germs, and dirt 30

Shame, embarrassment, and inappropriate thoughts and behaviors 31

Superstitions and rituals 34

Symmetry and perfectionism 34

Parenting OCD 35

Obsessive feelings and sensations 36

Separating OCD from Normal Worries 38

OCD and Diversity 39

Getting to a Diagnosis of OCD 40

Avoiding self-diagnosis 41

Avoiding misdiagnosis 41

Chapter 3: Meeting The Associates and Relatives of OCD 43

Recognizing the Guests or Associates of OCD 44

When anxiety and OCD hang out together 44

Moods and OCD 45

Meeting the Close Relatives of OCD 45

Body dysmorphic disorder (BDD): A seriously distorted self-image 46

Hoarding disorder 47

Trichotillomania: Pulling your hair out 49

Skin-picking: Excoriation disorder 50

Distant Cousins of OCD 51

Obsessive-compulsive personality disorder 51

Smelling bad: Olfactory reference disorder 52

Tics and Tourette's syndrome: Involuntary sounds and movements 53

Somatic symptom disorder: I think I'm really sick 55

Eating disorders: Intense fear of fat 56

Impulse control disorders: unstoppable bad habits 57

Chapter 4: Blaming the Brain for OCD 59

Looking at the Brain's Role in OCD 59

Connecting genetics with OCD 60

Getting inside your head 60

Choosing a Path to OCD 61

Taking information in 62

Selecting the shortcut 62

Picking the high road 63

Communication within the Brain 65

Electricity and chemicals 66

Serotonin, dopamine, and glutamate 67

Chapter 5: Developing and Living with OCD 69

Developing OCD Early 70

Good intentions; bad results 71

When bad things happen 73

Learning by seeing 75

Developing OCD as an Adult 76

Reinforcing OCD with Positives and Negatives 77

Supporting OCD with positive reinforcement 77

Supporting OCD with negative reinforcement 77

Combining positive and negative reinforcement: A double whammy 79

Worsening OCD with Bad Thinking 80

Exaggerating risk 81

Not accepting uncertainty 82

Needing everything perfect 82

Controlling thoughts 82

Being too responsible 83

Viewing thoughts as real 83

Thinking magically and illogically 84

Part 2: Starting Down The Treatment Path 85

Chapter 6: Overcoming OCD Obstacles to Change 87

Realizing Resistance Is Futile 87

Fearing treatment 88

Handicapping against treatment success 92

Believing the worst about yourself 96

Overcoming Resistance and Changing for the Better 97

Embracing the process of change 98

Defeating self-handicapping 100

Dismantling change-blocking beliefs 102

Taking one step at a time 104

Chapter 7: Getting Help for OCD 105

Going After the Types of Help You Need 106

Educating yourself about OCD 106

Getting support from family, friends, and others 107

Choosing a professional to help you 108

What to Expect in Therapy 113

Keeping your therapy private 114

Digging deep into an OCD diagnosis 115

Speaking the truth to your therapist 115

Evaluating your therapist 116

Reviewing the game plan 117

Part 3: Overcoming Ocd 119

Chapter 8: Cleaning Up OCD Thinking 121

Realigning Interpretations with Reality 122

Seeing common types of OCD distortions 122

Using CBT to correct distorted thinking 122

Defeating unreasonable doubts 123

Ending exaggerating risk 126

Rethinking the idea that thoughts have real power 129

Decoupling facts and feelings 131

Overcoming the need for perfection 132

Sidestepping obsessive thoughts 132

Letting go of feeling excessively responsible 134

Pushing Out OCD Thinking with New Narratives 137

Creating made-up, OCD-like stories 139

Writing down your OCD narratives 140

Assessing and rewriting OCD narratives 141

Chapter 9: Meta-Mindfulness for OCD 145

Thinking Erroneously 146

Separating Your Thoughts from You 147

Acquiring the Attitudes of Mindfulness 150

Making time to be mindful 150

Pursuing patience 151

Letting go of striving for striving's sake 151

Discovering acceptance 152

Suspending judgment about emotions 153

Living in the now 154

Minding Meditation 156

Breathing meditation 156

Walking meditation 158

Chapter 10: Tackling OCD Behavior with ERP 161

Exposing the Basics and Benefits of ERP 162

Understanding why and how ERP works 163

Seeing the upsides and downsides of ERP 164

Exploring an alternative when ERP isn't appropriate 165

Working through ERP Therapy 166

Step 1: Determining your OCD theme 167

Step 2: Making a list and choosing your challenge 167

Step 3: Identifying and preventing the response to compulsions 170

Step 4: Preparing to engage in ERP 172

Step 5: Moving through your triggers with ERP 173

Managing the ERP Process 175

Knowing what's cheating and what's not 176

Troubleshooting ERP 177

Rewarding yourself 180

Limiting ERP 180

Chapter 11: Considering Medications or Brain Stimulation for OCD 181

Deciding whether Medication Is Right for Your OCD 182

Getting a thorough check-up 182

Coming clean with your doctor about your health and medications 182

Looking at reasons for medicating your OCD 183

Understanding the side effects and risks of medications 185

Examining Your OCD Medication Options 187

SSRIs 188

Tricyclics 188

Other medications 189

Directly Altering the OCD Brain 189

Understanding how deep brain magnetic stimulation works 190

Looking at the evidence 191

Chapter 12: Responding to and Recovering from Relapse 193

Understanding the Steps of Recovery and the Risks of Relapse 194

Medication relapse rates 194

ERP relapse rates 195

CBT, metacognitive therapy, and mindfulness relapse rates 196

Responding Well to Relapse 196

Strategies for Reducing Relapse 197

Knowing the difference between a lapse and a relapse 197

Prolonging treatment 199

Phasing out your sessions gradually 199

Staging a fire drill 200

Remaining vigilant 201

Zeroing in on especially problematic beliefs 201

Recognizing events that trigger relapse 203

Part 4: Targeting Specific Symptoms Of Ocd 205

Chapter 13: Sanitizing Risk: Contamination OCD 207

Considering Contamination Obsessions 207

Germs 208

The disgustingly gross 209

Unusual contamination fears 210

Pandemic contamination 210

Staying Clean: Contamination Compulsions 211

Washing 212

Cleaning 212

Avoiding 212

Rituals 213

Discarding 213

Reassurance seeking 213

Confronting Contamination OCD 214

Making a list 214

Setting a goal 216

Exposure and response prevention (ERP) 216

COVID complications 217

Alternatives to ERP 218

Chapter 14: Dealing with Doubting and Checking OCD 219

Defining Categories of Doubting 220

Harming your home through negligence 220

Harming others through negligence 221

Harming others with your car through negligence 222

Harming your health through negligence 223

Getting stuck on unanswerable questions 224

Categorizing Approaches to Checking 225

Obvious or overt checking 225

Mental checking 226

Getting others to check 226

Taking Steps to Defeat Doubting and Control Checking 226

Step 1 Searching for signals, triggers, and avoidance 227

Step 2 Identifying obsessional doubts 227

Step 3 Compiling compulsions 228

Step 4 Disputing obsessional doubts 229

Step 5 Applying ERP to doubting and checking 231

Chapter 15: Subduing OCD-Driven Shame 235

Surveying Shaming OCD 236

Being afraid of losing control 237

Struggling with thoughts of aggression 237

Wrestling thoughts of acting out sexually 237

Worrying over losing control of bodily functions 238

Questioning established sexual identity 239

Taking religious or moral beliefs to the extreme 240

Treating Shaming OCD 241

Changing OCD...