​I have had an interest in treating OCD for more than 25 years and seen it take many forms. Common obsessions have included concerns about contamination from chemicals, sticky substances or germs; being infected with AIDS or herpes, accidentally harming or attacking loved ones or strangers, questioning one’s sexual orientation, being possessed, being a paedophile or rapist, flooding or burning the house down, being burgled, losing valuables, things being out of order or not “feeling right”. 

These intrusive thoughts then lead to all sorts of rituals including excessive hand washing; checking appliances, belongings, taps, lights, locks, seeking reassurance about what just happened; ritualised excessive praying; repeating behaviours a certain number of times and retracing ones steps or movements (either physically or in one’s mind) or re-reading emails, assignments, text books and letters.
 
The lives of these tortured souls become more and more narrow as they start to avoid situations that could trigger their obsessions. It can get to the point where some sufferers become unable to leave their room or perform basic activities we take for granted. The obsessions can limit behaviours such as showering, shopping, reading or writing, catching up with friends, preparing food or eating out, driving or catching public transport, using public toilets and cleaning the house. 
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​OCD tends to both wax and wane for the sufferer, becoming worse at times of increased stress. The tendency to obsess often arrives before the subject of its attention does.  If you have a mind inclined to obsess, it tends to look for a place to land – and relationships are a rich place for it to find a landing ground.
 
“Relationship obsessive compulsive disorder” or ROCD is a relatively new phenomenon. It was first described as recently as 2012.  However, it is receiving increasing attention by researchers and clinicians. When I started working in the OCD field, this condition was unheard of. However, recently, in one week, I had three clients who were referred for ROCD!
 
Essentially, ROCD is excessive ruminating about your feelings towards your partner or your partner’s feelings towards you, or the “rightness” of the relationship experience. ROCD, can cause you to spend hours analysing your feelings, or your partner’s flaws. It can lead to fears about your own inadequacies and whether you are about to be dumped or fears about future regrets. ROCD also leads to a great deal of reassurance seeking from your partner, friends and family or through internet searches. 

It's all about Doubt
It is doubt that gives ROCD oxygen. So why has ROCD arrived now? Is it because the current generation have witnessed so many parents separate that they worry about making the same mistake?  They are acutely aware of the impact on the rest of their life and the lives of children they might have.
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Combine this with easy access to the internet with a plethora of YouTube videos, quizzes and articles by relationship therapists and dating coaches. All offering advice to guide you in working out if you are with a “quality” partner or in a good relationship. While it is important to learn what we can about relationships and how to choose a healthy one, if you have a tendency to obsess, it may be better to see these experts in person than trawl the net and feed the doubt.
 
And then you have social media encouraging you to compare yourself and your partner with everyone else, promoting feelings of inadequacy and self-consciousness. And finally, we are now living in a world of internet dating and dating Apps where the options for choosing a partner have increased exponentially. Research has long demonstrated that the more choice you have, the harder it is to make a decision. This is known as the “paradox of choice” where more choice leads to less satisfaction. Again, it feeds us doubt. 
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All of these factors have created the perfect storm for those with the psychological and biological factors which predispose them to develop OCD, to have ROCD.

​Some warning signs of ROCD include:

• Spending a lot of time (more than an hour a day) ruminating about it
• Trying to counter the doubts by suppressing them or having thoughts to counteract them
• Constantly monitoring your feelings about and sexual attraction for your partner (nothing will kill this more quickly!)
• Excessively comparing your partner with others, or past relationships or characters in movies and novels
• Avoiding situations and people that might trigger your doubts
• Avoiding physical or emotional intimacy with your partner for fear he/she may end up being hurt
• Excessive time spent doing things designed to relieve your doubts like seeking reassurance from others
• Repeatedly asking your partner to confirm their love for you
• Confessing your doubts to your partner
• The doubts are unwanted and distressing
• The doubts are interfering with other aspects of your life (like work, study, family, socialising)
• The intrusive thoughts conflict with your values (e.g. you would not normally be concerned about this “flaw” in a person)
• The intrusive thoughts conflict with a part of you that knows that you have a reasonably good relationship
• The worries may be in the form of images, thoughts and urges, rather than just a verbal thought
• Other OCD symptoms or a past history of OCD
• A history of similar ruminations in previous relationships

​It can be very tricky if you have both ROCD and real concerns about your relationship. If this is the case, I suggest you postpone any decisions about ending the relationship until after you have had treatment for your ROCD, so your decision can be more reality based.
 
ROCD is treated with a combination of psychological strategies. These include learning about problematic beliefs which turn normal intrusions into obsessions; ways of challenging and managing intrusive thoughts; imaginal and real exposure to feared situations while stopping compulsive behaviours (like reassurance seeking) that maintain the ROCD.  Training in mindfulness skills to make it easier to let the thoughts come and go without engaging with them can also be helpful.
 
For more comprehensive information about ROCD and treatment, I recommend this website which was developed by the leading researchers in this field and contains numerous resources including information about the App they developed to assist ROCD sufferers.

I recently had the pleasure of attending a two day training on “Harnessing the Power of the Mind, presented by Dr Daniel Siegel (American psychiatrist and author of Mindsight:The New Science of Personal Transformation). 

In this training, Dr Siegel highlighted the results of the latest research into “neuroplasticity” which he defined as the capacity to grow new brain cells and create new connections in the brain in response to experience.  

The good news about neuroplasticity is that, unlike what was previously believed, new brain cells and new connections in the brain can be grown throughout our lives, not just during our childhood. Through his work in this area, Dr Siegel has identified six daily practices which everyone can do to maximize their well-being, brain health and ability to change their brain to create a better life.

Neuroplasticity and Psychotherapy
Dr Siegel explained that how we focus our attention actually shapes the structure of the brain. He highlighted how psychotherapy changes your brain by combining the attuned, empathic and safe relationship you develop with your therapist with the integration of past and current experiences, new information and insights.

Dr Siegel sees therapists as being “integrationists”. We integrate new ways of seeing things into growing new brain pathways as we choose who we want to be rather than being a slave to our past. Ultimately, as therapists, we harness neuroplasticity to grow integrative fibres in our client’s brains.  His research has found that both mindfulness (i.e. non-judgemental, focused attention) and secure relationships increase integration.

I have found these principles to be invaluable when I am helping my clients who have become demoralized by the seemingly insurmountable challenges of changing life-long mental health conditions and unhelpful habits. These ideas and the following six practices are relevant to anyone trying to recover from or overcome a whole range of conditions including depression, trauma, anxiety, substance abuse and unresolved issues from childhood.

It takes around two to three months to grow new brain cells and connections. Thus, while new insights may occur in therapy, allow time for these changes to consolidate. You can further boost the process of change by engaging in these daily practices that facilitate neuroplasticity. 

Six things you can do to maximise brain neuroplastcity
 
1.  Develop relationships with people and put time into connecting and interacting with others. Ideally, this is done face-to-face to fully engage the brain with verbal and non-verbal aspects of communicating and relating. Take time to appreciate your connection to the people around you as it will activate and reinforce your brain's relational circuitry.

2. Novelty promotes brain growth. Novelty can involve humour (as Dr Siegel notes,  most jokes and good stories involve a “violation of expectation”) as well as new experiences (e.g. travelling, learning a new language or musical instrument or skill).

5. Adequate sleep will give the brain the rest it needs to consolidate learning and recover from the experiences of the day.

6. Focused Attention - Close paying of attention (instead of multi-tasking which involves continuous partial attention) stimulates neuroplasticity. Regular mindfulness meditation practices strengthen your ability to focus your attention and thus change your brain. Dr Siegel recommends allowing time for sustained focused attention on both external stimuli (e.g. reading, artwork) and inner experiences (e.g. reflecting on sensations, images, thoughts and feelings). 

The Wheel of Awareness Meditation
Dr Siegel has developed a meditation called the Wheel of Awareness. It utilizes his principles of internal and external focus as well as focus on connection with others to promote well-being and strengthen your mind. A variety of free downloadable Wheel of Awareness meditations and other resources can be found at Dr Siegel’s website – just click the tab under resources.

Acceptance and Commitment Therapy (ACT), with its core principle of acceptance, has much to offer those who are suffering from a chronic health condition (see this article). One of the core skills used in ACT to help you step out of the negative spiral of dirty distress and shift your attention to meaningful activity is “Mindfulness”. In this article, I will explain how mindfulness is used with compassion to manage negative thoughts, feelings and emotions so that they do not stop you living a life you value.

Mindfulness
While mindfulness has been a part of the Buddhist tradition for over two and a half thousand years, it was only brought to the world of psychotherapy in 1979 by an American medical professor and author - Jon Kabat-Zinn. He integrated mindfulness into a treatment program (Mindfulness Based Stress Reduction) to successfully help people manage chronic intractable pain.

Kabat-Zinn defined mindfulness as “paying attention, on purpose, in the present moment and without judgment.” So, it is a form of meditation that cultivates focused attention on present moment experiences with full acceptance of whatever arises – including awareness of pain. The power of mindfulness is now being realised as more and more studies are finding evidence supporting the effectiveness of mindfulness to help people cope with anxiety, pain, depression, and chronic illness. Scientific research has also found that regular mindfulness practice can enhance immune functioning, decrease reactivity to stress and increase positive states of mind. 

Self-Compassion
One of the more powerful recent developments in therapy for me over the last decade has been Compassion Focused Therapy (CFT), developed by an English psychology professor – Paul Gilbert. Professor Gilbert has highlighted that we are often harshly critical of ourselves for things that are not in our control, in a world that is very challenging with a mind that is often chaotic and easily triggered into distress.

CFT aims to help you cultivate a compassionate resource within yourself to help you manage these realities. Although it has gathered momentum over the last decade, developing compassion for ourselves and others has its roots in the Buddhist teachings, as found in Loving Kindness meditations. Loving kindness practices are now being integrated into psychotherapy because of their power to transform suffering. 

Chronic Health Conditions and Grieving
When managing chronic health issues, it is helpful to be aware of the stages of grief outlined by psychiatrist Elizabeth Kübler-Ross. While she identified these stages in her work with people suffering from a terminal illness, they were later found to be just as relevant for those grieving for the loss of health in a chronic illness. You may have observed in yourself the Denial (“maybe they got it wrong, maybe it will go away”); Bargaining (“maybe I can fix it with this vitamin or that alternative approach”), Anger (“why do I have to have this ...it’s not fair”); Depression (I can’t do X, Y or Z anymore) and finally Acceptance (“It is what it is. I can make room for this, and live a full life around it”).

However, it is important to keep in mind that these stages are not just moved through sequentially and in this order – it is a back and forth movement and the feelings may arise at any time and in any order. Also, as grief is a very personal experience, not everyone experiences all the stages, and each stage can last for minutes to months to years, depending on the individual.

What makes grieving even more difficult is that your ailment may also be progressive, or have additional associated health conditions that may appear further down the track. Consequently, just when you think you have accommodated this illness, the goal posts are moved and there is more you have to find a way to live with. And there you are feeling angry or denying or bargaining again.

Use Self-compassion to Step Back from the Struggle
As mentioned in a previous article, when managing a chronic illness it is very common to find yourself struggling to “get rid of” it or to control it, which only makes matters worse. Knowing that grieving is a normal process of coming to terms with a chronic illness will help you to step back from it and notice the struggle, rather than stay in the struggle. Mindfulness can also assist you with disengaging from the struggle and having compassion for yourself in this process is vital.

This may be most relevant when you find yourself feeling angry and frustrated about your medical condition and your inability to control it. As I have said, anger is part of the normal grieving process in the face of losing health and managing limitations you are confronted with. However, as there are no suitable external targets for this anger, you may turn this anger inwards, feeling angry at yourself, or your body, for letting you down or creating this illness.  You may be criticising yourself for not being able to do more or cope better.

This is where Compassion Focused Therapy (CFT) can be invaluable. Instead of blaming yourself, CFT helps you to cultivate a “compassionate-self” by imagining what you would say to a dear friend if you wanted to be compassionate and caring towards them. Connecting to this compassionate-self can turn on the areas in your brain associated with self-soothing instead of self-criticism. The self-soothing system in your brain can be activated by speaking to yourself in a kind inner voice with caring words and using a loving facial expression with some gentle touching or patting of your face or body (our brains are intrinsically wired to be soothed by these actions). 

This compassionate-self would be like a caring buddy who can be with you 24/7 to support you at difficult times.  A part of you that is committed to your well being and has the wisdom to know and remind you that this is not your fault, and you are doing the best you can in a life that can be very challenging.  

Just imagine for a moment, what it would be like to go through life with a reliable, compassionate and caring companion by your side. That is exactly what CFT offers you. We are all told that you cannot be truly loved until you learn to love yourself. In the same way, I would say you cannot truly come to terms with a chronic illness until you learn to develop compassion – truly, deeply – for yourself. 

Appreciate what you can do
Another key to managing a chronic health condition is being mindful and appreciative of want you can do, rather than focusing on what you can’t do.  So, after kindly acknowledging the difficulties you are dealing with, this compassionate-self could also help you to shift your focus away from what you can’t do, to appreciating your body and the millions of things that you are still able to do. Bringing an attitude of gratitude to your daily life, and ‘counting your blessings’ in the midst of your limitations will help you through. 

This does not mean that you shut out your grief. You still need to allow some time to feel the loss and anger and shed some tears.  But then you will be more able to shift your focus and re-engage with the present and do something that you find meaningful or pleasurable.

I remember once being on a beautiful beach in the Whitsundays, but being unable to walk along it as I had an episode of plantar fasciitis (a painful foot condition). It was such a beautiful cloudless sunny afternoon that I did not want to miss out. So I got down on my knees and crawled along the beach and found the most beautiful tiny shells hidden amongst the washed up seaweed that I would never have seen otherwise. I was able to fully focus (mindfully) on the sand and shoreline, enjoying the colours, and textures, and really savoured this moment in time. I collected the shells in a bag which I keep in my office to remind me of being mindful of the small positive joys that may otherwise be overlooked in the midst of limitations and distress.

Mindfulness, Self-Compassion and Pain
Mindfulness can be used in one of two ways to manage pain or other unpleasant body sensations. Initially you may use it to assist with moving your attention away from the feeling onto more rewarding aspects of your present moment. Using your senses, you may shift your focus from the disagreeable sensations and worries, to more pleasant sensual experiences like tasty food, enthralling music, the smell of a flower, feeling a hug, stroking a pet, or looking at a beautiful sunset. You may also shift your attention to think about what you value and decide how you want to act in the present moment with the discomfort.

With more advanced practice in mindfulness and self-compassion, you will be able to observe your unpleasant sensations with curiosity and kindness. Subsequently, you will notice any thoughts, sensations and emotions as they arise, without trying to change them or condemn them. Rather, you will have the capacity to sit with them, describe them as they are in this present moment, and watch them come and go with compassion for yourself. Repeated practice will enable you to become more open to them and to give up the struggle and judgements that would make them worse.

To allow you to experience this with some guidance, I invite you to go to this website where you will find a range of free downloadable Loving Kindness meditations. One of my favourite meditations is the one by Mary Brantley (under Additional Guided Meditations) and is called Lovingkindness for the Body. This meditation is particularly soothing as it combines mindfulness with an attitude of gratitude and loving kindness. 

Changing your Brain
Psychologists have long known that what you pay attention to will change the way you experience your environment.  Recent studies have revealed that what you focus your attention on repeatedly over time can also ultimately make long lasting changes in brain pathways and structures. Just like building and maintaining muscle strength can be done with repeated weight lifting, repeated activation of certain brain pathways will create, strengthen and maintain them. Thus, regular self-compassion and mindfulness meditation will make changes in your brain. This will mean that what was initially a state of mindful awareness, acceptance and self-compassion, can become more of an enduring way of relating to yourself.

Again, it is similar to training with weights so that you can play a sport better. While you may not notice the benefits at the time (and it may even feel tedious), it is when you are out on the playing field later that you appreciate the time you have put into training to build up that strength.  Thus, I encourage you to put the time into a regular mindfulness and self-compassion practice (even if it is just a few minutes each day pausing to observe your breath and then wishing yourself well). If you put the time into developing this part of your brain, you will then have access to a resource that will allow you to maintain a degree of equanimity in the face of flare-ups and all the other challenges that come with chronic health conditions. 

Chronic health conditions bring many challenges such as pain or irritating sensations; fatigue; and restrictions on what you can do or eat. Which psychological therapies offer the most effective coping strategies for managing such challenges? My experience, (both personally and professionally) leads me to put Acceptance and Commitment Therapy (ACT) and Compassion Focused Therapy at the top of my list. In this article, I will discuss some core principles of ACT and how they can help with managing chronic illness and pain. ACT is a mindfulness–based behaviour therapy. In another article, I have talked more about the use of mindfulness and Compassion.

ACT (pronounced as the word “act”) was developed in the late 1980s by American psychologists Steve Hayes, Kelly Wilson and Kirk Strosal. They saw it as an evolution of the well-established school of Cognitive Behaviour Therapy. Since its development, research involving controlled randomized trials has supported the effectiveness of ACT in managing a range of conditions including depression, anxiety and chronic pain.

As the name implies, ACT involves both acceptance and commitment. ACT aims to assist you to acknowledge and accept what you cannot control (thoughts, feelings, body sensations … whatever life throws at you) so that you do not waste your energy struggling with and judging your illness and your reactions to it.  Instead, you commit to take effective action in areas you can control – like how you want to be in the domains of your life that you value (e.g. relationships, health, and personal growth).

When you have a chronic illness, the aim of ACT is to create a life that is rich and meaningful around pain, illness and negative emotional states and thoughts - rather than a life free of pain/ illness/anxiety/depression/stress etc. Trying to be free of these symptoms is simply an unhelpful pursuit as, by definition, a chronic condition is one you need to learn to live with. Paradoxically, despite what many believe, acceptance actually leads to symptom reduction as we remove the overlay of the disabling distress that comes from the ‘I want this illness gone’ mindset.

Acceptance
The principle of “acceptance” is the most valuable concept for you to embrace on your journey with chronic Ill health. The Buddhist teacher, Shinzen Young, developed this formula to explain suffering. He said Suffering = Resistance x Pain. This is where the notion of acceptance comes in, as acceptance is the opposite of resistance. So, the more you resist and struggle with your illness, the greater the suffering you experience.

In ACT, acceptance does not mean you like your illness or have no negative thoughts or feelings about it. It means:  

• you stop struggling to get rid of it or control it (which is not a battle you can win with a chronic condition) 
•  you stop judging it or criticising yourself for having it (which only compounds your negative feelings)  
• you stop analysing why you have a flare up now (when there are often no answers) 
  

Instead, you acknowledge and make room for feelings like physical pain, or sadness about limitations, so that you can be the person you want to be around these feelings. You do not let your pain and illness hold you back from life-enhancing and meaningful actions. And you don’t let them stop you from being the person you aspire to be. 

Clean and Dirty Distress.
ACT makes a distinction between “clean distress” and “dirty distress” when dealing with the emotional and physical pain associated with chronic illness. The essence of “clean distress” is that you are just experiencing the pure distress in the present moment (“I’m sad, this is unpleasant”; “I am in pain”) without muddying the waters by adding in further negative thoughts like:

•  judgements (“I should be able to cope better”; “I shouldn’t feel upset”), or
• assumptions (“This is my fault”; “Other people cope better than I do”)
• or predictions (“I’ll never be able to cope with this”).

 “Dirty distress” also refers to additional feelings about your feelings (e.g. irritated about being sad - “I shouldn’t feel sad – I should just get on with it”).  Thus, feeling irritated about your sadness over how you can no longer do that favoured activity or eat that favoured food is “dirty” distress. Judging yourself for being sad would also be “dirty” distress, while the sadness itself is “clean” distress. 

Just to be clear, it is not about being a “stoic” and soldiering on regardless. For example, ignoring pain could mean you do not pace yourself which could also take you down a path of more pain.  You do still need to make time and space to acknowledge the emotional distress that goes with the physical pain or chronic condition.

So how do you do this? Studies have shown that writing about or talking out loud (even if it is to yourself) about upsetting situations reduces emotional distress. On the other hand, just thinking about it increases negative feelings.  Keeping a journal will assist you with expressing your emotions, particularly if you want an alternative to talking to loved ones about it. (When pain and illness is chronic, friends and family do have their limits on how much they want to hear about it). 

Clarify Values
In ACT we also help people clarify their values so they can take actions towards creating the life they want. One ACT exercise to assist with this is to picture your funeral and imagine what people from different areas of your life (friends, family, work) will remember about you and how you lived your life. If what you imagine is not what you would like, this may guide you in making some changes now while you still have time.

Some other questions to ask yourself which may also help with values clarification are:

• What do I want my life to be about? 
• If my health was to get significantly worse in 12 months time, what would I regret not having done?
• What is most important to me? 
• Are my choices and actions in line with what I value?
• How do I want to be with friends/family/community/myself despite the challenges of this chronic health condition?
• In this moment, if I were being the person I want to be, how would I act right now? 
• If my health wasn’t such a problem for me, then I would _____________________.

Think about if there is anything you value that you have put on hold because you are making your life all about coping with your health condition. Actions and choices that take you away from the direction of what you value will lead to greater suffering. Actions and choices in the direction of what you value will lead to vitality. 

Applying ACT to Flare-ups
Coping with some health conditions may also mean coming to terms with the fact that they are chronic, waxing and waning ailments. Flare-ups happen, and finding a reason for a flare-up can drive you crazy. Often there is no pattern or obvious trigger to explain a flare-up. Therefore, no way of predicting it, and accordingly, no way of controlling it. This can be very frustrating.

Rather than trying to look back over what you did or did not do to cause this flare-up, or planning for every way you might avoid it in the future, it is better to acknowledge that you are having a flare-up because you have a condition that flares up. It is what it is.

So how do you want to be in the face of this flare-up? Kind and gentle with yourself in the present. Allowing yourself some space to feel the sadness, anger, frustrations etc, before engaging with how you want to be in this next part of your day. Making choices in areas that you do have control over. Choices that will be in the direction of managing this flare up and your health as best you can. This may involve:   

• meditating and/or medicating to assist with discomfort
•  pacing what you do if your are in pain 
• reminding yourself that flare-ups pass 
• shifting your attention away from “why?” to other things (sounds, people, and activities) in your present environment
• you may even choose to set aside some time to acknowledge (and even write about) your feelings now or later

Writing thoughts down (just as they are, without arguing with them) is a key strategy from ACT as it strengthens the “observing part of you” who can step out of negative spirals of thoughts and feelings. While you can’t control whether you have negative thoughts and feelings, you can choose what to do next. You can choose to believe the thoughts (like “I can’t do anything” or “I am a failure”) or you can see them as just thoughts which come and go and may or may not be true.

ACT emphasises that it is best to be guided by what your experience tells you is doable, rather than what your thoughts tell you that you “should” be able to do. Therefore, give yourself permission to take small steps in the direction of meaningful activities if you are unable to do as much as you would like. Even if they are small steps, they are still in the direction of what is important to you.

In a nutshell
To summarise, ACT is all about accepting what you can’t control, and committing to doing what you can in spite of the pain, fatigue, limitations and other challenges that come with chronic health conditions.  You do this in order to create a life you value.

There are many theories about what causes OCD. However, the cause of OCD is not fully understood as multiple factors – both environmental and biological, may be involved. These include brain functioning (for example, certain brain circuits (that help you decide to ignore or turn off urges) are not functioning. Also lower levels of serotonin (chemicals in the brain that help send messages between the brain cells) have been found with OCD. This is why medications which increase amounts of Serotonin like SSRI’s help. 

There can also be an inherited predisposition to develop OCD which maybe triggered (not caused) by environmental stressors. While many sufferers of OCD report a gradual onset and cannot identify a trigger, a large proportion of clients report acute onset following a significant life event. For example, some report the onset or worsening of symptoms coincided with pregnancy or the post-partum period.

Even though the exact cause of OCD is not known, it is clear what maintains this condition – rituals and avoidance. Thus, therapy can teach the OCD sufferer ways of managing and reducing this chronic condition. For more information about the best treatments for OCD, see my article.

Recently I was scanning the local free weekly magazine during my lunch break. I usually go straight to the recipes and restaurant reviews as food is one of my passions.  But along the way, I am sometimes drawn to read a regular column which highlights a happy partnership - a romantic and/or business relationship between two people.  It may be a couple in love or two family members or friends who complement each other in their work together. 
 
Happy partnerships
Each is interviewed to tell the story of how they came together in the partnership and why it works so well personally and business wise. Often there is a love story in there as they share how they met and what they love and appreciate most about their partner. It is set up in the form of “She says” “He says”, with each partner giving their separate glowing account of their partner and their relationship.

Accentuate the positive
This reminded me of what I do in therapy with couples who are caught up in the negative and have lost touch with why they want to stay together.  I ask them to tell me the story of how they came to be together and what they like most about each other. It occurred to me that the magazine interview is a good format to do this as it encourages people to accentuate the positives in their relationship.  Clearly a relationship has negatives too, but when you are being interviewed for a magazine, you tend to overlook these, just as you do when you first fall in love. 

Rose coloured glasses?
Before you question the value of formulating a rose coloured version of your relationship, consider that the way our brain works. Neuroscientists acknowledge that our brains have a negativity bias, where we naturally notice and remember the negative. This has survival value – much safer to remember there was a sabre tooth tiger at the waterhole yesterday than a beautiful sunset.  

Be mindful of the positive
As the Neuropsychologist Rick Hanson says – “The mind is Velcro for the negative and Teflon for the positive”. Thus, we do need to actively choose to be mindful of the positive, as awareness of the negative comes without effort and sticks.   

Positive to negative ratios
Further support of this approach to life comes from recent studies in the field of positive psychology. Researchers have found that people who “flourish” in life are more attentive to pleasant versus unpleasant experiences, with a ratio of three to one. Those who “languish” have a ratio closer to one positive to one negative.

And also consider the research by one of the leading couple therapists in the world - John Gottman. He found that happy couples maintain interest and soothing during a conflict by having a ratio of five positive statements to one negative. They also use positive emotions to de-escalate conflict so they are calm enough to resolve the issue. So doing anything that makes you feel better and more able to access the positive will help when your relationship is not going so smoothly.

A soothing resource
This ”magazine interview” tool could be a resource for any couple to access and enrich their relationship. Consider taking some time to imagine what you would say about your partner if interviewed and even giving your partner a copy of your “interview”.  The one rule, aside from highlighting the positive, is that it must all be true and sincerely believed.

Written, spoken or imagined
Your “magazine interview” could be done formally and explicitly, so that each of you writes a short “essay” about what you would say if interviewed. You could then give it to your partner to read.  Or you could take some time to sit with each other and talk about what you might say if interviewed. This could become a regular connecting ritual where you may share what you have appreciated most about your partner/relationship over the past month.

 It could also be done more informally and on the go at times of irritation or after conflict when you are just wanting to shift into a more loving and positive mindset about your partner. So you could just imagine what you would say if being interviewed. You may never share this, but just use it yourself as a calming tool.

Experiment with it. You may be surprised at what you discover. See below for three examples  of these magazine interviews.

Established psychological treatments
When it comes to psychological treatment, research suggests the most effective treatment is some form of Cognitive Behaviour Therapy (CBT). This would usually involve Exposure and Response Prevention (ERP) which means the OCD sufferer is asked to repeatedly confront the triggers of their OCD behaviour and refrain from doing any neutralising rituals.

For example, someone who compulsively checks locks when they leave their house would be asked to leave the house and only check once. Someone who fears contamination and washes repeatedly would be asked to touch something dirty and not wash, and to allow the anxiety to go down with time. While this may initially cause considerable anxiety, OCD sufferers soon learn that the anxiety goes down even when they do not ritualise. By repeatedly doing the ERP, they will create new pathways in their brain and the urge to check or wash will decrease.
 
Cognitive Therapy
Because ERP is a challenging task, often seeming too scary to even contemplate, it is broken down into manageable steps, sometimes beginning with delaying the ritual, or changing it in some way, before being able to resist doing it all together. Cognitive Therapy (CT) is often used before ERP to help reduce any anxiety about doing ERP.
 
Cognitive therapy with obsessional thoughts differs from traditional CT with “negative thoughts” as  instead of questioning the evidence for and against the obsession, (eg “I might harm someone”) and  trying to convince  someone they would not harm anyone,  it challenges the thoughts about the obsession (eg, “Having these obsessions means I need to take precautions because it could happen"). Learning to step back and observe obsessions rather than argue with them or try to stop having them is key to managing them.  

Involving Family
Family members can get unwittingly caught up in the OCD. Attempts to help, while calming the OCD sufferer in the short term, may end up making it worse in the long run. Moreover, hostility from relatives toward the OCD sufferer can lead to a poor response to treatment. Thus, educating family members about OCD and how to assist with ERP is also very important. 
 
Newer psychological treatments
While CBT is a well established treatment for OCD, more recent developments in psychotherapy are also being trialled with some success. For example, Acceptance and Commitment Therapy (ACT) has been found to help with OCD. A new form of Cognitive Therapy, called Inference based Therapy (IBT) has also been effective with OCD.

IBT sees doubt as the basis of OCD. Persons with OCD may doubt their senses (“Even though I can see it is locked, is it really?“ ) and themselves (”Could I be someone who sexually abuses children?"). IBT helps the OCD client distinguish between “normal” doubt and “obsessional” doubt and understand how they have been confusing real probabilities with imagined possibilities.  

OCD is an anxiety disorder with symptoms of obsessions (intrusive and persisting upsetting thoughts, ideas, images or impulses) and compulsions (behaviours and rituals designed to undo the anxiety caused by the obsession). Sometimes the rituals are behaviours you can see (e.g. checking, ordering, washing, cleaning, counting, asking for reassurance) and sometimes they are mental rituals (like counting, repeating special words, numbers or phrases silently, praying).

At times the person with OCD will do these rituals on their own and try to hide them from you. At other times, they may try to involve your help (e.g. get you to do some checking too). The obsessions can be about anything and may include themes involving health, sexual behaviour and identity, safety, aggression and religion.

Common Examples
For example, someone may have the intrusive thought that they have germs on their hands, so they will feel compelled to wash their hands repetitively (sometimes a certain number of times, sometimes in a certain ritualised way).  This may take up a considerable amount of time as they do not rely on their senses to decide when to stop or start washing. Instead, they rely on whether they “feel contaminated” or “feel better” rather than any visible signs of contamination. The washing ritual will reduce their anxiety in the short term, but keep the OCD going in the long term as it reinforces the belief that the way to undo the obsessions is to wash in this way.

Vicious cylces
Thus, people with OCD get caught in vicious cycles of trying to reduce their anxiety by giving into obsessions with behaviours that only end up keeping their anxiety and obsessions going. Usually they are aware that the obsessions and compulsions are irrational or excessive, but they have not learned other ways of dealing with these distressing obsessions. This is why it is very important to seek some professional help with this very challenging and upsetting disorder.

Getting Help
People with OCD often have a lot of shame about their condition and so hide much of what they are doing and thinking from others and are reluctant to seek help. There are very effective treatments for OCD, particularly Cognitive Behaviour Therapy (CBT), and it is unlikely to get better without some intervention. In fact, while some obsessions or compulsions may reduce, they are often replaced by different obsessions or compulsions.

Getting treatment early is important as the longer OCD runs the  sufferer’ s life, the  more restricted their life can become as the OCD infiltrate’s more areas of their  life and leads to more avoidance of situations that are involved in the OCD system. Learning ways of gaining back control of your life so that the OCD does not control you is a big feature of therapy. For more information on treatment for OCD, see my article.

The Australian Guidelines for the Treatment of Adults with Acute Stress Disorder and Posttraumatic Stress Disorder (PTSD) recommend two therapies which have the best evidence. These are EMDR (Eye Movement Desensitization & Reprocessing) and trauma focused Cognitive Behaviour Therapy (CBT).


EMDR faster than CBT
While I am trained in both CBT and EMDR, when it comes to treating trauma, I prefer EMDR as it more rapidly resolves symptoms. Clients also prefer EMDR as it has no real homework attached to it. 

My preference for using EMDR has also been supported by a study that was recently published in the British Journal of Psychiatry. This study compared EMDR with a trauma based CBT to treat 140 patients diagnosed with Post Traumatic Stress Disorder. It found that while both therapies were effective, EMDR worked faster and had less people who drop out of therapy. You can read the full study here. 

EMDR better than Aropax
Another recent study compared EMDR with an antidepressant (Aropax) to treat male survivors of war trauma who had moderate to severe PTSD. This study was presented at the 2013 International Congress of the Royal College of Psychiatrists. It found that 90% of the patients treated with EMDR improved while only 36% of those treated with Aropax improved. More importantly, those treated with EMDR had a significantly greater reduction in symptoms and without the side effects of medication.

EMDR is Well Researched
When EMDR first came out (In the early 1990’s) there was a lot of scepticism about it as it seemed a bit weird (involving moving one’s eyes back and forth while recalling upsetting memories) and seemed to work much faster than other trauma therapies. This has meant that a great deal of research has been done to demonstrate its effectiveness.  For more information on EMDR research see this website 

Understanding, Coping skills and Safety First
Treatment of PTSD begins with understanding exactly how the trauma has affected a person as similar events can hold very different meanings to different people. Next, a range of coping skills (like relaxation strategies) are taught to assist with the high levels of distress that may occur while reprocessing traumatic memories and between sessions. 

Once the client feels safe, therapy would move on to working through the trauma and reprocessing it in an atmosphere of support so the client is able to process the traumatic memories and finally put them behind them.

Medication may also play a role in treatment, particularly if psychological therapy is not available, or the client has not benefited from therapy. Either way, if insomnia is a problem, this should be treated, as sleep deprivation aggravates the condition.

Feelings, Thoughts and Body sensations
Trauma has many components that need to be targeted in therapy. Along with intrusive traumatic memories and images, and high levels of emotional distress, people often have negative beliefs about themselves and strong bodily sensations.  Sometimes they cannot put into words what has happened so a therapy that involves more than just talking about it is needed. In fact, just talking about major traumas can make things worse as it may get the person in touch with painful emotions but does not help them process them at an emotional level.

EMDR
EMDR (Eye Movement Desensitization & Reprocessing) is one of the two evidenced- based therapies recommended in the Australian Guidelines for the Treatment of Adults with Acute Stress Disorder and Posttraumatic Stress Disorder. In addition, the World Health Organisation (WHO) recommends EMDR for treating trauma-related conditions in adults and children.

EMDR provides the therapist with a structure that guides the client through their trauma and helps them to reprocess what happened, learn from it and put it behind them. Read this article to see why I prefer EMDR over other treatments for trauma.