OCD Newsletter - Intrusive Thoughts - November 2024
INTRUSIVETHOUGHTS
A NEWSLETTER FROM THE DEPARTMENT OF PSYCHIATRY'S OCD CARE TEAM
REFLECTIONS ON RUPTURE AND REPAIR
I like wrapping gifts haphazardly with the tape at random angles and the paper folded in off-kilter ways. When I present these gifts that look like a 5year-old wrapped them, I am aspiring to both accept and communicate that I cannot produce a perfectly wrapped gift. In the past, I tried to wrap things like I saw it done in stores or online. When that was my goal, I used to worry that my efforts to create a nicely wrapped gift would be laughable and embarrassing. I would worry that it seemed like I didn't care enough to make sure it looked beautiful or that I was somehow inadequate. When I leaned into preparing and giving gifts in insanely messy wrappings, I still had those fears and in fact they intensified. What I found, however, was that those who received my childishly bundled offerings often laughed with joy. They delighted in the unexpected silliness of the gift getting experience and we playfully connected because of it.
We are told that the actual act of giving and receiving gifts is supposed to be a joyous interchange. Often though, it can fall short of expectations or bring us disappointments and hurts that run much deeper than the actual process of gift giving. When we consider how the people we care about have let us down or think about ways we wish we had been a better friend, a better family member or colleague, it’s hard not to get stuck in anger, hurt, disappointment, self-doubt or self-blame. Expectations that we should be having joyful, satisfying, or even tolerable connections with loved ones over the holidays can make these feelings even more difficult. If what has happened in our relationships involves pain, conflict, separation, or distance (or all of these and more!), we can be drawn into an exclusive focus on what is NOT working, what is missing, and what has been lost.
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Sometimes the opportunities that arise from disruption come out of someone’s efforts to stay in relationship, to articulate difficult feelings, or to express the need for something different from the other person. These are scary things to do - we risk rejection or disappointment. I have found, however, that taking those risks often can lead to more depth and more understanding within the relationship. The idea of a deeper connection coming out of ruptured relationships resonates strongly with me. It’s not intuitive, but it nonetheless makes sense—relationships can be more meaningful after they’ve traveled through anger, disappointment, forgiveness and negotiation.
Years ago, as a social work student, I was struck by the body of research on interactions between infants and their mothers. Pairs of babies and mothers were each videotaped while they interacted and the close-ups of each of their faces were shown side by side so that their interactions could be analyzed moment to moment. These micro-analyses of infants and mothers interacting were coded for mirroring—moments when they matched gazes and vocalizations; they also were coded in relation to the times when the mother/infant interactions or rhythms were “off.” For example, sometimes the mother’s attempts to engage her baby were too intense and stimulating, so the baby needed to look away to lower his heart rate and calm himself. Some mothers were sensitive to this and would effectively wait until the baby was ready to be re-engaged before talking or trying to catch the child’s attention again.
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One of the key findings was that it was not the amount of perfect matching or coordination in gaze or vocalizations between mother and baby that predicted healthy attachment. It was the ability of the dyad to repair when there was a disruption or mismatch—to find some degree of attunement again after being misaligned—that predicted which pairs would demonstrate healthy attachment a year later. So, repair after rupture is where it is at! The baby gave the mother who messed up—who missed his cues or kept engaging when he was overwhelmed—another chance; he gave her the gift of forgiveness. And so, they tried again and if she could find a way to interact that was a closer match to his needs, they repaired and that led to healthy attachment. It’s a story of connection growing out of falling short.
And THANK GOODNESS that good parenting is determined not by getting it right the first time or even the 5th time, but by being able to repair after messing up! As a parent I have needed to remind myself of that daily. It is so easy to swim in the doubt of parenthood as well as in the uncertainty of being a good-enough daughter. But the gift of being forgiven or of finding that the other person is willing to give it another chance —that—I find powerful as an idea and as an experience. I am working on bringing into focus the ways in which repair from mismatches, missteps and experiences of failure can bring new connections. The combination of imperfection and forgiveness is the gift. It is the vehicle for seeing more, feeling more, and creating growth together.
Leonard Cohen, I believe, says some of this in a much more succinct way:
Ring the bells that still can ring
Forget your perfect offering
There is a crack in everything
That’s how the light gets in.
Sincerely,
Orah Fireman
GROUP OFFERINGS OUR TEAM
Dr. Rachel Davis MD - Medical Director and Psychiatrist
Emily Hemendinger LCSW, MPH, CPH, ACS – Clinical Director/Licensed Clinical Social Worker and DBS Coordinator
Dr Stephanie Lehto PsyD – OCD Therapist/Licensed Psychologist
Kasey Benedict LCSW -OCD Therapist/Licensed Clinical Social Worker
Dr Jake Gadbaw MD - Psychiatrist
Katie Sinsko MSW, SWC -- Social Work Fellow/IOP Therapist
Orah Fireman, LCSW, MEd -- IOP Behavioral Health Specialist/Licensed Clinical Social Worker
Erin LeBeau MSW --IOP Therapist/OP Therapist
Cate Rush MSW --OCD Therapist/Social Work Fellow
Jennifer Quigley PA-C --Prescriber, Physician Assistant
Jake Winchester LPC --OCD Therapist
Ambey Clark -- MSW candidate/Social Work Intern/OCD Therapist
Kensie Funsch -- MSW candidate/Social Work Intern/OCD Therapist
Jen Fishman -- Research Assistant
Interested in contributing to the newsletter? Email the editor at Emily Hemendinger@CUAnschutz edu
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Starting in January 2025: Mondays at 6pm For adults ages 18+ with OCD and related disorders
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For adults ages 18+ with OCD and related disorders
We do have a waitlist for individual and group therapy, please reach out to be added to our waitlist and/or send you other referrals.
Are you a clinician who wants to know more about OCD and ERP? We offer trainings, consultations, and supervisions!
STAFF SPOTLIGHT: ORAH FIREMAN
Orah Fireman, M Ed , LCSW is a Behavioral Health Specialist and Senior Instructor in the OCD Intensive Outpatient Program at the University of Colorado’s Anschutz Medical Campus. She is also Adjunct Faculty at the University of Denver’s Graduate School of Social Work. Orah has a Masters in Education in Risk and Resilience from Harvard University and a Masters in Social Work from Hunter College. She has conducted clinical work in a variety of settings in her 20+ years as a licensed clinical social worker. Orah has worked in community-based mental health, helped direct a therapeutic mentoring program for young people who have faced adversity, and counseled caregivers whose loved ones were going through cancer treatment Orah is committed to honoring and augmenting the strengths within individuals while utilizing evidence-based treatments in her clinical work She is originally (and always) a New Yorker but has lived in and loved Colorado for over 20 years
Bringing ERP into the holidays
By Katie Sinsko
Regardless of what comes up for us during the holidays, whether that’s stressful interpersonal/family dynamics, eating disorder triggers, depression, anxiety, grief, or loneliness, the holidays can sometimes bring stress and frustration to this time of year. These experiences can contribute to a guilt-shame cycle as well, which often makes us compare ourselves to how we feel we “should” be doing and feelingversus how we think we’re actually doing through these experiences.
Considering this, it becomes particularly important to evaluate ways to bring selfcompassion and humor to these experiences during these times. One potential way to practice taking care of ourselves during the holidays is to play an Exposure Bingo! The purpose in playing this is to relate to the common humanity of challenges during the holidays and potentially learn some boundary-setting/self-advocacy skills as well!
Step out of the room and refocus on self when needed
ERP Bingo!
Practice saying no – or set a relational boundary with someone
Ask friends/ peers to spend time together
Practice nonengagement responses if someone makes comments related to food/ portion sizes
Bingo space!
State a preference directly
Ask for a need to be met
Sit with discomfort for 5 minutes
Plan a self-care activity (for after stressful events, or on a day when you’re needing it)
ELECTION STRESS AND MORAL SCRUPULOSITY
By Erin LeBeau
Election season is a particularly stressful time for most Americans, which can lead to something psychologists have coined, “political anxiety” or “election stress”. This phenomenon is characterized by an inundation of political defensive and offensive strategies causing burnout, apathy, and disengagement. Driving factors of “political anxiety” include but are not limited to assassination attempts, political campaigns, hateful and fear-mongering messaging in the media, and discussions with family/ friends. According to an article by the New York Times, 68% of American adults reported that the election in 2020 caused significant distress and angst related to the choice between the two candidates.
This election cycle is no different; folks are experiencing similar fear, anger, bitterness and distress in 2024 that they had in 2016 when the phenomenon first emerged. Uncertainty is ultimately the underlying driver of “election stress”. You may wonder to yourself, “What is going to happen if ____ becomes the POTUS?” For those of us that are prone to anxious, obsessive, or catastrophic thinking, the answer may be distressing, uncomfortable, or worst-case scenario. While these thoughts may seem to be a reality, it is important to understand that our brains are projecting the future without having certainty. Are there real-life effects of elections? Of course! The goal is not to ignore the possibility of disaster, but rather to refocus on our values despite the fear or angst.
Perhaps those that are at the highest risk of suffering from “election stress” are folks with moral scrupulosity OCD. Last year, NOCD officially labeled “Social Justice OCD” as one subtype that may be at an all-time high right now. This subtype of OCD is highly concerned with doing the “right” thing, not saying the “wrong” thing, characterized by a fear of being “canceled”.
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While “cancel culture” is something we see in pop culture directed at celebrities, people with Social Justice OCD may be overly fearful of being doxed by friends, family, and people in their social circles.
So, how do we take care of ourselves this November despite feeling immense dread and uncertainty?
Take a step back. Oftentimes, we find ourselves in heated conversations with family, friends, or coworkers about contentious topics. Remind yourself that it is okay to walk away from the conversation. Walking away does not mean that you don’t care, or you are “faking it”, it simply means that you are prioritizing your mental health and interpersonal relationships in that moment. Try response prevention using nonengagement statements.
If your thoughts are telling you that you are a “bad person” for not posting something on social media, donating to a campaign, or engaging in a political debate, challenge this thought without checking or reassurance-seeking. Go for a walk. Walking serves multiple purposes including improved mood, grounding, and decreases cortisol levels. Finally, limit news apps or social media usage.
We are inundated with media about our current political climate. “Doom-scrolling” can be mitigated using tools that smartphones have built into their settings. By putting a limit on the amount of time you are allowing yourself to google, research, and read about politics, you are giving yourself a built-in break.
Lastly, it is important to reiterate that the purpose of this piece is not to encourage ignoring the very real and pressing threats to social justice in our country and abroad. The message is to practice changing your relationship to the content and take care of yourself in a way that allows you to engage in politics in a way that feels authentic to you and what you believe.
NAVIGATING DIET CULTURE OVER THE HOLIDAYS
By Stephanie Lehto
“Hey, see if they’ve got any pie. Bring me some pie! I love me some pie.” -Dean Winchester, Supernatural
We are once again at that time of year again, the leaves are changing, the snow will (maybe) start to fall, and the temperatures will drop. It’s also that time of year when we are faced with friends, family, and foods we see once a year. If you’re having thoughts of: “what will they think,” “what will they say,” and “how will I ‘make up’ for eating (insert food here)?” you are not alone.
This is the time of year where we can choose to think about what is normalized for eating during the holidays, doing the next best thing, and flexibility.
You may have some internalized beliefs about what you “should” and “should not” eat, what is “good” or “bad” and this is a reminder that all foods fit in moderation. The diet industry may be trying to convince us that we need to lose weight, eat less, and have meal replacements especially when we have photographs and family time coming up, and this is a great opportunity to challenge these messages and eat and dress in ways that are in line with your values. You are allowed to enjoy tasty treats.
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Food is food is food is food (practice food neutrality)
Movement is meant to be enjoyed, not compensatory or compulsive
Boundaries are important to set AND reinforce
Sometimes removing yourself from a situation is an adaptive thing
Some challenges are worth it (maybe eat the dessert?)
Self-compassion is like a spatula, you probably need it
At the end of the day, you are enough, no matter what did or did not happen
Here are some tips for navigating diet talk:
Set boundaries in advance
State your needs/emotions or reinforce your boundaries
Change the subject in the moment
End the conversation or remove yourself from the situation
Use your support system
Practice self-compassion and compassion for others
Think about the function behind dieting and diet talk and ask yourself: is this something that will help you or harm you
Holidays can be fun—we hope you’re able to think ahead (not to much, no mental preparation!) and care for yourselves this season!
BOUNDARIES DURING THE HOLIDAYS
By Cate Rush
As someone who formerly identified as a people-pleaser, I was not a fan of setting boundaries. I thought that setting boundaries meant letting others down and acting out of my own selfish interests. Setting boundaries was scary and not something I ever wanted to do. If I directly communicated my own needs, did that mean I was automatically discounting the needs of others?
The thing about boundaries is that they’re not selfish. In fact, they’re the opposite of selfish. Setting boundaries is a way to care for yourself and for others. Here’s an example: let’s say you have a friend who constantly talks about X, and for whatever reason, it makes you really uncomfortable. Imagine you go on letting them talk about it, and you never set a boundary that you’d rather not talk about that topic. You may become so frustrated with this person that you become resentful, and as a result, you distance yourself from them. Now, your friendship is not as strong as it once was. However, if you set a boundary and say “I love and care about you, but I’m not comfortable talking about X. When we’re together I’d like to talk about other things”, you are effectively practicing honest communication, and in turn, strengthening your relationship.
If you’re anything like I was, you’re probably scared to set that boundary out of fear that the person will be mad at you. Here’s one key tip to keep in mind: you cannot control how others will respond to the boundaries you set. As we head into the holiday season, family, relationship, work and other dynamics are likely to come up.
Here’s a few simple tips on how to set effective boundaries: Consider you goal: what are you hoping to achieve by setting the boundary?
Be clear- communicate your needs clearly and directly. Use “I” statements: Say exactly what it is that you need and try not to anticipate how the other person will respond. Communicate without placing blame on the other person.
Practice!: Consider practicing writing out what you’re going to say or practicing sharing your boundary with someone you trust.
By Heather Moeller
EXPOSUREPALOOZA 2024
The CU Anschutz OCD Program's team successfully orchestrated the second EXPOSUREPALOOZA event on October 13, 2024. This year the event had a record-breaking 124 people in attendance!
Through carnival games and mini exposures, community members were challenged to lean into discomfort and anxiety. Some fan favorite games returned, including the “bad fortune telling/ magical thinking” booth, which saw participants receiving a “bad” tarot card reading and/or taking a fortune cookie that had a “bad” fortune in it. This exposure challenges the magical thinking, we often see in OCD and can make even those without OCD uncomfortable.
The second annual EXPOSUREPALOOZA exceeded expectations not only as an educational community event but also as a celebration of hope, creativity and the collective strength.
EXPOSUREPALOOZA raised $6500 in support of the OCD program and we are looking forward to even bigger and better future events!
