Day 16 since I cured myself from OCD. Feeling great and happy 😊 Good night sleep and no thoughts at all. Learned in my therapy how to turn off rumination. There is almost 9 inches of snow outdide. Excited to go out after I finish my coffee and breakfast. I wish everyone speedy recovery ⛷

How did you get yourself to stop ruminating? What are some examples of core fears?

@NOCD Advocate - Greg J. How to Stop Ruminating I’m in the process of writing a more thorough manual about how to stop ruminating, but I wanted to make a barebones version available in the meantime: Here is the basic exercise I use to teach people how to stop ruminating: Identify a problem that you usually ruminate about. Your job is to not try to solve that problem. Do not try to push it out of your mind or forget about it. Don’t actively try to keep it in mind either. It can be there or not be there; it doesn’t matter. Your only job is to not try to solve it. If you were able to do this: Awesome. This is what it means not to ruminate. It doesn’t mean you forget about the problem. It just means you stop trying to solve it. Since you’ve now shown yourself that you are able to stop ruminating, if there are times in the future when you feel like you can’t stop, it’ll probably be because you’re justifying it. Remember that you do know how to stop, and you just need to make a clear decision to do so. If you had trouble with this exercise, what follows is a list of the problems people most frequently encounter, and a brief explanation of what to do about each one. If you feel like you are working hard or feel anxious throughout the exercise, there is probably something wrong with your approach, and you should consult the list below: “It keeps popping into my mind.” That’s fine. It can pop in, or even just stay there. That’s not a problem. The problem is trying to solve it. If it pops in, just refrain from trying to solve it. “I was able to stop but it was really hard. I don’t know if I could keep this up all the time.” Sounds like you’re imagining that if you don’t hold it back, the rumination will come flooding in. It won’t. Rumination doesn’t happen to you; you do it. Think of this like stepping off of a treadmill, not holding back floodwaters. “I keep trying to think about other things but it’s still there.” You don’t need to actively try to distract yourself by thinking about other things. If I asked you to stop solving a math problem, you wouldn’t try to distract yourself; you would just stop. Do the same thing here. “I keep trying to stay present/mindful but my mind keeps wandering.” You don’t need to do mindfulness or be present. You can think about whatever you want, or let your mind wander. Your only job is not to solve the problem. If I asked you to stop solving a math problem, you wouldn’t need to do mindfulness; you would just stop. Do the same thing here. “I don’t know what to do instead.” Literally anything. You don’t need to do anything instead; your only job is not to solve this problem. If I asked you to stop solving a math problem, what would you do instead? Whatever you wanted. Just don’t solve the math problem. If I asked you to get off of a treadmill, what would you do instead? Whatever you wanted. “I keep thinking about how to stop solving it” or ”I keep worrying that I’m ruminating.” Stop trying to figure out how to stop. That’s rumination, too. If the thought occurs to you that you might be doing it wrong, treat that the same way as the original problem: don’t try to solve it. For further discussion, check out Ruminating about Ruminating. “I’m not solving it exactly but I can’t stop thinking about it anyway.” It sounds like you’re directing your attention toward it, like looking over your shoulder to see if it’s there. Try to stop doing this. If you notice it, that’s fine, but try to let go of actively monitoring it. “I’m not trying to figure it out exactly, but I can’t stop seeing disturbing images or scenes.” Except in very unusual circumstances, you can’t really visualize something clearly or for a long time without doing so on purpose. The most visualizing that can happen outside your control is a vague image occurring to you for a brief moment. You are probably visualizing these things on purpose in an effort to figure something out (e.g., by checking your response to the images). “I still felt uneasy (or any other way).” That’s okay, that doesn’t mean you’re ruminating. Don’t try to control your feelings. Control your thinking. “I got upset whenever it came back into my mind.” That makes sense, since this is a problem that upsets you. Being upset about this problem doesn’t mean you’re ruminating. In fact, you’ll probably be reminded of this problem often, and you may feel upset for a moment, or even longer; your job is to refrain from trying to solve it anyway. Don’t try to control your feelings. Control your thinking. These are the problems people have most frequently when learning how to stop ruminating. There are some additional problems that people frequently encounter when they try to eliminate rumination at all times. For help with these, check out I Know How to Stop Ruminating but I Can’t Seem to Stop All the Time.

@NOCD Advocate - Greg J. The Core Fear Understanding the Core Fear is foundational to effective treatment of OCD, and can unlock even the most baffling cases. Dr. Elna Yadin introduced the idea that each person with OCD has a ‘Core Fear,’ and that their avoidance and compulsions are aimed at preventing it. This idea is very powerful, because OCD symptoms can seem very random and nonsensical, but when you see them as strategies aimed at preventing the Core Fear, they suddenly make a lot of sense. According to Dr. Yadin, the most common Core Fears are ruining (causing irreversible damage), suffering, being bad in some way, and death.* Though I fully agree with Dr. Yadin’s idea that each person with OCD has a Core Fear, I have a somewhat different perspective on what that means. Avoided Emotion Based on my experience, I believe that the Core Fear is always a form of emotional suffering, and that even if a person endorses a concrete event as their worst fear, what they are really afraid of is some specific form of emotional suffering associated with that event. More specifically, they are afraid of doing something that would lead to being in that state of emotional suffering permanently. The specific type of emotional suffering that an individual most fears can be highly individual, and cannot always be captured in one word. It is typically a form of emotional suffering that they have experienced themselves or witnessed someone else experiencing. Some common examples are: Feeling judged, ashamed, or rejected Feeling disconnected, untethered, alone, or abandoned Feeling guilty or regretful Feeling hopeless, helpless, or trapped Feeling contaminated, uneasy, or ‘off’ Feeling inferior, not good enough, or like a disappointment Feeling how I felt when X happened, when I was abused, etc. When the person perceives something as a potential path to experiencing this form of emotional suffering permanently, they attempt to prevent this from happening, via either avoidance or compulsion. When for some reason they begin to experience this form of emotional suffering, they frantically try to escape it through the same means. To summarize what’s been said thus far about the Core Fear: Each person has only one. It is a specific form of emotional suffering. The person is afraid of experiencing this state of emotional suffering permanently. A person is triggered by anything that causes them to feel that form of emotional suffering in the present, or represents a potential avenue to experiencing that state of emotional suffering permanently, in the future. All forms of avoidance and compulsion are attempts to protect the person from experiencing this form of emotional suffering permanently. Why the Core Fear is Impossible Emotional states don’t last very long unless we are maintaining them by ruminating. Thus, once a person knows how to eliminate rumination, it is impossible for a certain emotional state to last forever. Why the Core Fear Seems Possible Protecting ourselves from any threat makes us feel threatened by it. In the case of an emotional threat, thinking (i.e., ruminating) about situations in which we might experience it can actually cause us to experience it. Furthermore, anytime someone with OCD feels a hint of the feared emotion, they do something to escape it. This has one of two outcomes: If it makes the feeling of threat go away, then it prevents them from learning that that feeling would pass on its own if they did nothing. In light of the above, one of the main ways that treatment works is by showing a person that if they don’t do anything to avoid or escape the feared emotion (including not ruminating) it passes on its own. Why is it so important to identify the Core Fear? In my experience, I have found that identifying the Core Fear, and figuring out how all forms of avoidance and compulsion are aimed at preventing it, makes ERP more precise, more effective, and faster. It is one factor that has radically reduced the number of sessions I need to treat someone with OCD. I believe that the main reason it’s so important to identify the Core Fear is that OCD treatment is about choosing to take risks, and you can’t choose to take a risk if you don’t know what the risk is that you’re taking. Here are several other reasons it is so important to identify the Core Fear: It helps the therapist and patient to develop a simple and accurate case formulation. It enhances the patient’s sense of agency by showing them that their symptoms are actually strategies that they are using to protect themselves, and that they could choose to let go. By identifying the goal of the avoidance and compulsions as avoiding emotional suffering, it allows the patient to assess that their strategies are backfiring by causing emotional suffering. Mapping out the causal connection between the trigger and the Core Fear underscores the unrealistic nature of the sequence of events that would have to go perfectly and irreversibly wrong in order to arrive at the Core Fear (not to mention that even then, the state of emotional suffering wouldn’t be permanent). Identifying the outcome that is expected to occur without compulsion/avoidance provides the opportunity to see that this outcome didn’t happen. (As discussed above, one important example of this is seeing that if you don’t do a compulsion or ruminate, a distressing feeling will pass on its own.) As stated above, identifying the Core Fear facilitates precise exposure exercises. For example, let’s say someone is a compulsive wiper. Is the Core Fear feeling ashamed forever? Feeling contaminated forever? Being distracted, making a terrible mistake, and feeling regretful forever? Each might indicate a different approach to the exposure. It allows you to catch subtle manifestations of avoidance and compulsion that might not have been identified as symptoms but are important to address as part of treatment (and also provide opportunities for exposure). For all of the above reasons, it helps cultivate the willingness to let go of avoidance and compulsion and to participate in ERP. So how do you identify the Core Fear? Below are the steps I use to identify the Core Fear with my patients. I am excited to share this worksheet with you. It will take you step-by-step through the questions that will help you to identify the Core Fear. Monitor: Trigger → Feared Outcome → Behavior (Avoidance or Compulsion) Review the monitoring and for each Feared Outcome, identify the worst possible personal consequence, and how the person would feel if that happened. Identify the feelings that all of these have in common. Ask the patient if they can connect that feeling to one or more painful early experiences. In addition to providing a sense of coherency to the patient’s experiences, this can also help to clarify the nature of the feeling. Go back to any symptoms that don’t seem to be connected to the hypothetical Core Fear and see if the patient can figure out how they might indeed be connected, or adjust the hypothetical Core Fear to fit them in. If you have the right Core Fear, everything will fit. The Core Fear should ring true to the patient. Consider asking the patient to monitor their symptoms again with the hypothetical Core Fear in mind, and to either confirm that the hypothesis fits, or bring in examples of symptoms that don’t seem to fit. Adjust or refine the hypothesized Core Fear as needed. Start ERP work based on your hypothesized Core Fear, but remain open to revising it in light of new information. In my experience, identifying the Core Fear has been a key factor in making ERP more precise, and consequently faster and more effective. I hope the above will help patients and therapists to gain a better understanding of OCD, and that this will lead to better treatment outcomes. *Personal communication **This also applies when the compulsion is rumination. You would want to know what the rumination is aimed at figuring out, what the person is afraid would happen if they didn’t figure that out immediately, and how that could lead to the Core Fear.

@snuggle Puggly Thank you! That makes sense! Just stop trying to solve it.

@NOCD Advocate - Greg J. That’s all . I wish you speedy recovery 👍

@snuggle Puggly Thank you! Can I ask how did it help you? How soon did it help?

Thank you! I will try not to solve anything and just let it sit there

@NOCD Advocate - Greg J. It will vanish on its own after a while You’re gonna have less thoughts Don’t solve anything

@snuggle Puggly My ocd involves me thinking I’ll make a threat against a school or somewhere else. So I should not bother trying to solve if it’s true?

@NOCD Advocate - Greg J. Nope, just sit and let your thought be there. You know is there but you’re not gonna mess with it or get involved. As soon as you start: analyzing, mental checking, monitoring,focusing your attention to it, trying to figure it out it becomes major problem.

@snuggle Puggly Okay got it thanks!

@snuggle Puggly Hey sorry for bothering you but say a thought about harm comes into my mind. Do I just say to myself “this is ocd I need to move on” and try to let it just be there correct?

@NOCD Advocate - Greg J. You re not bothering me at all. When that harm thought comes to your mind. You just say ok that’s all. Keep doing what you were doing.You’re all good. It’s normal and it’s not a problem. When you start analyzing, trying to figure it out, look for that thought then it is gonna get you into rumination and never ending cycle.

@snuggle Puggly Okay yeah like agree with it or just acknowledge it’s there

@NOCD Advocate - Greg J. Acnowledge thats all . It doesn’t mean anything its just a thought

@NOCD Advocate - Greg J. Your job is to not try to solve that problem. Do not try to push it out of your mind or forget about it. Don’t actively try to keep it in mind either. It can be there or not be there; it doesn’t matter. Your only job is to not try to solve it.

@snuggle Puggly Okay I think I got it. Thank you!

@NOCD Advocate - Greg J. I am gonna send you this doctor and articles you may find it helpful.

@snuggle Puggly https://drmichaeljgreenberg.com/articles/