Cindy’s Story

Anxiety. Seems like a simple word, but if you experience it, you know it’s far from simple and can be quite massive in its impact. In hopes of encouraging and promoting talking about our experiences with mental wellness, I’ve decided to share some of my journey.

In my case, anxiety emerged as the first and most significant internal protector I can recall. It stood amidst the dangers, uncertainties, and pervasive sense of unsafety that marked my childhood. The constant need to anticipate and navigate potential threats shaped anxiety as a shield in those formative years.

As an adult, I've came to realize that these protective measures, once essential, now hinder my growth and connection and I had to learn that even though I said I wanted my anxiety to leave, this may not have been the complete truth. The grip of perfectionism, constant worry, compulsions, obsessions, irritation, unyielding planning and need for control has strained relationships and caused tons of emotional dysregulation. The emotional dysregulation has also been accompanied by my body’s experience of anxiety, that has included but not limited to, migraines, fatigue, sleep disturbance, pain in neck and shoulders, knots in my back and poor gut health. However, amidst the chaos, I've unearthed what appeared to be silver linings. My organizational prowess, acute planning abilities, extreme levels of multitasking and achievements, and highly empathetic nature towards others' concerns emerged as unexpected superpowers. These superpowers brought me praise and awe from others, and in turn a sense of pride in myself. But what had to be understood was that these “silver linings” were all experienced with high levels of anxiety such as a fear of failure, not being good enough or being seen as not caring.

I came to realize; it was crucial to examine the superpowers and what this meant to me on a deeper level. Despite the chaos it brings, people often marvel at my ability to juggle numerous responsibilities and achieve success. This underscores the reality that not all aspects of anxiety are perceived negative, making the release of it that much harder. Instead of criticizing myself for my daily experiences, it was essential to make peace with the idea that anxiety was essential to survival as a child and I continued to see it as necessary and helpful as an adult, until I began to learn new resources and skills.

Along my journey, I have learned that these “unexpected superpowers” are what I feared I would lose if I completely released anxiety. Upon this realization, I recognized that I no longer saw anxiety as something that I experienced, but something that I believed I needed to be seen as special or exceptional. This idea had to shift. This process requires continuous effort, a daily commitment to self-understanding, grace, and courage amidst the challenges.

Navigating the labyrinth of anxiety led me through a myriad of coping strategies from psychotropic medications, affirmations, various cognitive strategies, somatic exercises, microdosing to mindfulness practices. Each avenue contributed to my holistic well-being. The real breakthrough, however; came from truly slowing down and listening to what nurtures my soul. Therapy, immersion in nature, walking, music, reading, laughter, and silence are my current anchors in a passing storm.

Through this journey, I've learned that anxiety isn't my true self, but rather a protective part. Some days, it's absent or a quiet whisper; other days, a thunderous roar. It's in those moments of struggle I give comfort to the child within and grace to my adult self, and yes, apologies are still needed if and when my anxiety still reaches others in a negative fashion. Anxiety, while a formidable force, has taught me empathy, and the importance of self-care in a world constantly in motion. At times, its overwhelming presence triggers deep sadness and intense fear, reminding me of its pervasive nature. Self-doubt, inner critics, and imposter syndrome are familiar companions and all facets of the intricate tapestry that is anxiety.

I also want to emphasize that I no longer see my anxiety as inherently good or bad. I have learned and began to believe that it doesn't have to remain a constant for me to feel safe, organized, motivated, or to possess any of the superpowers I've mentioned. The most amazing part is that there is an empowering, focused, fun, and free life that also exists devoid of anxiety and at times, alongside it.  My hope for myself and everyone else is that we can continue to lean into these anxiety-free moments, but also not shame ourselves for the moments that may be sprinkled with anxiety. The truth is that by trusting ourselves instead of trusting anxiety, we can experience more regulation, peace, and fulfillment. For me, embracing the idea of being anxiety-free means that this part no longer needs to control me.

We have the power to shape our narrative and live authentically. As Glennon Doyle says, “We Can Do Hard Things.”

Options for Treating OCD

The treatment options for OCD are similar to those for the treatment of generalized anxiety. There are some key differences that I will explain and expand upon below. Unlike generalized anxiety which can ebb and flow based on situational stressors, OCD is lifelong. The goal in treating OCD is maintenance of the symptoms predicated on self-awareness, effective treatment, supportive relationships and, in most cases, medication management.

1. Medication management. Medication management is generally recommended in the treatment of OCD to address the interaction of glutamate and GABA. Glutamate is the major excitatory neurotransmitter, which contributes to brain development and plays a central role in circuits consistently implicated in OCD, including direct driving influences on serotonergic dorsal raphe neurons related to anxiety and tic behaviours. Selective Serotonin Reuptake Inhibitors (SSRIs) remain the leading medication used in treating OCD. Other medications can be added to address sleep disturbance and break through anxiety.

2. Individual therapy. While CBT is used in the treatment of OCD, it is not a stand alone treatment modality. Most notably because many people with OCD realize that their thinking is irrational or a problem. They can tell you the rational thought and reframe their thinking. They are unable to forego the adherence to the rule set or the compulsion. Completing the OCD chain becomes the mechanism that sustains the disorder. For this reason, treatment really needs to address interrupting the chain and increasing the individual’s ability to tolerate distress and identify alternatives. Foregoing the compulsive behavior and violating the internalized rule is usually more anxiety induing than the triggering event or thought. Individuals with OCD also benefit from understanding their condition and learning how to identify when they are adhering to a rigid rule. Exposure therapy also known as systematic desensitization may be used in helping the individual coexist with the anxious trigger (i.e. germs, incomplete homework or upsetting another person) and learning to tolerate the anxiety without engaging in a compulsive behavior.

3. Family therapy/couples therapy. This is often a necessary step in treating the disorder. When a family member suffers from OCD, the entire family system is impacted. Other family members, while well-intentioned, may aid the person in completing the OCD chain to reduce distress for the system. For example, a child who insists on getting all A’s and will not sleep until all of their study guide is completed and they have studied for 3 hours, may try to recruit a parent in helping them to study or complete the study guide. Without proper diagnosis and education, family members frequently aid in completing and growing OCD chains.

4. Nutrition. I bet you didn’t know that foods and vitamins can assist in reducing anxiety. Most people know that drinking too much alcohol or caffeine can increase anxious distress, but did you know that eating nuts like almonds and cashews can calm anxiety because they are high in magnesium, healthy fats and Vitamin E. Other recommended foods include salmon, yogurt, dark chocolate, green tea, turmeric, chamomile, eggs and blueberries. Working with a skilled nutritionist or naturopath may be an effective option for treating both long-term and situational anxiety.

5. Exercise. In a prior newsletter, I discussed the benefit of exercise for overall mental health. Not only does movement help to regulate our nervous systems, exercise boosts the release of neurotransmitters, which over time can take the effect of a natural anti-depressant. Light movement such as rocking, swimming, pacing and walking are also highly effective at calming anxious distress. This is why it is instinct for us to rock a crying baby.

6. Genetic testing. The GeneSight Psychotropic test analyzes how your genes may affect your outcomes with medications commonly prescribed to treat depression, anxiety, ADHD, and other mental health conditions. The GeneSight Psychotropic test provides your clinician with information about which medications may require dose adjustments, may be less likely to work for you or may have an increased risk of side effects based on your genetic makeup. The GeneSight test additionally looks for genetic mutations in the brain that may cause mental health conditions like anxiety and may benefit from supplementation.

7. Supplementation. This is used when an individual has a gene mutation with the MTHFR gene (short for methylenetetrahydrofolate reductase variant). MTHFR serves a critical purpose: the production of the MTHFR enzyme. The body has a number of raw materials that must be processed into a new form before they can be used by the body. Folate (Vitamin B9) is one of these raw materials and the MTHFR enzyme is the body’s tool to process it. In perfect circumstances, the MTHFR enzyme transforms folate into an ingredient the body can use – methylfolate. Methylfolate is a crucial element in our biology responsible for building the ingredients that determine how good we feel. It enables our bodies to convert the amino acid homocysteine into another amino acid, methionine. 4 

   Methionine is used to make brain chemicals essential for a number of aspects of our mental health—these include the neurotransmitters serotonin, dopamine, and norepinephrine. The good news is that this gene mutation can be augmented by taking methylfolate.

8. Sleep. Anxiety is frequently connected to sleeping problems. Excess worry and fear make it harder to fall asleep and stay asleep through the night. Sleep deprivation can worsen anxiety, spurring a negative cycle involving insomnia and anxiety disorders. Simply put, it is not unusual for sleep to become a trigger for anxiety in anxious patients. A sleep stabilization plan is highly recommended in this case and can involve taking medications, setting a bed-time, reducing blue lights, only using your bed for sleep, consuming sleepy time tea, listening to soothing sounds or a guided meditation.

9. Brain training. Neurofeedback aims to decrease anxiety symptoms by teaching people to change their brain wave patterns. Many patients with anxiety have elevated levels of fast beta waves, which can contribute to feelings of fear, insecurity, and panic. Neurofeedback can help reduce these beta waves, while promoting alpha waves associated with relaxation and meditation.

10. Mindfulness. According to Mindful.org, Mindfulness helps you learn to stay with difficult feelings without analyzing, suppressing, or encouraging them. When you allow yourself to feel and acknowledge your worries, irritations, painful memories, and other difficult thoughts and emotions, this often helps them dissipate. Mindfulness also allows you to safely explore the underlying causes of your stress and worry. By going with what’s happening rather than expending energy fighting or turning away from it, you create the opportunity to gain insight into what’s driving your concerns. Finally, Mindfulness helps you create space around your worries so they don’t consume you. When you begin to understand the underlying causes of your apprehension, freedom and a sense of spaciousness naturally emerge.

Recap of Topic: Options for Treating OCD

If you suspect that you or a loved one is suffering from OCD, proper diagnosis is critical. Without this, OCD may be labeled as an anxiety disorder. While CBT strategies are helpful in treating both OCD and generalized anxiety, OCD requires the extinction of the chain. It is the completion of the compulsive behavior that sustains and grows this disorder. Some widely used and recommended options for treating OCD include medication management, individual counseling, family counseling, diet, exercise, genetic testing, supplementation, sleep, brain training and mindfulness.

Supporting a Loved One with OCD

Living with someone who has OCD will cause you to question your reality and behavior. My oldest daughter has struggled with anxiety since birth. Yes, I mean since birth. She displayed minimal frustration tolerance, was frequently emotional and cranky, shy around others, and feared separation, to name a few of her behaviors. As she got older, she was able to speak to her anxiety better and explain her fears of hurting another’s feelings or performing poorly in school. She was maintaining with mild to moderate symptoms until COVID. When COVID hit, she stayed home for almost a year and a half. The stress of doing school from home, losing her routine and peer group and losing her sense of safety and normalcy pushed her over the edge. Her mild to moderate symptoms went to moderate to severe. It was when she stopped sleeping that I finally took her to see a psychiatric nurse practitioner. She was immediately diagnosed with OCD. Once those words were said, I felt relief and shame. I knew we had been approaching her incorrectly and supporting her OCD chains. For this reason, I stress the importance of a proper diagnosis if you suspect that you or a loved one are suffering from OCD. OCD can and does coexist with generalized anxiety. Below are suggestions for supporting a loved one suffering from OCD.

1. Co-regulate. Mindfulness, exercise and sensory based coping strategies can be used with your loved one to create a calm state of mind. Examples of sensory based coping skills include going for a walk, giving a massage or taking a bath or shower together. Parents and partners can use this technique to attune to their loved ones dysregulation. I used coregulation with my daughter for many years. While she would not choose a relaxed state on her own, I could hold her, cuddle with her, take a bath with her or lay on her. All of these techniques eventually worked to bring down her anxiety so that she was able to engage in a conversation about her experience. Once regulated, she was usually able to resume her other activities within 10 minutes.

2. Understand OCD. Even as a therapist, I did not have all the answers. When I reflect on the onset of her OCD, I can see numerous OCD chains that I assisted in completing. I frequently reassured her and told her that she was okay before realizing that she was engaging in a compulsive behavior to seek reassurance. To be clear, her behavior was well beyond the range of what we would consider normal as she would seek reassurance and offer apologies up to 50 times in a day. Knowing what you are looking at, developing language to talk about it and identifying ways to interrupt the OCD chain are essential tasks for caregivers and loved ones. Natasha Daniels has an amazing YouTube channel that I recommend to my clients and caregivers.

3. Advocate and encourage. Someone suffering from OCD, will receive messages both internally and externally that they are deficient and inadequate. You cannot prevent this. Advocating for your child by talking to their doctors and teachers may be necessary as their parent to ensure that the child receives the support he or she needs. Recognizing when your loved one is in need of encouragement is also critical as they will be down on themselves when their symptoms are hard to manage.

4. Don’t over-function or avoid. It will be tempting to fall into this behavioral pattern when living with someone with OCD. Individuals with OCD live their lives constantly adhering to their internal rules. The dysregulation that is created within the individual and the family system can range from mild to severe. My daughter has had anxiety spirals that have lasted for hours. It was very tempting to either complete the anxiety chain or collude in preventing the stressor from occurring so that the fall out did not occur. If you find yourself in this situation with your loved one, I highly encourage you to seek family counseling.

5. Create a calm environment. Individuals with anxiety frequently suffer sensory overwhelm. If you remember that their baseline anxiety is higher than yours, then it makes sense as to how smaller irritants (i.e. a dirty kitchen, a crying child, or a loud television) can stack up fast. Be mindful and respectful of their preferred environmental preferences, when possible.

6. Respect boundaries but create accountability. People suffering from anxiety will reach critical mass sooner than someone who does not experience anxiety. They will be more dysregulated by conflict or overwhelm and may need to call a time out to come back down. As their loved one, it is your job to respect when a time out is called and ask for a reasonable time frame to readdress an issue or topic of conversation.

7. Develop language to discuss OCD. The development of shared language to discuss when compulsive behavior is happening and how to pivot is incredibly helpful for both parent and child. I recently told my daughter, “What you are doing right now is an example of your compulsion to seek reassurance. This is why you are asking over and over. While this is uncomfortable, if you can accept that is all that is happening then you can choose to not be ruled by it.” I saw her think for a moment, look confused and anxious and then relax her shoulders and rest.

8. Monitor for self-harm. Self-harm in the form of eating disorders, restrictive eating, hitting or slapping one self and cutting are all symptoms consistent with OCD. This makes sense if you consider that the compulsive behavior is the act of self-harm and the individual feels the need to adhere to the compulsive behavior otherwise they experience marked distress. If you suspect that a loved one is suffering from self-harm, I encourage you to seek help immediately. As a parent, you will also need to create clear boundaries and expectations around self-injury. This may lead to hospitalization, partial residential treatment or residential treatment. I encourage a behavior contract clearing explains the rules and consequences associated with continuing to engage in self-harm. As part of this contract, you can also incentivize the use of positive or healthy coping strategies.

Recap of Topic: Supporting a Loved One with OCD

When a member of the family has OCD, the entire family will suffer from OCD. Accepting this as truth and learning how to recognize the compulsive behavior and alter OCD chains is equally the work of the individual and other family members. Breaking OCD is largely counter-intuitive. For this reason, I encourage family’s to seek counseling from someone experienced in treating OCD to learn how to address this disorder as a team. Other ways to support someone with OCD include, but are not limited to, co-regulating, understanding OCD, advocating and encouraging, monitoring for over-functioning, creating a calm environment, respecting boundaries, developing language and monitoring for self-harm.

^{Recommended Product of the Week}

This week’s recommended product(s) is the Breaking Free of Child Anxiety and OCD: A Scientifically Proven Program for Parents. In this book written by Eli Lebowitz, parents will learn how to alleviate their children's anxiety by changing the way they themselves respond to their children's symptoms - importantly, parents are not required to impose changes on their children's behavior. Instead, parents are shown how to replace their own accommodating behaviors (which allow anxiety to flourish) with supportive responses that demonstrate both acceptance of children's difficulties and confidence in their ability to cope.