Introduction 1 About This Book 2 Foolish Assumptions 2 Icons Used in This Book 3 Beyond the Book 3 Where to Go from Here 3 Part 1: The Ins and Outs of Ocd 5 Chapter 1: Facing Obsessive-Compulsive Disorder (OCD) 7 What Is OCD? 8 Suffering shame 9 Wrestling with risk 9 Dealing with doubt 10 Counting the Costs of OCD 10 OCD and the Media 11 Pandemic panic 11 Disgusting filth 12 Exploring Treatment Options for OCD 13 Changing the way you think with CBT 14 Thinking about thinking: Metacognitive therapy 14 Approaching OCD mindfully 15 Modifying behavior through ERP 15 Controlling OCD with medications 16 Sending signals deep into the brain 17 Helping People with OCD 17 Chapter 2: Understanding What OCD Is All About 19 Seeing the Two Sides of OCD 20 Obsessing about obsessions 20 Considering compulsions 22 Coming to Terms with OCD 24 The OCD worry cycle 24 Thinking and believing 26 Inspecting impulses 27 Categorizing the Types of OCD 28 Doubts, fears, and uncertainties 29 Contamination, germs, and dirt 30 Shame, embarrassment, and inappropriate thoughts and behaviors 31 Superstitions and rituals 34 Symmetry and perfectionism 34 Parenting OCD 35 Obsessive feelings and sensations 36 Separating OCD from Normal Worries 38 OCD and Diversity 39 Getting to a Diagnosis of OCD 40 Avoiding self-diagnosis 41 Avoiding misdiagnosis 41 Chapter 3: Meeting The Associates and Relatives of OCD 43 Recognizing the Guests or Associates of OCD 44 When anxiety and OCD hang out together 44 Moods and OCD 45 Meeting the Close Relatives of OCD 45 Body dysmorphic disorder (BDD): A seriously distorted self-image 46 Hoarding disorder 47 Trichotillomania: Pulling your hair out 49 Skin-picking: Excoriation disorder 50 Distant Cousins of OCD 51 Obsessive-compulsive personality disorder 51 Smelling bad: Olfactory reference disorder 52 Tics and Tourette''s syndrome: Involuntary sounds and movements 53 Somatic symptom disorder: I think I''m really sick 55 Eating disorders: Intense fear of fat 56 Impulse control disorders: unstoppable bad habits 57 Chapter 4: Blaming the Brain for OCD 59 Looking at the Brain''s Role in OCD 59 Connecting genetics with OCD 60 Getting inside your head 60 Choosing a Path to OCD 61 Taking information in 62 Selecting the shortcut 62 Picking the high road 63 Communication within the Brain 65 Electricity and chemicals 66 Serotonin, dopamine, and glutamate 67 Chapter 5: Developing and Living with OCD 69 Developing OCD Early 70 Good intentions; bad results 71 When bad things happen 73 Learning by seeing 75 Developing OCD as an Adult 76 Reinforcing OCD with Positives and Negatives 77 Supporting OCD with positive reinforcement 77 Supporting OCD with negative reinforcement 77 Combining positive and negative reinforcement: A double whammy 79 Worsening OCD with Bad Thinking 80 Exaggerating risk 81 Not accepting uncertainty 82 Needing everything perfect 82 Controlling thoughts 82 Being too responsible 83 Viewing thoughts as real 83 Thinking magically and illogically 84 Part 2: Starting Down The Treatment Path 85 Chapter 6: Overcoming OCD Obstacles to Change 87 Realizing Resistance Is Futile 87 Fearing treatment 88 Handicapping against treatment success 92 Believing the worst about yourself 96 Overcoming Resistance and Changing for the Better 97 Embracing the process of change 98 Defeating self-handicapping 100 Dismantling change-blocking beliefs 102 Taking one step at a time 104 Chapter 7: Getting Help for OCD 105 Going After the Types of Help You Need 106 Educating yourself about OCD 106 Getting support from family, friends, and others 107 Choosing a professional to help you 108 What to Expect in Therapy 113 Keeping your therapy private 114 Digging deep into an OCD diagnosis 115 Speaking the truth to your therapist 115 Evaluating your therapist 116 Reviewing the game plan 117 Part 3: Overcoming Ocd 119 Chapter 8: Cleaning Up OCD Thinking 121 Realigning Interpretations with Reality 122 Seeing common types of OCD distortions 122 Using CBT to correct distorted thinking 122 Defeating unreasonable doubts 123 Ending exaggerating risk 126 Rethinking the idea that thoughts have real power 129 Decoupling facts and feelings 131 Overcoming the need for perfection 132 Sidestepping obsessive thoughts 132 Letting go of feeling excessively responsible 134 Pushing Out OCD Thinking with New Narratives 137 Creating made-up, OCD-like stories 139 Writing down your OCD narratives 140 Assessing and rewriting OCD narratives 141 Chapter 9: Meta-Mindfulness for OCD 145 Thinking Erroneously 146 Separating Your Thoughts from You 147 Acquiring the Attitudes of Mindfulness 150 Making time to be mindful 150 Pursuing patience 151 Letting go of striving for striving''s sake 151 Discovering acceptance 152 Suspending judgment about emotions 153 Living in the now 154 Minding Meditation 156 Breathing meditation 156 Walking meditation 158 Chapter 10: Tackling OCD Behavior with ERP 161 Exposing the Basics and Benefits of ERP 162 Understanding why and how ERP works 163 Seeing the upsides and downsides of ERP 164 Exploring an alternative when ERP isn''t appropriate 165 Working through ERP Therapy 166 Step 1: Determining your OCD theme 167 Step 2: Making a list and choosing your challenge 167 Step 3: Identifying and preventing the response to compulsions 170 Step 4: Preparing to engage in ERP 172 Step 5: Moving through your triggers with ERP 173 Managing the ERP Process 175 Knowing what''s cheating and what''s not 176 Troubleshooting ERP 177 Rewarding yourself 180 Limiting ERP 180 Chapter 11: Considering Medications or Brain Stimulation for OCD 181 Deciding whether Medication Is Right for Your OCD 182 Getting a thorough check-up 182 Coming clean with your doctor about your health and medications 182 Looking at reasons for medicating your OCD 183 Understanding the side effects and risks of medications 185 Examining Your OCD Medication Options 187 SSRIs 188 Tricyclics 188 Other medications 189 Directly Altering the OCD Brain 189 Understanding how deep brain magnetic stimulation works 190 Looking at the evidence 191 Chapter 12: Responding to and Recovering from Relapse 193 Understanding the Steps of Recovery and the Risks of Relapse 194 Medication relapse rates 194 ERP relapse rates 195 CBT, metacognitive therapy, and mindfulness relapse rates 196 Responding Well to Relapse 196 Strategies for Reducing Relapse 197 Knowing the difference between a lapse and a relapse 197 Prolonging treatment 199 Phasing out your sessions gradually 199 Staging a fire drill 200 Remaining vigilant 201 Zeroing in on especially problematic beliefs 201 Recognizing events that trigger relapse 203 Part 4: Targeting Specific Symptoms Of Ocd 205 Chapter 13: Sanitizing Risk: Contamination OCD 207 Considering Contamination Obsessions 207 Germs 208 The disgustingly gross 209 Unusual contamination fears 210 Pandemic contamination 210 Staying Clean: Contamination Compulsions 211 Washing 212 Cleaning 212 Avoiding 212 Rituals 213 Discarding 213 Reassurance seeking 213 Confronting Contamination OCD 214 Making a list 214 Setting a goal 216 Exposure and response prevention (ERP) 216 COVID complications 217 Alternatives to ERP 218 Chapter 14: Dealing with Doubting and Checking OCD 219 Defining Categories of Doubting 220 Harming your home through negligence 220 Harming others through negligence 221 Harming others with your car through negligence 222 Harming your health through negligence 223 Getting stuck on unanswerable questions 224 Categorizing Approaches to Checking 225 Obvious or overt checking 225 Mental checking 226 Getting others to check 226 Taking Steps to Defeat Doubting and Control Checking 226 Step 1 Searching for signals, triggers, and avoidance 227 Step 2 Identifying obsessional doubts 227 Step 3 Compiling compulsions 228 Step 4 Disputing obsessional doubts 229 Step 5 Applying ERP to doubting and checking 231 Chapter 15: Subduing OCD-Driven Shame 235 Surveying Shaming OCD 236 Being afraid of losing control 237 Struggling with thoughts of aggression 237 Wrestling thoughts of acting out sexually 237 Worrying over losing control of bodily functions 238 Questioning established sexual identity 239 Taking religious or moral beliefs to the extreme 240 Treating Shaming OCD 241 Changing OCD th.