Details about the 2018 Annual Conference will be posted soon!
Carol Hevia, Psy.D. Presented on "Killing your mom, going to hell, sex with a camel and more: Treating OCD obsessions that generate guilt, shame, and disgust"
Summary by Rachel Strohl, Psy.D.
On Sunday March 5, 2017, Carol Hevia, Psy.D. presented at the annual conference of OCDNJ. Dr. Hevia has been working for 20 years with children, teens, and adults who suffer from OCD. She received her first Master's degree from the counseling psychology department at UW-Madison. She then did a post-graduate one year training certification program at the Boston Institute of Cognitive-Behavioral Therapies. Her second Master's degree in psychology and her Doctorate in Psychology were both from the Florida Institute of Technology in Melbourne, Florida. She did her Fellowship in Clinical Psychology at Harvard Medical School. She is a licensed psychologist in Massachusetts, Florida, and Arizona. Since 2005, Dr. Hevia has served as an Assistant Psychologist on the clinical staff of the OCD Institute at Mclean Hospital, part of Massachusetts General Hospital, considered by many to be one of the top inpatient OCD treatment centers in the world.
Dr. Carol Hevia
Dr. Hevia began the presentation by instructing the audience to "don't think about the pink elephant!" She explained that the more one tries to suppress a thought, the more it "sticks" in one's thoughts. It is important to understand that intrusive thoughts are normal. "Everyone has grossly inappropriate thoughts sometimes," such as standing on a train platform and thinking about pushing someone into the train.
These thoughts are normal, but "it is the OCD reaction that is problematic." OCD reactions to intrusive thoughts include: 1) increased importance and meaning placed on thought, 2) evidence of character flaw, 3) sufferer is evil, 4) moral disgust, and 5) pathological guilt. Thought action fusion may occur when one has the belief that a thought is as bad as the action, and that having the thought increases the likelihood that an event will occur.
She explained there are two types of harm intrusive thoughts: 1) Harm by intent, which is fear of intentionally harming others, e.g., stab, strangle, or run a pedestrian down with a car on purpose. It can also be fear of intentionally harming yourself when you don't want to do that. 2) Harm by neglect, which is fear that one will harm another by accident, due to not being careful enough, e.g., driving, food preparation, or responsible for catastrophe such as fire, burglary, or flood. Magical thinking may occur which allows OCD beliefs "to bend the laws of logic and physics."
Other intrusive thoughts involve sexual obsessions: 1) Fear of being a pedophile. 2) Fear of being gay, when you are straight, or vice versa. 3) Fear you will commit sexual acts with animals. 4) Fear you will grab a stranger inappropriately in public. 5) Fear you will impregnate someone or become pregnant without having sex. Dr. Hevia said that "content is irrelevant. The person with OCD keeps reacting to the thought that keeps the OCD pattern going." The brain is a sex organ and if one thinks about sex, one may respond sexually. OCD sufferers use sexual response as evidence for guilt. "Getting better from OCD involves changing one's reactions to intrusive thoughts."
Scrupulosity is intrusive thoughts that involve blasphemy (e.g., going to church and saying bad things), sin, offending God, and sexual thoughts about God, Jesus, and Mary etc. Moralosity is obsessions and preoccupation with right and wrong. These intrusive thoughts are mostly about self not targeting others, such as returning 25 cents found in a vending machine to the rightful owner or picking up litter for hours.
Relationship OCD involves the sufferer questioning and worrying obsessively about an aspect of the relationship, which is disruptive to the relationship. Examples include: 1) what if I don't truly love my partner?, 2) what if I'm attracted to another person?, 3) what if I'm not a good mother?, or 4) what if I don't want to spend quality time with my kids? This type of intrusive thought can be "tricky and misdiagnosed because the obsessions appear 'normal' and related to the actual relationship."
Dr. Hevia conducted an experiential exercise called the "Evil Meter", in which sufferers rate from 0 to 100 their sense of being evil. Sufferers feel inherently bad or evil, and the intrusive thoughts are the evidence of "badness." Similarly, one sees a behavioral urge as evidence of guilt, such as the feeling one is about to grab a knife or push a person.
She reported that the evidence based treatment for OCD is ERP, exposure and response prevention therapy. Extinction bursts occur with ERP, and it is important to normalize ups and downs in treatment. Imaginal exposure involves trigger words, sentences, or paragraphs that vary to increase or decrease difficulty level. An OCD sufferer can write, read silently, say out loud, or in public the imaginal exposure. It is important to go for the uncertainty to trigger the worry. Add-ons for imaginal exposure could include props such as knives, photos, or movies, and live props such as driving, children, or animals. Mental rituals can be reduced by: 1) retriggering, e.g., I can't ever figure this out, 2) identify and shift attention to another task, 3) mindful activities, 4) narrate and describe events, and 5) write an imaginal script ending with I will never know. OCD sufferers learn that "catastrophe does not happen, and they learn they can tolerate much more negative emotion than they previously thought."
Our "Living with OCD Panel"
Our Panel and Moderator, Dr. Allen Weg
The conference continued with an emotional highlight: the Living with OCD panel moderated by Dr. Weg.
Dr. Allen Weg
The panel consisted of a 25 year old female who is married and works as a Physician Assistant. As a child, she recalls counting over and over, and asking questions and telling her mom and friends things ritualistically. While in graduate school, her OCD focused on seeking reassurance about failing. Currently, her OCD obsesses about HOCD (homosexual OCD) but she does exposure therapy. She considers herself 60% better and "plans to get stronger than OCD in the future."
A 17 year old female who is a junior in high school, and has a twin without OCD. At age 10, she asked mom reassurance seeking questions repeatedly and found certain words became "triggers, such as nine." She experienced magical thinking if she didn't do her rituals. She said that she "doesn't want OCD ruining or controlling her life," and finds the support from her psychologist and family so helpful.
A 39 year old female who recalls her first experience with OCD after she threw up in a waiting room at age 8. She remembers the urge to step on pink tiles in the bathroom. Her OCD focused on harm during her college years, and she described rituals of getting dressed and getting off the toilet each taking 2-3 hours each. ERP and medication allowed her to currently experience "95% remission," and she has volunteered for IOCDF for the last 7 years working as an advocate.
A 22 year old male who was diagnosed at age 8 with OCD and panic disorder. He believed OCD rituals worked to prevent panic, such as washing hands before playing with toys. He recalls the water being burning hot, and the soap becoming contaminated. He developed emetophobia (fear of vomit) and was hospitalized, in addition to experiencing Tourettic OCD which "looks like Tourette's but OCD is behind it." He ended by saying he continues to fight against OCD.
A 23 year old female who is a graduate student at Rutgers University. She remembers at age 8, washing her hands excessively and changing her clothes over and over, until the clothes became contaminated and avoided. She experienced an "irrational fear of HIV" and ritualized because of it. Cognitive behavioral therapy was very difficult for her, but she persevered and tattooed the "bad number 13" on her body as a permanent exposure. Currently, she goes to therapy on and off as needed, and has learned tools to manage her anxiety.
A 29 year old male who is a jazz guitarist and works for his own business involving music instrument accessories. Around age 24, he noticed daily panic attacks from intrusive thoughts (e.g., existential questions such as, "how do I know I exist?"). He would ritualize on dates to prevent the obsessions and panic attacks, and spent most of his time obsessing about the unknown. After year of medications and still struggling, he began CBT therapy 3 years ago and found exposure challenging but helpful. He said therapy is "worth the fight," and he's now off all his medications. The panic attacks stopped under stressful situations, and he's now "living a fulfilling life." The hours he used to spend on OCD are now spent running his company.
The Living with OCD Panel
Each shared their brave experiences living with OCD, and then audience members asked the panel questions about a variety of topics. As in previous years, the panel members encouraged, informed, and offered hope to the individuals with OCD, their loved ones, and the professionals that treat them.
Dr. Rachel Strohl is a licensed psychologist at Stress and Anxiety Services of NJ in East Brunswick. She is on the Board of Directors at OCD New Jersey. She may be reached at 732-390-6694.
Photo Montage from the Conference
The OCDNJ Board and Dr. Carol Hevia
OCDNJ Volunteers with Michelle Villani, Volunteer Coordinator
Nikki Torella, OCD New Jersey Board Member and Head of Conference Registration
Representative from Rogers Behavioral Health
Representatives from NAMI
Representatives from Gen Psych
Representatives from Hoarders Express
Our AV Guys helping out at the OCDNJ Table
Previous Annual Conference Reviews and Photos