shame

There’s no Shame in Having OCD – Addressing Shame in OCD Treatment

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Shame is all too common among people with obsessive-compulsive disorder (OCD). Almost every person who I have worked with has expressed feeling ashamed and embarrassed about the content of their intrusive thoughts or the nature of the compulsions they engage in to combat them. This has been true for my clients whether they have been struggling with obsessions about contamination, self-harm, relationships, or something else. A common question I hear is “Why can’t I do X, Y, or Z like a ‘normal person’?” Along with such questions usually comes a barrage of self-critical thoughts like, “I’m such a weirdo” or “I’m so weak for repeatedly giving in to my intrusive thoughts.” In addition, it certainly doesn’t help to hear friends, family, and strangers – even if unintentionally – belittle your struggle when they talk about “being so OCD” as if this were a punchline.

Hopefully you are already well aware that highly effective, evidence-based treatments for OCD exist (e.g., Exposure and Response Prevention, Cognitive Behavioral Therapy, Acceptance and Commitment Therapy)and are provided by our expert clinicians in the Portland Psychotherapy Anxiety Clinic. A lesser known component of these treatments is that they often involve an explicit focus on developing skills to more effectively respond to shame and self-criticism. Below are two examples of how evidence-based OCD treatments might address shame and self-criticism related to OCD, including links to helpful resources.

ADDRESSING SHAME VIA ENHANCING SELF-COMPASSION

People, including individuals with OCD, are often naturally skillful at acting compassionately towards others. However, it can be much harder to turn that compassion inwards. Therapeutic approaches to enhancing self-compassion include learning about self-compassion, understanding how it operates in your own life, and developing a consistent self-compassion routine via practicing self-compassion-focused exercises. To learn more about self-compassion and to see example exercises, use the following links:

ADDRESSING SHAME VIA COMBATING OCD STIGMA & MISINFORMATION

The reality is that most people’s understanding of OCD is limited to media caricatures they have seen of people who are highly perfectionistic and/or extremely focused on cleanliness. One of the most common initial tasks of OCD treatment is to dispel common myths about OCD and provide more factual information. Whenever possible, I like to incorporate individuals’ main support systems in this “de-mystifying OCD” process. It becomes easier to feel less ashamed about OCD when you and the people around you understand OCD and feel like you’re on the same team in treating it. For folks who encounter OCD-related stigma especially frequently, treatment may also involve learning and rehearsing ways to practice self-advocacy. Lastly, people often find it helpful to develop a sense of community in order to feel less isolated and alone in their struggles with OCD. To learn more about OCD and to see example exercises and resources, use the following links:

https://iocdf.org/about-ocd/

https://iocdf.org/realocd/

https://iocdf.org/programs/conferences/

The Newest Study Supported by Portland Psychotherapy: Helping People with the Stigma of Injection Drug Use and HIV in Russia

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Stigma is a pervasive problem that can negatively impact healthcare outcomes for those affected by it. Stigmatized groups, such as people living with HIV who inject drugs, can face many barriers to care that stem from societal attitudes toward their condition. HIV and substance use stigma, when combined, can lead to further avoidance of care and poor health outcomes.

The findings from the SCRIPT (Stigma Coping to Reduce HIV Risks and Improve substance use Prevention and Treatment) study were recently published. This study was conducted by Karsten Lunze, MD, of Boston University Medical School, in collaboration with Jason Luoma, the CEO of Portland Psychotherapy. This study aimed to test an intervention developed by Dr. Luoma to help people cope with intersectional HIV and substance use stigma. The research studied people with HIV who inject drugs, who often face significant barriers to accessing care due to both HIV and substance use stigma.

To develop the intervention, the research team modified an Acceptance and Commitment Therapy (ACT) approach to target people with HIV who inject drugs. ACT is a type of cognitive-behavioral therapy that focuses on accepting difficult emotions and thoughts rather than trying to eliminate them. By teaching people how to cope with stigma through acceptance-based approaches, the study aims to reduce the link between internalized attitudes, fears, and shame, and healthcare avoidance behaviors.

The SCRIPT study aimed to evaluate the intervention’s effects on HIV and substance use stigma, care engagement, and injection drug use frequency. The study will also assess the intervention’s implementation by looking at participant satisfaction, intervention fidelity, and uptake.

The study found that people who received the intervention were more likely to start HIV and substance use treatment than those who did not receive the intervention. The increase in care engagement may be due to the fact that the intervention helped people to cope with stigma and reduced their avoidance of healthcare settings. The intervention was not designed to directly reduce shame and fears related to stigma, but rather focused on helping people to cope with stigma and improve their behavior and care seeking.

The implications for practice are that acceptance-based approaches can be effective in reducing stigma and improving care engagement in people with HIV who inject drugs. Healthcare providers should be trained to recognize and address intersectional stigma in their patients and use interventions that incorporate acceptance-based approaches to reduce stigma’s negative impact.

Portland Psychotherapy’s involvement in this study exemplifies the organization’s commitment to using its resources to address societal problems. By supporting research that aims to improve healthcare outcomes for stigmatized populations, Portland Psychotherapy is helping to make a positive impact on the community.

The Effects of Sexual Assault on the Brain and Body

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While it is common knowledge that sexual assault can be traumatizing, many people do not fully understand the profound effects it has on a survivor. As a society, we do not always discuss the immediate and long-term impact on the brain and body, but it’s important for both survivors and the people who support them … Read more

Haunted by Memories of Sexual Assault? How Therapy Can Help Decrease Shame and Transform Your Emotions

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Sadly, countless people in this country have been sexually assaulted. And for a long time, they were taught that they should not speak up about their trauma. Over the past few years, a long-overdue conversation about the prevalence of sexual assault has opened up. The #MeToo movement encouraged people to share their experiences with sexual … Read more

Shame and substance use are not related: Surprising results from the first ever meta-analysis of this relationship

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Many researchers and theorists discuss shame as an inherently negative emotion that is always problematic. In this view, shame involves negatively evaluating one’s self and is often contrasted with guilt, which involves negatively evaluating one’s behavior. According to this view, shame motivates people to avoid situations and withdraw from others so that they can protect … Read more

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