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Cognitive Behavioral Therapy

Spontaneous Blushing A Symptom?

by Kristina Randle, Ph.D., LCSW
written by Kristina Randle, Ph.D., LCSW

Ever since I can remember, I’ve always had a problem with blushing when I am the center of attention. It was so bad when I was growing up that even if a single person would talk to me for any length of time, I blushed or was terrified of blushing. I would obsess about not blushing so much while communicating with a person that I wouldn’t pay attention to anything the person said. This blushing problem has improved since I became an adult, but from time to time while engaging in conversation with anyone (especially men), I still get that anxiety and make excuses to end the conversation or anything to avoid the person seeing me blush. Blushing has always been a huge source of embarrassment for me. I want to know why I had and still have this problem and what I can do to change it. Is it a symptom of something?

I know of no mental health disorder in which blushing is a specific diagnostic symptom. While blushing is not a specific symptom of any one particular mental illness per se, it may be associated with social anxiety disorder. Individuals with social anxiety or social phobias feel particularly anxious in the presence of other people, especially when they are the center of attention. These symptoms seem to match your experiences.

Among individuals with social anxiety disorder, everyday situations can be fearful. Individuals with social anxiety often do not feel confident about themselves. Because of this, they tend to avoid the situations that make them anxious. In the short run, avoidance decreases anxiety but overtime, it can increase its severity.

Can social anxiety be treated? The answer is yes. Cognitive behavioral therapy (CBT) has been shown to be effective. CBT is a treatment that addresses both behaviors and thoughts related to anxiety. Generally CBT lasts for approximately 12 weeks but the length of treatment depends on problem severity. Some CBT therapists require clients to complete homework assignments such as recording your daily moods or feelings. Therapy sessions can be conducted individually or in a group setting. Another very effective treatment is exposure and prevention response (EPR) therapy. Usually, EPR is used to treat individuals with obsessive-compulsive disorder though it has been effective for other types of anxiety disorders.

Another idea is a concept called “hyper-intension.” I’ve written about this concept in other answers but I think it may apply to you. The idea was written about by psychiatrist Viktor Frankl in his 1946 book Man’s Search for Meaning. He believes that when a person intensely focuses on their fear that attention may have the unintended consequence of producing or increasing the fear. In other words, a person’s fear is made worse by their intense focus on it.

The solution to this problem, Frankl says, is to apply a technique called “paradoxical intention.” Paradoxical intention means that you do the opposite of what you would normally do in response to a fear.

What is encouraging about your problem is that it has improved. The reason for this may be related to an increase in self-confidence. Another reason may be because you have trained yourself to be less anxious over time. There may be other explanations as well.

When you feel the blushing occur, I would encourage you to remain in the uncomfortable situation. If you force yourself to endure your anxiety it will diminish. Don’t avoid a situation because you think you may blush. As I mentioned earlier, avoidance could make your anxiety worse.

Also, keep in mind that while you may focus on the blushing other people may not notice. If you surveyed the other people present when a blushing episode occurred you would likely find this to be the case. Even if others did notice they most likely would not comment. Blushing does not necessarily have a negative connotation. In fact, some people may find it endearing.

If this is a problem that continues to bother you then I would encourage you to see a therapist. Because your fear is so specific (i.e. blushing) and it has improved over time, it may only take a few targeted therapy sessions to extinguish. I’d highly recommend it. I wish you well. Thanks for writing.

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Good Thoughts Always Seem to Turn Bad

by Kristina Randle, Ph.D., LCSW
written by Kristina Randle, Ph.D., LCSW

My mind tends to wander and daydream on random topics throughout the day. (undiagnosed ADHD as a child and adult)
For years these thoughts, who are always pleasant at first, always take a turn for the worst and a replaced by a common themed negative thought.
Example:
I see someone play soccer.
I remember back to when I played soccer in school and I’m happy.
Then my mind flashes back to a memory of soccer that I cringe and am ashamed at.

or it could be something unrelated

I’m sitting in my car about to go to work.
I’m listening to random music.
A memory of myself failing a huge project randomly flashes across my mind.

I swear at myself every time this happens and I can’t control it. The only thing I can do is to just shut my mind off and do nothing. For me, it’s second nature when a time, place, or event comes up I flashback to my worst experience with that thing is. Right now, I don’t even want to touch the programs I learned to use in college because I’m plagued with memories of my failures and how I disappointed the teachers that set me up with such high standards from my previous accomplishments only for me to prove them wrong and break down at the end when I really needed to succeed. My fears and anxieties got the better of me. My lack of self confidence from these thoughts has really hindered my want and ability to acquire a job in my industry and if I could get a handle on them, it would be a great help and relief.

This type of negative self talk is often indicative of depression. At a minimum, it indicates that you have a negative self-opinion. Each of us has a similar inner dialogue. It’s basically like a running commentary on our lives. Yours happens to be negative but you can change it with counseling. In counseling, you can learn to have a more realistic view of yourself. Think of counseling as an opportunity to “change the script” of your life.

The way we think about ourselves impacts our behavior. As you noted, negative thoughts are degrading the quality of your life. They are keeping you from getting the job you want and living a satisfying life. It doesn’t have to be this way. If you choose to seek help, things can change. Your life can improve.

Negative thinking is a very common problem. It is also a very treatable problem. The best treatment for it, is cognitive behavioral therapy (CBT). This type of talk therapy targets negative thought patterns and attempts to change them to be more accurate and rational. Studies show that CBT is an effective treatment for depression, anxiety and many other disorders.

Therapy is the ideal solution to your problem because it involves consulting a professional who is trained to treat the very problems with which you are struggling. Should you decide to seek help, choose a therapist who specializes in CBT.

In addition to counseling, you might also try reading self-help books. The Feeling Good Handbook by David Burns is very good. You can watch his Ted Talk here to get a sense of the topics he addresses in his books. Your library might have some other great books as well. Good luck.

Dr. Kristina Randle

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Is this OCD?

by Dr. Marie Hartwell-Walker
written by Dr. Marie Hartwell-Walker

From a young man in the Netherlands: I love order, and structure. So every time I lose track of it, I start over. I can’t help myself. I think I’ve made more than 20 email addresses, had more than 16 diaries, I have had multiple accounts on Twitter, Facebook and Instagram, and I keep resetting my MacBook to factory settings every couple of months.

For some reason it empties my mind. When I get rid of everything it clears up the sky. But it can be a pain. All goes well as long as I can control it. I need structure in my phone, every contact has to have a photo and it needs to be a nice one. My diaries have to have nice handwriting, and my MacBook a good folder structure etc. When I start getting sloppy, or I start receiving too much spam mails, I’ll make a new account. Right now it’s come so far I even spent hundreds of dollars buying the same software on new Apple accounts or Adobe Software, just so I can get everything on ONE emailaddress (the latest one I made)…

How can I accept the fact things will get messy out of control sometimes (like spam mail) and is there a word/explanation for this? Do people recognize it? It was never a problem, but the internet is getting crowded with inactive accounts when you Google my name, and I’m running out of possible e-mail addresses.

Thank you for writing. This is a hard way to live, I know. The difference between a “quirk” of personality and a mental illness is whether the behavior interferes with social, occupational, or daily functioning. The amount of time you are spending with examining, managing, and fixing every account to perfection probably is getting in the way of more important tasks.

Although I can’t make a diagnosis on the basis of a letter, your description of your behavior is consistent with a diagnosis of Obsessive Compulsive Disorder (OCD). OCD is an anxiety disorder. The individual with OCD falls on some behavior(S) that seem to relieve the anxiety. Often what starts as a harmless diversion takes on a life of its own. When the person gets anxious about recurring thoughts or sensations or ideas (obsessions), they come to believe that the only thing that will relieve it is to do something or some combination of things (compulsions).

Compulsions can take many forms. What you describe is a kind of “checking” behavior. You check and double check and triple check to make sure something is correct and perfect. If untreated, OCD can get progressively worse — as you have experienced.

My guess is that the obsession has something to do with perfectionism. Your answering compulsion is to try to make things as perfect as you can. Of course, “perfect” is unattainable so you get caught in a loop of overconcern about how good something is, trying to make it better, being unsatisfied, trying again to perfect it, etc.

OCD does not go away on its own. But the good news is that it is treatable. Cognitive Behavioral Therapy (CBT) has been found to be very effective. CBT is a problem focused treatment that helps you change your patterns of thinking (obsessions) and find other ways to relieve your anxiety. Sometimes some medication is also prescribed to help bring the anxiety down.

If the pandemic has limited your ability to get out to see a therapist,  consider making an appointment with an online therapist.

If you can’t find a CBT therapist right away, do consider purchasing a workbook on managing OCD. There are a number of really useful workbooks available for you to use as a way to start helping yourself.

I wish you well.
Dr. Marie

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Insecure Only in Relationships

by Daniel J. Tomasulo, PhD, TEP, MFA, MAPP
written by Daniel J. Tomasulo, PhD, TEP, MFA, MAPP

Being successful works against me because no one understands why I’m so insecure.
When it comes to school, work, finances, I feel like I have things together. Even though I feel like I don’t really know what I’m doing I manage to keep things together on my own and be successful. However, when it comes to relationships, I feel handicapped. In the past 5 years I finally realized that I was physically abused, emotionally abused, neglected by my parents and I let this happen to me until the age of 21 when I finally moved out after my mom cornered me and beat me up for asking her to calm down. I always felt like I was walking in a fog, going through the motions, trying to be normal but not quite achieving it. It wasn’t until I was 24 and started to realize that I was gay that I started really connecting to my own reality and realized that I was abused. I feel like being successful works against me because everyone thinks I’m normal and such a pleasant person, but when I’m in relationships, my partners can’t handle me. They feel I’m too demanding, too needy, I make them anxious and make them want to pull away from me. They don’t understand how I’m so successful and yet so insecure. I feel so embarrassed because of this. This makes me hide my needs from everyone and avoid relationships because I think I’m defective and that no one could ever really handle me. I feel like no one sees me for who I am and only sees everything that I’m not. A couple of friends have told me to lighten up and enjoy relationships, but I can’t. I don’t want anyone to take advantage of me or to leave me, and I get scared and my heart pounds out of my chest if anything goes wrong. I was taken advantage of and emotionally abused in my first relationship, and I don’t want it to happen again. I’ve been to counselors but they seem to think I’m completely ok and that I just need to lighten up and change my thoughts. I’ve done cognitive behavioral therapy and it works well when I’m single, but in relationships it makes no difference. I feel like logic is out of the window and its a deeper issue than my thoughts. I’m so afraid someone will hurt me and I don’t trust anyone. I think I also have this need to please people, so sometimes in therapy I let the therapist take over and I feel worse after the session cause I didn’t get to really say what I wanted to. I don’t know if I’m just complaining over stupid little things and I do just need to lighten up but I’m writing because I want to know if either I’m making things too serious or if maybe I need a different kind of therapist. I started researching and I think I might have ptsd but I’m afraid to tell people that because they may think I’m over exaggerating my problems and self diagnosing which you aren’t supposed to do. I’d appreciate your feedback.

Thank you for sending in just a thought-provoking question. The issues that you are bringing to light should be brought to your therapist. The struggle for intimacy is great, and the resilience you have shown in moving toward understanding and cooping with these problems. I would elaborate with your therapist the particular struggle with trust and the history of your relationships if you haven’t done this already.

This will give you a chance to develop a bit more trust with the therapist. This is important because often the relationship we have in therapy mirrors the relationships that we long to develop. Being vulnerable, and being willing to discuss these issues is perhaps the most direct way of allowing yourself to change.

Wishing you patience and peace,
Dr. Dan

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I Believe That I Have a Form of OCD, Memory Hoarding

by Kristina Randle, Ph.D., LCSW
written by Kristina Randle, Ph.D., LCSW

All my life, I have had some strange compulsions. I used to make sure my toilet paper was folded perfectly before use. I am very superstitious and I always have to knock on wood or make sure I apologize to myself over and over if I say something even remotely offensive about someone. I never feel deserving of things and I always feel bad accepting things from others that are given to me (ie., free food, money as gifts, a favor). I think the most prominent symptom of my self-diagnosed OCD is that I always want to save my good memories so I don’t lose them. I am generally VERY nostalgic and emotional which isn’t a terrible attribute but living this way often has negative effects on my life. Sometimes, I look back on good memories in hopes that they mask whatever I am going through. Other times, I convince myself that I need to save my memories because I want to make sure that I have something good to look back on to share with others around me. I am often concerned that I won’t make good memories again and all of the good memories I have must be protected. I feel that memories must be protected and maintained like fragile objects. I do gymnastics full time and I often get upset if I cannot repeat skills the same exact way as I have done them in the past. I am always trying to repeat good memories in hopes that it will make me feel better about myself. Do I sound like a memory hoarder?

Memory hoarding is not a term that can be found in the Diagnostic and Statistical Manual for Mental Health Disorders (DSM), the book used by professionals to diagnose mental health disorders. Most of the information about memory hoarding seems to come from blogs or other nonofficial sources. It might be a term that is used informally, among people with OCD, to describe a certain type of mental compulsion in which they attempt to mentally store certain special or important memories. They seem to be focused on attempting to store these memories in a very specific way, exactly how they happened. Perhaps, what they are attempting to achieve is a “perfect memory.”

The problem with memory hoarding is that there is no such thing as a perfect memory. Studies consistently show that our memories are not as infallible as we may believe them to be. In fact, in psychology, there exists a phenomenon called the “forgetting curve.” This idea has been around for more than 100 years and it essentially says that people are unable to retrieve approximately 50% of information one hour after memory is encoded into our synapses. In other words, people are quick to forget details, especially over time. Stress and anxiety even further erode memories. This is contrary to the public perception which essentially believes that memory is akin to a video recording. It most certainly is not.

Anyone who is attempting to have perfect memories will find themselves frustrated by the limitations of human memory. It’s an impossible task.

The symptoms you have described seem consistent with obsessive-compulsive disorder (OCD). Obviously, I cannot diagnose anyone based on a short letter over the Internet and thus I would advise consulting an in-person professional to determine if you have OCD. Most importantly, meeting with a mental health professional will allow you to begin treatment. All of the symptoms you have described are distracting and take away from your life. They limit what you can do and the pleasure you have. Thankfully, good treatments exist for OCD.

Another element of your letter is the idea of perfectionism. Perfectionism commonly co-occurs with OCD. Essentially, it’s a tendency to hold excessively high standards to the point where if the standards are not met, it causes significant distress or impairment in an individual’s life. In the context of OCD, research indicates that some individuals hold the opinion that there is a perfect solution to every problem and that the only way to do anything is to do it perfectly and to make no mistakes. Even minor mistakes, in the mind of the person with OCD, will have serious consequences and cannot be accepted.

That type of thinking is problematic because it is not based in reality. Everyone makes mistakes. “To err is human…” as the famous quote says. That’s the nature of humanity. The goal should not be to never make a mistake. A much more realistic goal is to try to make as few mistakes as possible while allowing for the very real probability that mistakes will be made. You can reduce the number of mistakes you make by focusing on reality and by becoming a critical thinker.

Cognitive behavioral therapy is especially effective for OCD. With the right help and commitment to treatment, you can overcome these issues. Thank you for your question and please take care.

Dr. Kristina Randle

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I’m Afraid of Being Influenced by Others’ Opinions

by Dr. Marie Hartwell-Walker
written by Dr. Marie Hartwell-Walker

From Indonesia: I am sorry if my English is not that good. I’ve been diagnosed with pure Os for 10 years or so, and I’ve been drinking SSRIs for 2 years, which helped me a lot. Now my obsessions are lowered and there is only one kind of fear that buggers me a lot. I am afraid of being influenced by someone’s opinion, when that person doesn’t like the things that I like. I am afraid that by understanding her/his perspective, I’ll stop enjoying the things that I do enjoy. It works on some emotional level even when I understand how unreasonable is that fear of mine.

Also I am afraid of losing some of my abilities I value the most. For an example, there was a guy who told me that he is bad with remembering names of people and things. I am aware that it is a common thing and I know that there are environmental and natural causes that make many people bad with remembering things. Yet, I have become obsessed that I will get his perspective and I will stop remembering names. Even, I somehow get the feeling that it is wrong for me to remember names and I should stop doing it. I know my reasoning is flawed, yet I believe it on an emotional level.

Is there a way, to stop worrying about those things? Have you had similar cases and how did you manage to help them?

Thank you for writing. Let me see if I can help: Researchers have not yet discovered why some people develop obsessions. It likely has something to do with your neurology. But whatever the cause, it can be debilitating. It can interfere with a person’s social and occupational life. Like you, people with obsessions know the obsessions are irrational and want them to go away. But wanting them to go away is rarely enough.

Medication is often helpful. You said that SSRIs have reduced the number and intensity of your obsessions. For that reason, I do suggest that you return to your prescriber to talk about whether a change in dosage or a change in the type of SSRI would be helpful. It might also be advisable to augment the SSRI with another medication. Sometimes medication that has been working for a while becomes less effective. When that happens, a prescriber might consider another type of medication.

You didn’t mention therapy. I encourage you to consider adding therapy to your treatment. Cognitive Behavioral Therapy (CBT) is often effective in further reducing the unwanted and intrusive thoughts. The goal of CBT is to help a person change the way they think, feel, and behave.

It is unlikely that you will completely stop worrying about things. OCD is a chronic condition. But you can become more in charge of your thoughts and less stressed by them. I’ve had success with a number of clients who came to me after years of suffering. A combination of good medication monitoring and regular therapy helped them a great deal.

I wish you well.
Dr. Marie

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Hypochondriac with a constant anxiety attack

by Dr. Marie Hartwell-Walker
written by Dr. Marie Hartwell-Walker

Every couple of months or weeks…I seem to come up with a new scenario as to how I am dying. I always have this general feeling of malaise. I can’t remember the last time I was ever genuinely happy. I am always down. I have no desire to do anything. Well, recently my self-diagnosis is that something is wrong with my heart. It feels like I am constantly on the verge of a complete panic attack. I feel way overly aware of the organ inside my chest. I feel sick, I just feel it beating the wrong way all the time. I panic to the point where it palpitates and majorly picks up speed…and when it does that, I think about how that is also a sign of something being wrong with my heart. And I can’t decipher what is happening out of panic, or what could be me dying. My chest gets so tight and I’m always thinking about it. It’s always hard to breathe because I am trying so hard to stay calm. But heart problems can cause those exact symptoms as well. I get chest pains, over my entire chest. It feels like they happen mostly when I am breathing very hard. Every time I think about it anymore the worse the panic gets. I keep looking up all these symptoms trying to convince myself it’s all in my head but it’s so hard to tell when anxiety generates the same symptoms. I just had my first literal anxiety attack about it and this is where I need to draw the line. I had to lie on the floor and just breathe. My ears were ringing, my heart was beating so hard I could hear it over the ringing in my ears. I couldn’t really see, everything was echoing…and I was certain I was dying. Then suddenly I snapped back, I got up…took an anxiety pill and got on here to write. It was a lot easier to deal when I was convinced I had any other disease…but this one is so hard to set aside. There is ALWAYS the possibility that something is SERIOUSLY wrong too. And I am far too terrified to go see a doctor to find out if I am right. I’m just going insane. I don’t want to leave this earth just yet. But every day feels like my last because of this panic. I want out of my mind. What am I supposed to do?

What you are supposed to do first is see a doctor. Just because something is in your head doesn’t mean that there might not be a real problem. It’s always important to check on the medical facts first. If there is a medical root to your problem, the first step toward a cure is to get a diagnosis – which will lead to a discussion about treatment. But without a diagnosis, you are only making yourself crazy thinking about all the possibilities.

If you are medically clear, then we’re looking at a psychiatric issue. You are probably correct that this is anxiety-based. Where you are not correct is in thinking that an anxiety pill is going to fix what ails you. The medicine will help settle you down, it’s true. But you also need to learn how to calm yourself and interrupt those racing thoughts that lead to a full-blown panic attack. Cognitive-Behavioral Therapy has been found to be very effective with people like yourself. Take a look at “Feeling Good: The New Mood Therapy” by David Burns. The book is very readable and easy to understand. You may find that you are able to use the tools described in it on your own. If not, please consider finding a therapist to coach you. There is no reason to go through life going “out of your mind.”

I wish you well.
Dr. Marie

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Constantly Checking Things

by Kristina Randle, Ph.D., LCSW
written by Kristina Randle, Ph.D., LCSW

…counting to certain number, punishing myself for something that didn’t go right. I’ve been constantly checking my drawers on my dresser and night stand about at least 5 to 10 times. And also my closet door to see if it has been shut properly i do this also about 5 to 10 each. Also i will check my alarm clock up to 6 to 7 times. And i will also count up to the number 37 times every night on my alarm clock. I do this in the same order every night before i go to sleep. And it seems like i can’t stop myself from doing this. I tried a few times but evertime i would try if feels like i want to punish myself for it. Also if something doesn’t go right i will also have a feeling like i want to punish myself or hurt myself for this. I would like to take an antidepressant but i’m afraid to because i have epilepsy and i don’t want it to cause any seizures. I feel to ashamed to tell my parents or anybody i know i’m even to ashamed to tell my family doctor about this. I’ve been feeling this way since i was about 24 years i’m now 32 years old i was just wondering if there is any other treatment for this besides taking an antidepressant?

It sounds as if you might have obsessive compulsive disorder (OCD). A diagnostic interview with a mental health professional could determine your diagnosis. Antidepressants are one form of treatment for OCD but there are others. One of the most effective treatments for OCD is a behavioral-based treatment called exposure and response prevention therapy (ERP). In some cases, ERP can effectively cure individuals of their OCD. Cognitive behavioral therapy has also been shown to be effective for OCD.

The arts and entertainment channel A&E produces a reality television show about OCD called Obsessed. The show features therapists providing ERP treatment to their clients. I would suggest going to their website to view one of their television shows. It is not currently being shown on television at this time but you can view clips or entire episodes online. Watching the television show should not be considered a substitute for treatment but it will give you the opportunity to learn more about the basics of ERP therapy.

I would also encourage you to seek help for your problem. There is nothing to be ashamed of. Millions of people seek help for problems that are very similar to yours. OCD (if that would turn out to be your diagnosis) is relatively common and, as I described above, effective treatments exist. In addition, the sooner you begin treatment the sooner you can deal with this problem and eradicate it from your life. This is particularly important with a possible diagnosis of OCD because if left untreated it tends to become more severe over time. What this means in practical terms is that you may find yourself engaged in your checking behavior more often and for longer periods of time. Putting off treatment is not recommended.

Click on the find help tab at the top this page to locate a therapist in your community. Choose a therapist who specializes in the treatment of OCD and has been trained to provide ERP therapy. That would be the most efficient way to treat OCD. I wish you the best. Please take care.

Dr. Kristina Randle

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