OCD is an extremely debilitating disorder as a whole, ranking as one of the top ten medical and mental illnesses in the world- right alongside such things as Heart Disease, Major Depression, and COPD, according to the World Health Organization. With 2 out of 3 people reporting severe impairment at some point in their lives (e.g., work, relationships, school), you can count on OCD to create an ever increasing set of problems- without effective treatment. Furthermore, around 90% have at least one comorbid mental disorder, such as Major Depression, Panic Disorder, or a Substance Use Disorder. OCD has a tendency to make sufferers “hostages"- feeling stuck in an ever-narrowing loop of behaviors and/or thoughts that usually seem nonsensical to the person themselves, which tends to drive even more shame. Families and support are collateral damage. It is crucial to identify the threat and connected suffering of OCD in order to fully address its impact- and to have the proper perspective and motivation in getting necessary treatment. ​

Attempt to really understand your loved one’s suffering, and understand how to help, howa not to help, and how to stay healthy yourself. Finding effective support and treatment is crucial. You don’t have to have diagnosable OCD to be an incredible advocate. Myself and a majority of my OCD specialist colleague/friends do not have diagnosable OCD.
Knowing treatments that are effective helps to stay grounded and focused. In short, a specific subset of CBT (Cognitive Behavioral Therapy) known as ERP (Exposure and Response Prevention) is the Gold Standard in treatment. SSRI medications (and clomipramine, a TCA) are used as the first line psychopharmacological treatments. 
 Supportive psychotherapy is not evidence-based first-line treatment for OCD. You may love a counselor who is very supportive, but if they’re not doing some sort of exposures or behavioral experiments, and there’s not a noted clinical reason why they cannot, consider an OCD specialist, because they are not following clinical practice guidelines. Again, check out my Intro Brochure​ and ERP for OCD Presentation for more on the research and specifics.

Taking OCD seriously involves seeing it- and you may help your loved one see it more clearly through your loving support. When it is beneficial to a client, I almost always recommend involving a supportive loved one at some point in treatment. We would consider it odd or unusual not to involve a family member in many other medical treatments. A major challenge with mental illness is making the unseen seen.  ​

Support needs to strike a balance between being overly-accommodating and overly-emotionally expressive (outbursts, hostility, negativity, etc.). The well-researched terms we use to describe these are Family Accommodation (FA) and Emotional Expression (EE). Break the Cycle!! Don’t Do Compulsions for them (by proxy). Begin (with a plan) to minimize your accommodation. Typically in therapy, I help to incrementally get rid of accommodation altogether without “pulling the rug out” too fast (i.e., in one day). Therapeutically, all client rituals must ideally be terminated to maximize outcomes. Helping a loved one ritualize only feeds the cycle. Don’t Give Reassurance. To do this well, you often need to be involved in the prior steps this article elucidates. It can be tricky to know what is reassurance and what is not. Ask questions of your loved one. If they are not open to sharing, you may have to do your best to set your own boundaries, make an informed guess, and base your limits on your own personal boundaries until they're willing to communicate further. Part of feeding obsessions involves engaging the content of obsessions with logic, emotion, and reactions. The person with OCD must learn to live their goals and values without following the content of obsessions. Be careful not to get pulled in, either through accommodation or emotionality. Offer to go to therapy with your loved one if they are willing. You can also gain much support by doing your own therapy, as well! Part of support may be helping covering costs of therapy.
 Just to be clear- you get to have your own emotions, whatever they are! But EE refers to when these emotions are expressed in harmful ways.
​

If you have made it this far to read this article, you are quite likely a key support of someone who has OCD. It is then very likely that you care and want to make a difference. You rock. Keep up the good work. 
​ ​

An editor for the American Counseling Association reached out to me about OCD from a Specialists' perspective.  (I was so proud of them for doing their research with multiple specialists!!). The following are excellent questions that may help inform their ACA magazine article in February 2020.  Whether they utilize any of these or not, I hope they are helpful for you as they cover important questions to consider with regard to treatment.  



"What presenting issues might bring these clients into counseling?" 

• Intrusive thoughts!  Many of my clients initially seek out counseling because they have been plagued by intrusive, unwanted thoughts.  They wonder what this says about them, even though there is often some sense of it being senseless and out-of-context (we call it ego-dystonic).  
• "Tipping point" behaviors- people start to notice problems in routines that begin taking too long, physical  pain caused from washing, mental stress from extensive rituals (needing to "feel" a certain way, pray a certain way, walk through doorways multiple times, pick 7th item at the grocery store, and so on).
• Family, friends, and spouses are a great source of support (and pressure, at times), which can help lead to a client first coming for a session.  Some of my clients (more often than not, in the pediatric population) have low motivation for themselves, and it is a concerned loved one who (hopefully lovingly, sometimes not) asks them to seek treatment.

"What are some “red flags” for counselors to listen for that might indicate OCD in a client who came in for something else (anxiety, ADHD, etc.)?"
If a counselor begins hearing the exact same things, worded or behaved in similar ways, this is a good indicator to watch out for.  Many of my clients are good at exactly quoting themselves on what they've said before.  Obsessions are repetitions on a theme; if you get good at catching the theme, you can usually spot an obsession miles away.

At its core, it's not remarkably difficult to identify criteria in OCD (in most straightforward cases) if a counselor brushes up on what they're looking for (dust off that DSM-5!). 

Furthermore, if a client isn't improving from certain methods (especially things like Cognitive Restructuring in CBT), this is "Getting Stuck 101" and needs further assessment.  Most of my clients have had prior experience with a counselor who had no idea how to treat OCD from an evidence based way and approached the same as regular old automatic negative thoughts. This is not typically helpful. 

"What counseling methods/techniques can be helpful when working with clients with obsessive behavior and/or OCD? Please explain how this/these method(s) work well for this client population. If possible, please talk about a case example (without identifying information) who worked with you and showed improvement. What were his/her presenting issues, what methods did you use and what issues did you focus on in counseling sessions?"
Exposure and Response Prevention (ERP) is the GOLD standard treatment (which is a very specific subset of CBT).  It is indicated as the starting point for all OCD treatment.  This is a strong statement, but it is backed by the research (the most RCTs by far) and organizations like the IOCDF, APA, and so forth.  SSRI (and Clomipramine, a TCA) medications are also first-line psychopharmacological treatments, though with less effect on average than ERP.  Both combined can be helpful, though may not necessarily increase the overall benefit of just ERP alone. Another first-line treatment for OCD (though not the "gold standard") is Cognitive Therapy with Behavioral Experiments.  Along with medications, it is seen as sometimes a more agreeable option for those who are hesitant to engage in exposure therapy (which intentionally and repeatedly provokes distress in order to respond differently- i.e., without compulsions).

Adjunct therapies, medications, and treatments are utilized.  In the interest of brevity, research has discovered the integration of Acceptance and Commitment Therapy (ACT), Motivational Interviewing (MI), and other techniques can be helpful to provide well-rounded treatment and/or facilitate the practice of ERP.

To share a classic example [identifying factors changed to protect confidentiality- this type of case is remarkably common], one woman came to me with severely distressing thoughts about harming her children (no history of harm or abuse).  She knew it was irrational, yet it felt so real to her; the more these intrusive thoughts continued to appear, the more difficult it was for her to determine her intent from confusing feelings and "impulses" to stab her kids.  Upon receiving a diagnosis of OCD, I thoroughly assessed history with symptoms, and educated on the CBT model for understanding OCD treatment with a rationale for CBT and ERP. We discussed medication options, to which the client was willing to pursue with their Psychiatrist.  The client was very cooperative due to a high willingness and intrinsic motivation to be able to engage at home with her two children and spouse. As can be very typical, the stress also took a toll on most every area of life, making work difficult. Once we began ERP, we started with doable exposures while learning how to stay present with triggers and distress- without compulsing.  Upon successful practice of more manageable triggers on their hierarchy, they- with the incredible support of their spouse and church and loved ones- made a jump in their exposure work that began with "scripts" (imaginal exposure stating/writing distressing thoughts and quickly progressed to holding knives and stating these feared thoughts aloud) and transitioned to  practices situationally at home, holding knives and saying scripts aloud (in separate rooms appropriately not in front of their young children).  The incredible support around this client, along with a sense of strong purpose, helped facilitate (this is part of ACT) the integration of ERP into daily life. They would be considered recovered at this point, scoring so low on the Y-BOCS (gold-standard assessment in rating severity) that their symptoms are sub-clinical. In relapse prevention planning, they understand the chronic nature of OCD and the necessity of staying on top of their good progress, with the plan to follow-up at occasional intervals for "booster sessions."  I gain so much joy from stories like these.


"People with an OCD diagnosis may be taking medication and seeing other professionals (psychiatrists, psychologists). How could a counselor work in tandem with these other professionals? Please include a case example, if possible."
Coordinating care can be difficult, but worth it for the best client care!  Although seamless communication and record exchange between providers is likely ideal, it just rarely happens in real life.  Working within the space and limits that exist, I have found that outside of those very few therapists and Psychiatrists I can have near immediate communication with, it is still very helpful and feasible to at least request/give one way communication to a provider.  In complex cases, it is almost unheard of for me to not outreach another provider that is connected somehow to shared treatment concerns. I think we need to be realistic about other providers' schedules and communicate what we can- how we can. This often looks like me leaving a Psychiatrist a voicemail after release is given- and not hearing back- but at least they have the information. It may be coordinating with another therapist who is treating other concerns. Early on, I used to welcome other counselors working at the same time on separate diagnostic concerns. Though I may work with someone now who is seeing another professional for something like, say, Depression, it is usually quite imperative that I make known to the patient and also the other provider the pitfalls of feeding compulsions through reassurance, ruminating, and so forth. This is a great opportunity for education of those who are not specialists in OCD.  But OCD being as debilitating as it is (2 out of 3 people experience severe impairment at some point in their life), I need to work hard upfront to educate especially the patient about how hard they will need to work (and not undermine) their exposure therapy. Also, many other comorbidities can often improve significantly just by treating the OCD first.  

"How, particularly, are counselors a “good fit” for helping clients with obsessive behaviors? How can they help people with OCD differently than a psychologist would?"
It has been my personal experience that my colleagues who are counselors (Master's level, typically), bring to the table incredible creativity and "outside the box" thinking.  Many of the hands-on resources, videos, blogs, and social media that exist to help the sufferer of OCD often come from Master's level clinicians. I believe there is great flexibility many of my counselor colleagues have (which is a positive and a weakness all at the same time, sometimes lacking the rigors of adhering to the evidence based treatment protocols).

There are actually quite a few more Master's level clinicians than Psychologists, and there is a great need for more clinicians offering great treatment.  Counselors can help fill this gap.

"As a practitioner who specializes in working with OCD, is there anything else you would want counselors who don’t specialize in this area to know?"
For many reasons, I love work with clients who have OCD.  I have found they are some of the kindest, hardest working, conscientious individuals on this planet.  This is where I believe many of their personality strengths arise once moving through pathology. It is a joy every day to see recovery, growth, and maturity bloom out of suffering.

"Any main take-aways to share?"
OCD Treatment can be so rewarding! It has very effective treatments for most, very clear evidence, incredible improvement that can be witnessed in a short period of time, and there are wonderful opportunities to get invested in this world with a community of professionals, sufferers, and supporters who are incredible. 

Sincerely,
~Justin K. Hughes

“Why can’t I stop thinking about this?”  “Why can't I stop?  I know it doesn't make sense.” 

William went to the Middle East after his unit was deployed from Ft. Hood.  Most of what he heard about soldiers’ experiences were rumors and media stories- he had no way to be prepared for what would happen.  After nearly 6 months of swallowing sand stirred up by 110 degree winds, William had 5 days left until he would return home.  Momentarily losing his hearing, all his senses were shaken when an IED tore shrapnel through his three closest friends.  They were dead.  Just like that.  After being rushed by helicopter for triage medical care, William soon discovered he only narrowly missed death- the same shards of nails and rocks that killed his friends were found inches away from where he stood. 
Returning home is where cleaning up the fragments took the longest.  After being debriefed and allowed medical and family leave, Bill struggled getting back to civilian life.  Some of the most difficult times he faced were trying to overcome his own unexpected reactions to situations, usually late at night where he would awake from a noise, pulling his wife down from the bed onto the floor to take cover.  When he became calm, he was covered in sweat, visually stunned by recalling what had happened weeks before- and so embarrassed to be dragging his wife- literally- into the center of his problems. 

This is trauma.  This is the story of William’s PTSD (post-traumatic stress disorder).  Hopefully his story can help bring understanding to struggles faced by those dealing with trauma and respect for our service men and women. 

It’s not very difficult to have some sense of empathy for William’s situation.  It’s often much harder to understand another very real and very overwhelming problem.  It is called Obsessive Compulsive Disorder (OCD).  You may be curious why this article spends so much time talking about PTSD, only to discuss OCD.  Two reasons.  OCD actually has some similar features and neurobiology to PTSD, and secondly, if we are to listen to the struggles of others, often we must start with something we do grasp a little more readily.

Whether a person is triggered into feeling distress from trauma or obsessions, their brain is becoming hyperactive in warning of a threat.  This wonderful system when working properly can be nightmarish when the reactions surface out-of-context.  Think of the panic you would feel if you saw someone almost being run over by a car- your fight/flight/freeze response would activate and prepare the body and mind.  Now imagine it occurring at random times and being uncontrollable.  

Despite popular references of, “I'm so OCD” and “He really likes the house OCD clean,” [FYI, OCD is not an adjective] this diagnosable mental health condition is a serious disorder- and far beyond a person’s immediate ability to just “stop it.”  Because the anxiety and distress a person with OCD feels is so bothersome and intrusive, they naturally seek to alleviate it- sometimes with elaborate mental rituals to “do away” with the anxiety (e.g., counting, prayer, neutralizing statements) and sometimes with physical compulsions and avoidance to feel better (e.g., “I feel anxious when someone touches my clothes and need to change and wash them immediately”).  To some people, this sounds "crazy."  But in our age of neuroscience (and OCD is remarkably well established), we cannot deny scientifically the paint and suffering involved in the sufferer's life.  Their mind- and often body- SCREAM with discomfort until they do something to alleviate it.  And the compulsion works!  Momentarily, at least for a bit.  It problematically, though, reinforces the learning, connections, and neural pathways linked to disorder as opposed to reinforcing healthy, non-compulsive behavior. 

To stand up to OCD, a person needs to ultimately eliminate all compulsions.  What do we make of this?  Do we expect the person with PTSD to just jump back in to just get on with their lives?  Nope.  Let me be clear with OCD (and this is also true of PTSD).

There is hope and very effective treatment.  

We don’t have to understand, ultimately, to love.  As many as 1-3 % of the population wrestle with this.  Look around- that’s someone in your neighborhood or at the restaurant where you ate.  Will you lend a helping hand to those who suffer?  I will.

Yours truly,
Justin K. Hughes

​Check out more resources on my page dedicated to them:

​It's here!  This is your FREE Mindfulness Practice Worksheet!  It's colorful, pretty, and I hope it really helps you grow in being mindful and staying present.

This one's a bit different from the average mindfulness practice you might be familiar with.  The reason it's called "Exposure-Friendly" is that it is specially designed to help a person be mindful of whatever they are experiencing, not just attempting to feel better.  This is a hallmark of exposure therapy: being able to tolerate distress without engaging in pathological responses (rituals, safety behaviors) that negatively reinforce fear.  Distractions and relaxation when facing our fears can backfire (see the research at the end).  So if we need a different set of tools to face fear, here's one of them.  I hope it helps.

FREE VIDEO Coming Soon

Blessings,

~Justin

I didn’t think much about it.  Once I began to shift from a trim guy in my young 20’s to borderline overweight/obese by my late 20’s, I was introduced to research on the deleterious effects of consuming so much added sugar in my diet.  But I also gained maybe the most crucial part of any health advice: the support to live it out.

The most significant early clinical and research voice for me was Dr. Mark Hyman, Director, Center for Functional Medicine at the Cleveland Clinic.  I was watching a documentary on Netflix in 2015[2] that featured him significantly.  It added to my already growing knowledge and personal experience, which especially helped me a) stop compartmentalizing nutrition (150 calories from Coke ≠ 150 calories from vegetables) and b) look more closely at what I put in my body.  

Bolstered by personal recovery in multiple areas of my life, and leaning on my wife who was super supportive of me, these convergences facilitated what I hadn’t been able to do prior:

• I almost entirely cut out added sugar from my daily diet at first, and now use sparingly with a limited number of desserts.  
  • I lost 45 pounds in about a year and a half, the first 5-10 pounds was just cutting out sugary sodas.  
  • I slowly cut consumption (small things to begin, like not eating past 10:30 pm at night), and then really worked on eating vegetables.  If I wanted a snack, I’d learn to find vegetables, nuts, and fruits). I found foods I enjoyed that I could eat basically as much as I wanted.
  • I began to look BIG-picture at food with an observant eye- and discovered (shocker!) that even my favorite salads possessed added sugar, and not just in the dressing.  Places like McDonald’s and Chik-fil-A add sugar into different items in their salad toppings and breadings (can anyone say candied pecans?).  Stores like Costco sell a lot of “organic” items, but when I look at the packages and see the ingredients lists on most items, I still find a lot of added sugar, sodium, etc.  
  • I still enjoy dessert!  I just had two slices of cake at my sister-in-law’s wedding!  And I loved it.

One of my discoveries is that existing advice often conflicts, and (as with all things) can be driven by profit, greed, and ambition.  Instead of getting embroiled in all these details, I began to think critically for myself and make a plan with support. Here’s the simplest advice that’s now supported relatively across the board:

Recommendations for Added Sugar:
CDC (U.S.)

• In a 2,000 calorie diet, 50 g of added sugar is the max recommended (10% of total energy intake).

WHO (World Health Organization) Recommendations[3]

• Strongly recommends less than 10% of total energy intake as free sugars, 
• And conditionally less than 5%.

Part of a healthy body, mind, and spirit involves an honest look at what we put in our bodies.  Nutrition is, of course, one of the most important realities of daily life. Much success and suffering comes from our consumption and discipline around food- and in that regard, it’s not much different from other areas of life such as our thoughts and beliefs, exercise, generosity, and work and rest.

I’m nowhere near an expert in the food realm, and this post is more personal in nature.  I hesitated writing it for a while so as not to make another one of those ‘Look at me now!’ posts.  The last thing I want is for anyone reading this to feel shamed by a braggadocious post on self-improvement.  I personally didn’t have a bunch of shame about my weight prior, nor would that have helped. I want to thank my sister-in-law, Camille, for encouraging me that people might benefit from my personal story.  I hope it helps.  

As a therapist, I walk with people every day through CBT and counseling to take action.  Traditional medicine, articles, and diets all serve their purpose.  My job is to help people make change, personalized to them, in the context of reality- that we must all live in, or not- only to our detriment.  

If you take nothing else away from this, here are the keys I want to share:

• You (and others) are inherently valuable.
• Nutrition is a significant part of life that, when it goes well or poorly, affects all other aspects of life.
• Consider introspection over your relationship to things like added sugar that, when over-consumed, creates major problems.  
• Goals are great, but change has to be doable.  Unrealistic expectations are a killer of motivation and long-term success!
• I’m here as a resource if you need me!
• Everyone is different, but all of us have to live by the principles of reality.  The more realistic we are about looking and facing it squarely, the more congruent our lives will be.

Sincerely,

Justin


[1] Added sugar is different than sugar as it naturally occurs, like in fruits and vegetables.  See Harvard Health's post here.
[2] “Fed Up”- not that I endorse everything in it, but there were a couple key lessons that I have incorporated from this documentary.
[3] This whole resource is quite fabulous with lots of good research and narrative.  I nerded out with it!

Addiction is confusing.  It is confusing to seasoned professionals.  Let’s just admit it. 

It is not a specified diagnosis under the DSM or ICD; it’s only broadly referential to a sometimes amorphous categorization.

• Under the DSM-IV in 1994, only one vote separated the task force on substance abuse from using the term “addiction” instead of “dependence.”

Society doesn’t help give any clarity.  One of my favorite taco joints in Dallas’s tagline is, “Welcome to your new addiction.” That misses the point.  People say all sorts of wild, off-handed things.  "I’m addicted to sparkling water," “I’m so addicted to this band." Addiction is not an adjective.
​
Take a look at a broad array of definitions (some even from reputable research organizations), which emphasize sometimes different things:

• “Addiction is a chronic disease characterized by drug seeking and use that is compulsive, or difficult to control, despite harmful consequences.” -NIH’s National Institute on Drug Abuse
• “Abnormally dependent on some habit….” -Dictionary.com
• “The state of being enslaved to a habit or practice or to something that is psychologically or physically habit-forming, as narcotics, to such an extent that its cessation causes severe trauma.” -Dictionary.com
• “…Continued use/act….becomes compulsive and interferes with ordinary life….” -Psychology Today
• “Addiction is a primary, chronic disease.” -American Society of Addiction Medicine (ASAM)
• “Compulsive substance use despite harmful consequences” -American Psychiatric Association
• “Addiction is a psychological and physical inability to stop consuming a chemical, drug, activity, or substance, even though it is causing psychological and physical harm.” -Medical News Today
• “Cannot control” - HBO
• “Addiction involves craving for something intensely, loss of control over its use, and continuing involvement with it despite adverse consequences.” -Help Guide with Harvard Health
• “Addiction is a condition in which a person engages in the use of a substance or in a behavior for which the rewarding effects provide a compelling incentive to repeatedly pursue the behavior despite detrimental consequences.” -Psychology Today
• “…can’t stop….even when you know the drug is causing harm.” - NIH’s Drugabuse.gov

Clarity through the confusion
While still in the middle of a ‘call to arms’ in clarifying Addiction is, we ultimately have a very stable understanding of the symptoms/criteria of problematic behaviors, and most of the time, how to treat them.

• Let’s look at the premier addiction society’s- The American Society for Addiction Medicine (ASAM)- short definition (which, by the way, only lists “characteristics” vs. actual criteria).  
  • "Addiction is a primary, chronic disease of brain reward, motivation, memory and related circuitry. Dysfunction in these circuits leads to characteristic biological, psychological, social and spiritual manifestations. This is reflected in an individual pathologically pursuing reward and/or relief by substance use and other behaviors.  Addiction is characterized by inability to consistently abstain, impairment in behavioral control, craving, diminished recognition of significant problems with one’s behaviors and interpersonal relationships, and a dysfunctional emotional response. Like other chronic diseases, addiction often involves cycles of relapse and remission. Without treatment or engagement in recovery activities, addiction is progressive and can result in disability or premature death."
  • The long definition is impressive, but complex. 

Substance Use and Addictive behaviors do exhibit many consistencies despite the actual substance or reward behavior pursued, and they respond to similar treatments.  Regardless of the organization, the following are usually consistent details across definitions:

• craving a substance or behavior
• with loss of control
• despite significant adverse consequences,
• with an inability to abstain or moderate.  

"Types" of Addicts
There is an extensive history of attempts to categorize addiction, through “typologies.”  Prior to scientific research, which began with E.M. “Bunky” Jellinek, there were many attempts to understand the mystery of addiction, but mostly from an observational or anecdotal standpoint.  

• AA in 1939- we see Dr. William D. Silkworth at Towns Hospital attempting to typify addictive struggles.  AA offered a new solution, albeit targeted towards the most severe “hopeless” cases. They differentiated between:
  • “Real alcoholic” who is “hopeless” d/t loss of all control (AA, pp. 20-21)
  • “Hard drinker”
  • “Moderate drinkers”
• The Jellinek Curve was created shortly after in the 1940’s. (Accessed from  https://www.in.gov/judiciary/ijlap/files/jellinek.pdf)
• Since then, there are many other attempts to classify the differences that exist and to account for the heterogeneity that exists.

We don’t have any consensus yet, but why is it important to know what type or level or continuum a person is on?  At a minimum, we need to understand where a person falls on a continuum if we are to treat effectively.  

Here is one continuum of use problems (Adapted from Earleywine, M. (2016). Substance use problems (pg. 2). Göttingen: Hogrefe.):

• Abstinence
• Initiation
• Infrequent, non-problematic use
• Regular, non-problematic use
• Problems, subclinical
• Abuse (early problems clinically)
• Dependence
• Disorder (mild)
• Disorder (moderate)
• Disorder (severe)

Effective Treatment
As I like to say, "Don’t drive your lawnmower on the freeway."  Just like you wouldn’t do this (I hope), don’t assume that therapy alone, or a doctor alone, or worse, doing nothing- alone- will be enough “horsepower” to get you where you need to go.  

Effective treatment requires applying the factors necessary to get the job done.  The person who abuses a substance occasionally on weekends will need to be treated different than the person who is “hooked” on something.

Two categories of professional treatment exist, with incorporation of several additional supportive factors:

1. Behavioral
2. Pharmacotherapy

Besides treatment, supportive factors often include, but are not limited to:

1. Drug Testing / Accountability for using and acting out
2. Support groups / meetings
3. Family and friend involvement
4. Fun and enjoyment
5. Service of others and engaging life with purpose
6. General health and well-being

​
My plea:
Take addiction seriously.  Don't know whether your are addicted or not?  Find out. 

Addiction is a complex- bio-psycho-social-spiritual- issue.  Problems with drugs, alcohol, or behaviors on a spectrum of addiction cause substantial disability, even death.  And here's the kicker- people who have problems with these often experience lapses in judgement and poor insight into having a problem.

Start with a strong assessment by a competent professional who is trained and experienced.  Look for evidence based treatments (think CBT or Motivational Interviewing). Advocate for truth and be assertive.  Ask hard questions of your provider. When providers get shifty or start to recommend some unusual treatment when you need a first line treatment, exercise caution.

I'm Justin K. Hughes, MA, LPC, and I specialize in the treatment of Addiction through CBT and Motivational Interviewing (MI).  As always, please like or follow me, using whatever platform you prefer.  Also, subscribe for meaningful content regularly!

According to Dictionary.com, their word of the year is "Misinformation."  Defined as "false information that is spread," misinformation occurs "regardless of whether there is intent to mislead."

Misinformation, and its brother, disinformation, can be harmful.  Clearly.  Though much of the current state of discussion around this concerns external affairs.  Much of what we are responsible for at least begins internally (how we respond and engage).

Aligning our thoughts, beliefs, and behavior with reality- what's true and realistic- is a crucial "mechanism of action" that helps facilitate positive outcomes.  This is particularly true in the method of therapy I use- CBT (Cognitive Behavioral Therapy), 

We know that cognitive distortions [click for pdf list] only prevent us from succeeding and growing.  These errors are harmful especially when they are consistent approaches to thought, such as All-Or-Nothing Thinking (I missed my workout today; I might as well skip this week), Mental Filtering (I know they said they enjoyed meeting me, but they must not like me because they talked more to other people), and jumping to conclusions (I just know that she got off the phone quickly because she thinks I'm an idiot!).  The deeper these go, the more impactful they are and harder to break.  

So in a world of misinformation, make sure you first tell yourself the truth, whether it's difficult or comforting.  In this time of the year that is special, wonderful, challenging, or downright awful for some, what can you do?

Be realistic.  Tell yourself the truth, and to others.  Align your thoughts, beliefs, and actions with commitment, purpose, and meaning (and if you're not sure what yours is, find it with help!), and try to get as close to what's honest and accurate.  Be a good researcher (humble).  Don't get snowed by misinformation.  Give the gift of realistic, truthful thinking.  Your brain will thank you (and probably everyone else will, too).  

Merry Christmas, and Happy Holidays!

Yours truly,
~Justin

Want a surefire way to experience more gratitude?  Be grateful.  

I'm not trying to sound trite; those who practice gratitude are more grateful.  I struggle to apply this discipline myself.  But when I do, I see the world differently.  Enjoy the following video (thanks to my brother for passing along).  

Happy Thanksgiving.  

$1.6 Billion.  That's 1,600 x 1 MILLION Dollars.  For the person who won roughly that amount in South Carolina (and the rest of us):

Would it surprise you that your emotional well-being really doesn't improve by becoming wealthy?  There’s been a host of research in recent years that look into happiness and money.  Possibly the most commonly known one is the National Academy of Sciences study on well-being and money.
This study’s now famous $75,000 mark suggests that a person’s emotional well being (how they feel day-to-day) AND their evaluation of life (their overall perspective of how they are doing) improves up to the point of earning $75k per HOUSEHOLD in the United States.  Beyond this mark, emotional well-being doesn't significantly improve, though a person will evaluate their life as better if they earn beyond this mark.  To quote their findings, “We conclude that high income buys life satisfaction but not happiness, and that low income is associated both with low life evaluation and low emotional well-being” (Kahneman, et al. 2010).

So what do "happy money" spenders do?  Research by Elizabeth Dunn and Michael Norton in Happy Money: The Science of Happier Spending (2014) reveals how money is spent makes the crucial difference in happiness.

1. Buy Experiences.
   • Connect with people; target experiences over stuff.
2. Make It A Treat.
   • Making something special and novel increases its enjoyment.
3. Buy Time.
   • Make time to slow down and pursue what's valuable to you.
4. Pay Now, Consume Later.
   • First, don't consume with money you don't have.  Second, enjoy at a later point- anticipate.
5. Invest In Others.
   • An incredible thing happens when we give: happiness.  "It is more blessed to give than to receive" (Acts 20:35, The Bible, ESV).

Are you making the most of what you have?  Are you caught up in materialism and consumerism?  Today is always a great day to do something different.  

Yours Truly,
Justin K. Hughes, MA, LPC

Do I want this, or do I not?  Is this my actual desire, or what I don't want?  Does this thought or desire define me?  What if it's terrible or horrible?


Sometimes the things I think about are because I value them or desire them.

Sometimes the things I think about are because I don't value them or desire them.

What the heck?  


Egosyntonic and Egodystonic are two psychological terms to describe phenomena of thoughts/urges that are synonymous and antonymous to what a person desires or wants.  Sometimes our thoughts reflect very much what we desire or want, but around 90% of people endorse having "intrusive thoughts," or unwanted thoughts.  

It is crucial to do a good functional analysis on a thought/behavior to determine whether someone is doing something in order to pursue- or to avoid- the very same thing.  

Most people think I’m an extravert.  They see me being sociable, laughing, communicating- and the consensus is, “There’s NO way you’re an introvert.”  My friends have confused being outgoing with being extraverted.  In fact, even in counseling, the average person I work with believes that extraverts are outgoing and communicative, introverts shy and introspective.  And though this can apply, it is not actually the technical definition- nor the most helpful definition of what it means.

Simply put, think “Recharge” when thinking Introversion / Extraversion (I / E).

I will spare you the extensive history of folks like Jung and the modern day Myers-Briggs test, and there are many wonderful resources available on our topic we are considering- so feel free to consult my friend, “Google,” for more on the topic.

I have come to believe that, at least in terms of personality psychology, understanding and application of this domain is one of the most significant for personal success.

I am an introvert.  Most of my life I have tried to be an extravert.  Most days now I accept how I function, but I still find myself expecting I will magically change this.  I find myself around groups of people almost all day for several days in a row, and I wonder, “Why am I getting so edgy, tired, and experience a pressure to just want to go home and get away?  I want to just be able to power through!”  Ohhhh yes.  That’s right.  I’m a mid-level introvert.  

Many claim that our world rewards extraverts.  Maybe that’s true.  But I know that if you are an extravert, your success is not handed to you on a platter.  In fact, some of the hallmark characteristics of the introvert include abilities that many with extraverted tendencies desperately want. 

The best way to think about I / E is, “How do I recharge?  Where am I most focused (the external world or the internal world)?  How do I get energy?  In what capacity do I restore and recharge my batteries?”  If your answer is a clear, “With people!” or “Alone!” you may have a more obvious answer.  If it’s a mix of the two, you may be more in the middle, or an “ambivert.”  (There’s testing you can do to figure this out better, such as the MBTI or five factor model testing (FFM)/”Big Five”)  But the answer to this question is pivotal to how you approach life- and frankly, how you NEED to approach life.  No one questions the merit in stopping to eat a meal or getting a good night’s rest.  But, how easy it is to question the way our own body and mind gets its energy back!  For me, I question myself usually because I want to be more “productive,” able to knock out more things to be “successful.” But getting more stuff done is not necessarily a good thing in many circumstances.

When dealing with buried emotions with clients, I often say a phrase my supervisor taught me: “Emotions buried alive never die.” We therefore have to deal with these emotional “undead.”  So it is with how we recharge.  Our needs will eventually come up, and if we haven’t been nurturing them in a reasonable way, they will come up with a vengeance, ready to threaten burnout and exhaustion.

One of the keys to the application of one’s recharge style is how to work within a system of an infinite number of variables, styles, and circumstances.  Put another way, we must learn to function both independently and dependently in the system with which we find ourselves.  Extraverts, you will need to find ways to connect with others, but have to be disciplined (and usually work harder) at resting and reflection.  Introverts, you will need to find ways to be alone and collect your thoughts, but have to be disciplined (and usually work harder) to make sure you stay social.  “Ambiverts,” well, you’ve got it all together.  :)  All joking aside, ambiverts will need to find ways to connect and be alone, but have to be disciplined to have a foundation that allows them not only to “go with the flow,” but to make choices for both ends of the spectrum rooted in their own convictions.

My personal journey with I / E will always be evolving as life changes and I transition through different stages. It is nice, now, to not have to waste energy in being the “vert” I want to be and focus on living faithfully with the reality that is.

~Justin
​{And just for the record, my writing of this blog was 90% introversion, 10% feedback from others.}

You may have just gotten an activity tracker over the holidays, or maybe you’ve already jumped on the bandwagon of wearable tech.  Not only do activity monitors like Fitbit, Apple Watch, and Spire track steps, heart rate, sleeping, and more, you can turn your tracker into an ally for mental health.

Here’s how.  

Being able to track and monitor your thoughts, mood, emotions, symptoms, and sensory experiences is arguably one of the central tenets of most schools of therapy.  It is nowhere more prominent than in Cognitive Behavioral Therapy (CBT), where awareness of internal processes is a first step to changing outcomes.  For years, techniques such as journaling and monitoring have been used, but this new technological age adds a few extra tools that can be a boon for awareness.  But you also have to build the emotional intelligence and discipline to catch what’s going on and translate that into meaningful action.  Following are some tips.  (Remember that some people will have more stress by using a monitor- if so, practice these same tips without help from Mr. Fitbit).

1. Be aware.  Occasionally throughout the day, check in with yourself (or a buddy!)  Ask if your heart rate, breathing, sleeping, thoughts, or mood fits the goals you have (see #3).  Pay attention to little details.  Was my heart rate elevated over the holidays because of my activity level, or stress?  Did I sleep less last week because of something planned, or because of insomnia?  Was I irritable at work?  Did I feel anxious around people?  If you want to change something, you have to identify what you’re working with first.  Allow yourself to take note without spending too much time on any one thing.  
2. Let an external tracker add to your awareness.  Utilize the unconscious observations your tracker makes to correspondingly assist in your own mindfulness.  Those of you who have had the helpful feedback of a trusted support can attest to the value of observations made outside of yourself.  I, for one, appreciate the occasional fashion police!  :)
3. Identify the goal.  What are you trying to accomplish?  Better sleep?  Getting less stressed at work?  Being clear about this in a reasonable way gives you a target to aim for- and helps you see if you need extra resources in getting it done.  (See my Setpoints resource to help further.)  
4. Identify solutions.  Once you have tracked your experience and know the goal, then you can apply solutions.  Heart rate at 110 while sitting at work?  Try some deep breathing and a de-stressing activity.  Notice you’re not taking many steps?  Take 3 minutes to get up and move.  Sleep getting off track?  Develop some sleep hygiene techniques.  And so on and so forth.  
5. Be social.  Whether you are extroverted/introverted or outgoing/shy, connecting in some way with others is essential to your health.  Trackers give lots of options to do this in fun, cute, and challenging ways.  

Make it fun, and happy healthy tracking!  Sincerely,

Justin

I hate to admit it.  Mom and Dad, please don't laugh too hard when I say....this.... I sometimes miss being told what to do.  There.  I said it.  

I remember the drill of childhood.  "When did you last eat?  Here, have some food."  "Looks like you could use a hug."  "You're getting cranky; it's time for a nap."  

In my super-mature “I'm-smarter-than-a-child” mentality, I miss some of the plainest truths in life.  One of these is the importance of rest.  It’s the weekend before Christmas, and all through my house are temptations to “achieve” and find my worth in what I do and the approval of others.    

I’m trying to step back and rest.  And I often will remind myself, “I’m more efficient when I rest.” What’s funny about that statement is that I still am finding an excuse for resting.  What would it be like if I stop running the show for a moment?  Slowing down the crazy pace of life is not only a discipline, it is an act of faith- one that acknowledges that I don’t control all and know all.  And I don’t have to carry the universe on my shoulders.  That’s freeing.  I hope you “achieve” some great rest during this time of the year.  Merry Christmas and Happy Holidays!!

​Yours truly,
​
Justin

Happy September (Recovery Month)! School’s back in session and vacations are over for many.  If you’re like most, you’ve been seeing everyone’s summer pics on facebook and Instagram. While you might expect this post, written by a Professional Counselor, to talk about the influence of social media on self-esteem or depression, I want to invite you into a more personal journey- one of compulsive behavior, learning, and communication.

The Back Story
Starting early in 2015, I had been recognizing for months how distracting my daily social media consumption was to me- and how much time and emotional energy was being spent. And then a stroke of insight came- why not just stop? I didn’t have to make any extreme commitment or do a PR campaign. Why not just see what happened? And see what happened I did. With no end in sight, I stopped personal social media use through May 2016.

My days started to become more efficient at work; I found creative ways to engage or disengage with people; I was less stressed over the high dose of negative news I was seeing; I let go of the pressure of having to keep up with posting or needing to respond; I focused on the core things that mattered as opposed to the (look, a SQUIRREL!) distractions.
​
I began to see how compulsive I had become, even a little dependent. I felt fear about missing out on something. I got a “hit” (or high) from that next new message or like or share in my notifications. I had worried if someone didn’t respond soon enough.

The Addiction Framework
In the addiction world, physiological dependence is two things: tolerance (more is needed to achieve the same result) and withdrawal (I feel powerfully adverse negative affects when the “drug of choice” is removed). The treatment world has been closely watching the impact of using the internet, apps, social media, and the like- to see how it activates and affects the brain and body and mind in similar ways to substances. And we’re starting to acknowledge how behavior can trigger some of the same brain processes as a substance being ingested. DARN, I guess I can’t say, “Well, it’s not like I’m abusing drugs or anything.” Actually, sometimes I am abusing the chemicals already in my brain that drugs simply play with.  Varying levels of compulsivity exist, and my expertise in Professional Counseling focuses on providing help and hope when a person can’t break through their compulsive patterns.

Even though a year break taught me about my personal misuse of social media, don’t expect a crusade AGAINST social media from me today. As much as I benefited from my “vacation,” there were a few things I missed out on, too. I overlooked a few announcements (sorry for missing that birthday heads-up). I lost a bit of connection to the world around me. In essence, some communication was actually stunted for me. And I missed out on a little healthy distraction I find encouraging.

The Rest of the Story
My personal story may not be yours. Here are some observations:

The modality of communicating by tech IS effective and helpful for many.  We can complain all day about children not learning to communicate well because they “can’t even” (and I do believe that is a concern to be aware of as a parent).  However, social media can be helpful.

Social media is a communication platform. Whether we like it or not, things like social media are the new telegram or front porch conversation of years ago. And they don’t appear to be going away any time soon, only adapting and changing.

As with many things in this world, the actual vehicle of social media may be relatively neutral- what makes it egocentric, compulsive, and harmful OR helpful and relational, is likely the purpose and motivation and heart behind its use.  I want to be “linked in” to the latter so I can live free, not compulsively.

Sincerely,
Justin


Further Reading:
Dr. Geraint Evans- “What I Learned in My Year Off Facebook”
Dr. Kristen Fuller- "Social Media Breaks and Why They Are Necessary"
Shala Nicely, LPC- "Are You Handcuffed To Your Devices, and Is OCD At Fault?

You’re surrounded by setpoints every day.  They literally keep you alive.  One of them is your set body temperature.  If your body drops or rises a mere 15% beyond your core temperature, death occurs.  Think of a setpoint like a reference point, a sort of boundary.  Medically, it’s called homeostasis.  The body regulates internal functioning (temperature, blood flow, oxygen) despite external circumstances.  The body is always seeking homeostasis.  So is the brain.  And you can intentionally take charge for your mental, emotional, and relational health.

Examples
In our bodies, we break out in a fever when something is wrong- which is one way the body makes conditions unfavorable to viruses and bacteria- because they are temperature sensitive.  In addicts, their brains have faced an onslaught of dopamine rushes- and the brain counters it by producing less dopamine to balance out- even sometimes ELIMINATING dopamine receptors.  This is the brain naturally seeking to turn down a party that’s gotten too loud.

The system
Balanced functioning (homeostasis), whether biological, technological, or psychological, will involve three interdependent elements that help reach homeostasis- all centered on a setpoint:

1. Receptor– A sensing component that observes changes in the environment. The receptor then sends information to the Control Center.
2. Control Center– determines an appropriate response, having a set range in place (setpoint).  Then the control center sends this information to an effector.
3. Effector– Structures that receive signals from the control center and correct deviation by negative feedback, thus putting a system back into its normal range.

Remember from above how dopamine in the brain works with substance abuse?  But we can actually gain the upper hand by being active in our decisions- including making setpoints for ourselves.

Get negative
In order to bring a system back to normal, negative feedback is used to regulate it.  So when I say, “get negative,” or course I’m not telling you to have a negative outlook on life.  What I AM saying is that a system that is out of control will only be put back in control/order by it being regulated by setpoints, carried out by either an internal or external force- and this is negative feedback.
Okay, have I been sufficiently nerdy?  Let’s get practical!!

Sample exercises  
Check out how William uses all three processes of homeostasis as a married entrepreneur with children, who is also dealing with some alcohol abuse (#2 in each is the setpoint).

Entrepreneur-
1) Financial accounts are reconciled daily by William (outside help oversees them weekly).  2) The business plan was developed with a setpoint of no greater than $100,000 debt.  Crossing $50,000 debt signals a problem and requires meeting with the board.  3) If the setpoints are not honored, the board has full power and autonomy to enact established strategies.

Temperature-
1) William’s two year old, Thomas, is running a fever- revealed by his behavior, and then it was gauged with a thermometer.  2)  If 24 hours pass with a fever over 100 F- or at any point it goes beyond 103 F- the setpoint has been crossed.  3) Visit the doctor immediately.

Remodeling-
1) Extra money was left over- discovered in the budget by William’s wife, Katie.  2)  They determine no more than $10,000 will be spent on a kitchen remodel.  The goal is $8,500; beyond the goal is a warning flag.  3) At the $8,500 mark, a conversation will be held with the contractor to hold to the budget.

Alcohol Use-
1) After running into various troubles with alcohol, William considered his personal/family values and health recommendations.  2) A setpoint was made: only 2 drinks or less daily.  3) If this line is crossed, the commitment is to have an entire month sober.  If this cannot be done, it is agreed on with his support team to increase treatment (e.g., go to a group, go to counseling).
​
Got the hang of it?  These steps can be applied to about anything, though I mostly use the Setpoints Exercise (click on the link below to access!) to help increase ownership and boundaries with addictions.  It’s a straightforward way to get honest with anything you are facing, the amount of help you need, and what supports can get you there.  This concept has helped assist many of my clients to face problems squarely, and in turn, to be more successful and realistic in addressing life challenges.  Give it a try!

In Latin, Quid Pro Quo means, “something for something.”  You scratch my back; I scratch yours.  Tit for tat.  It’s how the world runs.

Or is it?

In the business world, this often works.  Social psychology calls it “reciprocity.”  In relationships, well, this is where it gets fuzzy.  Relationships require sacrifice regularly; they require that you stick around, presuming it’s reasonable to do so.  In business, if someone doesn’t offer you a good deal, you can move on.  If you keep doing this with relationships, you will bankrupt your heart and anyone close to you quicker than ever thought possible. 

Relationships involve the molding and holding of hearts.  Business involves the flow of money.

I want to call to the table that many principles that work for business DON’T in relationships, which is partly why someone can be extraordinarily successful in the business world but trade in relationships as often as changing underwear.  The concept of reciprocity is fascinating, and I regularly utilize it in respectful ways when I consider how to engage in business, such as when I “add value” to interactions with businessmen and women by offering helpful counseling materials.  This, in turn, increases my odds of getting a favorable response.  Nothing wrong with it.  I attempt to not do it ONLY for this reason.  However, when I expect a certain response- demand it, even- I am not respecting a person’s freedom, uniqueness, or spontaneity.  And this is precisely the problem when quid pro quo is present as a foundation in relationships.

Everyone from Hendrix to Gottman to Eggerichs (see references below) point out the necessity of proactive initiative in love- an active, intentional doing what’s best for another, choosing love over “balancing the budget.”  In fact, the eminent researcher Dr. John Gottman states the myth of quid pro quo in The Seven Principles for Making Marriage Work (2002): “But it’s really the unhappy marriage where this quid pro quo operates, where each feels the need to keep a running tally of who has done what for whom” (p. 15).  

Isn’t this the definition of selfishness?  And it tears relationships apart.  I don’t know of anyone who says, “Yes, being completely selfish is good; I want to live by the principles of selfishness and teach my kids to do the same.”  No one really debates this.  How quickly it takes over, though!  My role as counselor isn’t to point a finger; it’s to help uncover what’s holding people back.  Consider how you might be “losing while winning,” holding grudges, keeping a record of wrongs.  These things are the opposite of contentment- and love.  "Love keeps no record of wrongs," (1 Corinthians 13:5d) as is often quoted at weddings.

Don’t wait for a person to do good to you.  That’s the whole importance of the Golden Rule and the Greatest Commandment.  If you wait around for the other person to “play by the rules” in loving you, prepare to be unsatisfied.  There will come a time (in EVERY relationship) when loving another becomes hard: when the "high" of newness wears off, when the attractiveness of another becomes the norm, when that little quirk that you thought was wonderful turns out to annoy the heck out of you.  If it’s left up to reciprocity, we’re screwed.  In friendships, romantic relationships- ANY relationship.

If a relationship fundamentally relies on quid pro quo, it will prove an unhappy ending.  Find out how to love others despite what they bring to the table, and reap the overflowing results.  If one person brings a feast to the table, just because the other doesn't bring one won't mean you can’t enjoy yours- and just maybe win them over in love.

Sincerely yours,
Justin


For more information:
Business Networking That Works...It's Called Quid Pro Quo (Forbes)
Getting the Love You Want (Drs. Harville Hendrix and Helen LaKelly Hunt)
Influence and Persuasion (Robert Cialdini)
Love and Respect (Dr. Emerson Eggerichs)
The Seven Principles for Making Marriage Work (Psych Central summary)