The Guide above is provided entirely for free to newsletter subscribers.
One of my first questions to a professor in my earliest IOCDF BTTI (Exposure Therapy training) at Massachusetts General Hospital was, “What happens if someone actually gets sick after a contamination exposure?” I haven’t forgotten the simplicity of the answer that went something like this: “People get sick all the time. Yes, that might create some additional hesitancy to face exposures at first, but you have an incredible opportunity for learning.” Life involves not only facing bad things that don't happen, but also bad things that do.
Exposure Therapy involves the systematic confrontation of fearful triggers while reducing and eliminating fearful, pathological responses. In the end, it can relieve a lot of suffering.
During this global pandemic of COVID-19, people actually are getting sick. One might not think the principles of exposure therapy would apply (i.e., "Don't you do exposure therapy for risks that don't happen?"). Quite the contrary. I believe exposure therapy provides one of the best evidence-based ways forward, helping us stand up to fear we need to squarely face. So today, whether you have a disorder or not, there is an opportunity for learning and growth in the face of COVID-19.
This guide, "Thriving Mental Health Alongside COVID-19," is dedicated to my clients and the IOCDF and provides a thorough summary of the main steps of Exposure Therapy with me, with key tips for general mental health. May you be enriched by this!
Whether you have a mental disorder or not, there is an opportunity for learning and growth in the face of COVID-19 (SARS-CoV-2). Now, more than ever, we need stable footing to stand on. People go to every extreme. You don't have to. Mental health is about being grounded in reality, insomuch as we can grasp it.
Getting sick will happen. Yes, people die. Relationships break up and fail. Businesses go under. We might get it wrong. However...many people can experience health. Some people live with purpose and to the full (which is not the same as perfect). Relationships can be incredible. Businesses can thrive. We can get things right.
When I utilize the method of Exposure Therapy in counseling (a subset of Behavioral and Cognitive Behavioral Therapy), it involves the systematic confrontation of fearful triggers while reducing and eliminating fearful, pathological responses. It is Gold Standard treatment for OCD & Phobias, and is a first line treatment for all Anxiety Disorders and PTSD. What we think happens is that relearning occurs, which for most increases confidence and decreases disruption in life when they follow the treatment. Exposure, then, gives us two opportunities:
2. To learn we can face it anyway.
Its principles connect us to some of the best of life: face the thing you have reason to face; gain the opportunity to live more fully.
This guide is a very brief summary of the main points of the exposure therapy process with me, particularly with clients who have OCD and Anxiety. Many of my clients actually are faring better in this crisis than people I have talked to and seen in the general public- and why wouldn't they?! They've been training and learning- and now it's game-time.
Click "Read More" for a Summary
This post is intended for Christians looking to deepen their faith and mental health and may not apply to my entire reader base.
I am honored to be surrounded by incredible people who exhibit incredible strength and faith in the most trying circumstances. These past few weeks as the Coronavirus has led to increased fears, panic, product hoarding, and expressed racism, I have seen the stellar example of many clients and friends wading these uncertain waters with confidence, skill, and calm.
Many of you know that treating OCD and Anxiety Disorders is how I spend most of my time clinically. Despite the fact that the 'neurotypical' person may think those with disorders are probably “going crazy” right now with the Coronavirus (and it’s definitely been really hard for many), I have found in my practice much the opposite. I am observing right now during the Coronavirus pandemic how those who have trained themselves to persevere through difficult stressors and triggers- with intentional acceptance of uncertainty, mindfulness rather than obsession, and valued action rather than compulsion- are revealing how beneficial the training of the mind and heart is. I have personally experienced more frantic, panic-induced efforts by folks I’ve come in contact with outside therapy than inside my office. I’ve also seen several of my Christian clients reveal an incredibly deep faith that inspires me (even if they suffer with worry and anxiety).
For those of us as Christians, we can rely on awesome skills we develop in therapy, and it also needs to go deeper than skills. Here are some questions to help you consider the truth we stand on:
Are we walking by faith, not by sight?
“So we are always of good courage. We know that while we are at home in the body we are away from the Lord, for we walk by faith, not by sight” (2 Corinthians 5:7, ESV).
Do we believe nothing- nothing- can separate us from the love of God?
“For I am sure that neither death nor life, nor angels nor rulers, nor things present nor things to come, nor powers, nor height nor depth, nor anything else in all creation, will be able to separate us from the love of God in Christ Jesus our Lord” (Romans 8:38-39).
Do we practice mindfulness in what's true?
“Finally, brothers [and sisters], whatever is true, whatever is honorable, whatever is right, whatever is pure, whatever is lovely, whatever is admirable—if anything is excellent or praiseworthy—think on these things. Whatever you have learned or received or heard from me, or seen in me, put into practice. And the God of peace will be with you” (Philippians 4:8-9).
Are we loving our neighbor (which is everyone- see Luke 10:25-37)? Considering others’ needs?
“Each of you should look not only to your own interests, but also to the interests of others” (Philippians 2:4).
I hope you are encouraged- as I have been by others’ faith today- in where our focus as believers is to be. Faith. Hope. Love. The greatest is love.
Justin K. Hughes
This post was originally published on 02/13/2014 on my wordpress and is newly updated.
“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.
Justin K. Hughes
Check out more resources on my page dedicated to them:
This post is intended for Christians looking to deepen their faith and mental health.
The Bible has a lot to say about fear and anxiety. In fact, some variation of “do not be afraid” is the most common directive in Scripture, occurring in some fashion more than ‘do not steal,’ ‘do not kill,’ and even ‘love your neighbor.’
How do anxiety and fear work? When we study these constructs in research, we are understanding mechanisms through which the body/brain is informed to face a threat or danger. We can argue these responses are inherently good, with their purpose being survival, protection, and preparedness. Its activation results in the sympathetic nervous system being primed: adrenalin and noradrenalin are produced, cortisol increases, heart rate increases, blood flow moves to muscles and away from extremities, speed and depth of breathing increases, and many other physiological changes occur. I’m grateful to have these responses- when they are in context. Out of context, they suck, to put it bluntly. Problems like panic attacks, worry, phobias, obsessiveness, skin/hair picking/pulling, preoccupation, social fears, avoidance, and more can be quite terrible.
One of the things I love most in my walk with Christ is context. Direction.
“The Lord is at hand; do not be anxious about anything, but in everything by prayer and supplication with thanksgiving let your requests be made known to God” (Philippians 4:5b-6, ESV).
What is being said here? Partly, “Do not be anxious about anything.” Since anxiety is a feeling of imminent threat- or in other words, it’s at hand- it’s very interesting that immediately before this phrase in Scripture we have another observation revealing a different type of imminence: “The Lord is at hand.”
In the context of the Lord being near we are told, “Do not be anxious.” This Greek word for ‘be anxious,’ μεριμνᾶτε (transliterated as “merimnate”), means to be divided and distracted, fearful, and caring for things that are out of context.
Sounds a lot like anxiety disorders, right? Yep. Or even just day to day worry/anxiety? Yep. When a person feels anxiety and fear and misinterprets this as significant, a person’s entire life and values can shift to focus on whatever is the subject of their fear, whether classified medically as a disorder or not. This can lead to a preoccupation with avoiding something or someone (spiders, relationships, sex, social situations) to obsessively checking to make sure everything is okay (car, stove, locks, bodily sensations, health, perfectionistic behavior), or pursuing something (money, security, approval of others)- and MUCH more.
To help work through these things and avoid pathological responses, I believe we need supports like therapy, help from friends, breathing techniques, mindfulness, exposure techniques, etc. This only underscores our complexity (we are “fearfully and wonderfully made” yet simultaneously all messed up) and highlights what we are told in Scripture about our limits. We can rightly use these tools to help us, just as we do nutrition, medicine, community, and so forth. But there is one thing these tools can’t do on their own: attach us to the very God of the universe and give us a lasting hope and focus- with meaning and purpose at the highest level.
So God gives us a jewel of a passage in Philippians 4 where we are kindly reminded what our attention is to be on (context), and a little bit of how we can live it out (practice). It is well known within the anxiety treatment world that even the most effective therapies (here’s looking at you, classic CBT, which I love and specialize in) often need supports to connect to larger beliefs, values, and commitments (ACT, DBT, and MI are some of the most common modalities). If we don’t connect a person to larger motivations and goals than “I just want to feel better,” it is often near impossible for a person to grow with sustainable change for the long term because they don’t have a sufficient reason and value to keep them invested. God gives us this.
Want more? Well, there’s two tips in the next two verses, Philippians 4:8-9
“Anxious for nothing” will take a lifetime to put into practice. I’m grateful to have the opportunity.
 Continued misinterpretation and repetitive experience of these symptoms worsens disorder, like in Panic Disorder, GAD, Phobias, OCD, PTSD, and more.
 Bible Hub. (n.d.). 3309. merimnaó. Retrieved July 13, 2019, from https://biblehub.com/greek/3309.htm
 I think it’s very important to note that we have to be very careful with saying anxiety/fear is sin- and what we mean by this. A lot of Christians get tripped up on this, and many, ironically, become more anxious. The extent of this point would likely require an entire book, so I will not take the space here to elaborate.
 Psalm 139:14; Genesis 1:26-27
 Jeremiah 17:9; Romans 3:23
 Psalm 73:26; 2 Corinthians 12:9-10
 Oh yes, there’s a whole lot more in Scripture on this topic. Let's not reduce a couple sentences into a "how-to-manual."
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).
Incredibly sad is the news that in a matter of days, two revered, loved, and famous celebrities committed suicide. This morning I was hit by discovering that after Kate Spade ended her life, Anthony Bourdain also ended his. After I prayed for their families, I knew I needed to send out this blog.
Suicide is an incredibly complex issue. Let me be simple at the risk of sounding reductionistic. Working in various settings in mental health for around 13 years, I have seen incredible hope bloom out of the desolate landscape of deep, dark depression. I have seen hope abound where there seems to be no hope. Personally, I have lost a friend, a neighbor, and a fellow college colleague to suicide over 15 years- and those are just the closest to me. There’s more. It’s so sad.
But there is hope.
How can I say this? I see it every day. None of us can ever fully control even our own best intentions for ourselves, let alone outcomes for others. Even as a counselor, I don’t have any more ultimate power to stop someone from committing suicide. Treatments that work for most are readily available. Treatment is often very effective. Sometimes several tries and different types of programming are needed. But you must take a step. Maybe it is to help, maybe it is to seek help.
Things that don’t work:
Things that do work:
If you or someone you love struggles, please seek help! My industry’s entire focus is helping people. Please call 911 or go to the hospital if your life- or someone else’s- might be in danger. There is no shame in this. Reach out to a therapist who is experienced in treating your concerns. May you find hope for yourself or others- hope that runs deeper than the saddest and darkest moment.
National Suicide Prevention Lifeline
Look under “Crisis” or find other helpful resources.
A Psychotherapists' thoughts on healthy living.
All Content on this Site, justinkhughes.com, was created for informational purposes only. Content is not intended as a substitute for professional advice, treatment, or diagnosis. Always seek the advice of your own personal health provider who is qualified to treat you, along with asking them any questions you may have regarding medical or other conditions. Never disregard professional medical advice or delay in seeking it because of something you have viewed on justinkhughes.com. Also, due to the sensitive nature of topics and material covered through this Site, which contains very descriptive and/or advanced content, you may not want to use justinkhughes.com. The Site and its Content are provided on an "as is" basis. Some posts are written for specific populations (OCD, Christians, Professionals)- with the intent to remain respectful to all- some content may not fit or go counter to your beliefs, perspectives, and what is explored for you in a professional counseling session with Justin K. Hughes, MA, LPC. The posts are intended solely for the population they are written to and can be designated by their titles and tags.
Links to external educational content are taken at your own risk. Justin K. Hughes, MA, LPC is not responsible for external content.