I see a common phrase that goes around: “Feelings are not facts.”  While I agree with the inherent sentiments, it’s wrong.  Feelings are facts.  Your interpretation of feelings may not be factual.  

Actual feelings are factual insomuch as they reflect disparate and connected processes within the body and mind, occurring in real time.  They give you information.  Sensations and emotions link us in to a wealth of details.  Researchers have long struggled to pinpoint feelings exactly (this is one of the reasons why there are no definitive feelings charts/references and why therapists will list anywhere from 3 basic emotions and as many as 100 or more), and though neuroscience is helping us understand more what occurs biologically in the brain, the conclusion is far from definitive.  

Making this separation that feelings are facts may seem a bit pedantic- splitting hairs.  My first supervisor I ever had in my internship would tell me something along the lines of this: “Separating feelings from thoughts is foundational for emotional intelligence.”  Agreed.  And it’s just plain healthy.  CBT (Cognitive Behavioral Therapy) helps us get really good at being honest with the interaction between thoughts, feelings, and behaviors.  Problems with anxiety, depression, dissociation, psychosis, narcissism, and all of mental health at some level deals with how much a person is living in reality.  None of us are 100% or will be perfect at it.  However, we can grow.  Do our thoughts line up with the bigger picture?  Are thoughts and emotions congruent?  Do behaviors fit what we believe?  If I feel chest tightness, racing heart, or my stomach drop when I’m around another person, the conclusion is not necessarily that that person is bad or I need to get away.  Yes, sometimes that is the case.  I have also had these feelings around people I trust implicitly.  There are a number of factors that can lead to feelings- amount of sleep I got last night, hunger, and stress in general, to name a small few.

So when people say feelings are not facts, I understand what they’re saying and support the gist.  I think your mental health will thank you, though, if you appreciate that your body and brain is created to give you information- and that information is factual insomuch as it exists and is connected to you.  How you interpret the meaning may not be factual.  If you separate these two, you will better honor what your body and mind are telling you, while, if you pursue growth, you can learn to line up your life more congruently for your mental health and the wellbeing of those around you.  ​

America today sees one of the highest levels of anxiety of any place in the world.[1] We are clamoring for attention online, wanting to be seen, to be loved.  Suicides by teens and young adults appear to be higher than they’ve been in years.[2]  We are the wealthiest nation on the face of the planet,[3] and we can’t rest.  We have more than anyone else (as a whole), and we can’t stop.  Children who are now becoming adults are feeling this crushing weight of anxiety and expectation (whether on themselves or from outside)- ‘get the degree and the top job, get married, have the house, have children, don’t screw it up.’   And we know that anxiety has biological and genetic influences, but these are not 100% causal by any means.  Our response makes a difference.[4]

• “Like most individual characteristics, psychopathologic symptoms are determined by many factors. The individual family environment is a relatively weak predictor of neuroticism and other personality traits, with genetics explaining much more of the variance…. There are also strong cultural influences on psychiatric symptoms — that is, an environmental influence outside of the individual family. Over time, American culture has increasingly shifted toward an environment in which more and more young people experience poor mental health and psychopathology, possibly due to an increased focus on money, appearance, and status rather than on community and close relationships” (emphasis mine).[6]

Generalized Anxiety Disorder (or GAD, the disorder most connected to general worries) is more impairing in higher income countries.[6]  The occurrence of GAD (lifetime prevalence) boiled down to:

• Countries with the following incomes:
• Low:        1.6%
• Middle:        2.8%
• High [U.S.]:    5.0% 

This is different from OCD, for instance, which sees about a 1-2% worldwide occurrence and doesn’t seem to vary a whole lot from country to country.  Depression seems to occur fairly consistently across the world, as well.  

I think the ultimate answer lies in Christ.  Hebrews 4:9 says, “...there remains a Sabbath rest for the people of God.”  Matthew 11:30: “My yoke is easy and my burden is light.”  

*Insert deep relaxing breath.
  
God ordained rest from the beginning of creation.  Genesis 2:2-3: says, “And on the seventh day God finished his work that he had done, and he rested on the seventh day from all his work that he had done. So God blessed the seventh day and made it holy, because on it God rested from all his work that he had done in creation.”  God purposed rest for us, his creation.  God wasn’t winded and saying, “Oh boy, that creating sure made me tired...let me sit back and take it easy.”  We know he created it for us.  Jesus states, “The Sabbath was made for man, not man for the Sabbath” (Mark 2:27).  If we back up to the institution of the Sabbath given as law to the Israelites, in Deuteronomy 5:15 we are given a reason why God so seriously wanted His people to be obedient in this: “remember that you were a slave….and the Lord your God brought you out…”  So to pause and rest is to say, GOD is my provider, and my striving only results in results because of God (Seriously, check out these passages: Deuteronomy 2:7; 1 Chronicles 29:12; Psalms 23 and 147:8; Matthew 6:25-33; Philippians 4:19).

Observationally, we don’t have to look far to understand our need for regenerative rest.  Sleep is one of the greatest things we can “do” for our well being.[7]  Our bodies need one third of our day just to be restored.  ⅓!!  Living to 75 that’s 25 years of our life spent sleeping!  When we try to cheat this, various problems ensue.  And by the way, the U.S. has a tremendous problem with sleep, as well.[8]  It’s hard to even grasp the scope of this due to the myriad ways people attempt to rest that may not be directly researched or studied in any one experiment (sleep aids, watching media, abusing substances- including over-the-counter cough syrup and benadryl).

The Doctor Who episode “Sleep No More” features the attempt to cheat sleep and maximize productivity.  Scientists discover a device (“Morpheus”) that takes only a few minutes to compress a month of sleep.  Serious problems ensue (enter evil “Sandmen” into the equation, for any of you Doctor Who nerds).  Sleep and rest are common themes in literature and life.  No doubt, they play a substantial role in our well-being- or downfall. 

Though therapy is highly efficacious in addressing disorders specifically and often helpful for much personal growth, it is not set up to be a worldview (a personal understanding or philosophy of the world)- it was never meant to be!  Therapy is the clinical application resulting from theories and science on human thought and behavior, just like medical practitioners study from a particular perspective and approach (“Western”, naturopathic, Traditional/Chinese, etc.).  Psychology cannot be an entire worldview, by definition, because it’s only one subset of study, research, observation, and experience.

Back to Jesus: “Come to me, all who labor and are heavy laden, and I will give you rest.” (Matthew 11:28). 

Are you tired of striving in your own strength?  Jesus speaks to the question of trying to be good enough. The Bible presents a very large pill to swallow that is offensive to our Western, pluralistic and politically correct sensibilities: your striving is empty without God.  BUT, here is the hope, and this is the Gospel: being made right with the God of the universe through Christ, we have peace. We have freedom. We have hope. We have purpose. We are forgiven.  We are loved.

• “Therefore, since we have been justified by faith, we have peace with God through our Lord Jesus Christ” (Rom 5:1).
• “Thou hast made us for thyself, O Lord, and our heart is restless until it finds its rest in thee” (St. Augustine of Hippo).
• “Unless the Lord builds the house, those who build it labor in vain.  Unless the Lord watches over the city, the watchman stays awake in vain.  It is in vain that you rise up early and go late to rest, eating the bread of anxious toil; for he gives to his beloved sleep” (Psalm 127:1-2).
• “Cease striving and know that I am God” (Psalm 46:10a).

From the poorest and most overlooked member in the slums of Calcutta to the Billionaire on 57th Street in NYC: You are loved. You are valuable. Striving and anxious pursuits are nothing without God- let us seek his rest.

References:
[1] Newman, T. (n.d.). Is anxiety increasing in the United States? Retrieved October 07, 2020, from https://www.medicalnewstoday.com/articles/322877.  “When they compare the levels of depression, no single area has significantly higher rates. When it comes to anxiety disorders, however, it’s a different story; the Americas are head and shoulders above all other regions, including Africa and Europe.”
[2] 

• ​Oren Miron, M. (2019, June 18). Suicide Rates in Adolescents and Young Adults, 2000 to 2017. Retrieved October 07, 2020, from https://jamanetwork.com/journals/jama/fullarticle/2735809
• Santhanam, L. (2019, October 18). Youth suicide rates are on the rise in the U.S. Retrieved October 07, 2020, from https://www.pbs.org/newshour/health/youth-suicide-rates-are-on-the-rise-in-the-u-s
• https://www.cdc.gov/nchs/data/nvsr/nvsr68/nvsr68_09-508.pdf
• https://www.cdc.gov/nchs/data/databriefs/db352-h.pdf

[3] Silver, C. (2020, September 18). The Top 20 Economies in the World. Retrieved October 07, 2020, from https://www.investopedia.com/insights/worlds-top-economies/
[4] This is not to shame you.  You may have a legit challenge with anxiety due to disorder- if so, I’m sorry!  You may have tried seemingly everything to feel better and it just hangs around.  Keep reading, if this is you, because the post still applies, it’s just that I want you to know that you may have it harder than others, and you may need treatment.  Truly, this world is not fair.  But stay with me; there’s hope.
[5] http://www-personal.umich.edu/~daneis/symposium/2012/readings/Twenge2010.pdf
[6] The disorder is significantly more prevalent and impairing in high-income countries than in low- or middle-income countries.
[7] Walker, M. P. (2018). Why we sleep: The new science of sleep and dreams. London, UK: Penguin Books.
[8] CDC - Data and Statistics - Sleep and Sleep Disorders. (2017, May 02). Retrieved October 07, 2020, from https://www.cdc.gov/sleep/data_statistics.html
All Scripture quotations are ESV.  

“You want me to do what?!”  Many of my clients, and particularly for the sake of this article, Christian clients, are a bit surprised when I ask them to practice exposure.  Repeating scary, terrible thoughts on paper or aloud.  Doing things that feel risky.  It seems as a clinician I’m disrespecting your beliefs and don’t really get it.  Maybe I’m asking you to do something unbiblical, blasphemous, against what God would want.  But what if I do understand and am helping you live in line with your beliefs?  What if exposure is a powerful tool under God’s grace (Matthew 5:45) to help you get over a disorder?

The Great Hesitation.  When some clients start their treatment with me, I come across familiar hesitations when we begin discussing Exposure Therapy and facing one’s fears:

• What if I really am at risk of doing this thing I fear?  Won’t exposure make it worse?
• Are you asking me to do something that could go counter to my faith?
• Don’t I need to avoid this thing rather than giving it more credit?
• Isn’t this a spiritual problem?  Shouldn’t I pray more about this?
• Isn’t this Satan telling me lies?  
• If I have “bad thoughts” (thoughts of harming someone, making someone or myself sick, perverted sexual thoughts), shouldn’t I be on guard?  Flee temptation?  

Maybe.  I of course do not know your (the reader’s) story, so I cannot say for you personally.  Though, here’s the problem many of my clients run into: they are reinforcing fear every time they avoid and run from thoughts/urges/impulses/feelings that are out of fear rather than a want (see an important article on this for more: FACE fear, FLEE Temptation).  Some basic science is in order here: when you fight and resist a thought, it persists (e.g., don’t think of the pink elephant, trying to get a song out of your head, etc.).  That’s the way it’s supposed to work- a threat believed to be a threat is supposed to feel like a threat.

This is where exposure therapy comes in.  As a summary, exposure is the systematic and intentional triggering of fear while minimizing- and ideally eliminating- all pathological responses.  In the therapy process, when I start to introduce clients to the idea of sitting with fear mindfully and not fighting it, most have hesitations.  “You’re telling me to do what?!  You want me to repeat these horrific thoughts again and again?!”  I get it; it seems paradoxical.  Most people can rather quickly wrap their heads around an exposure to an overt situational fear (like holding a kitchen knife when you have an intrusive harm fear) but have a harder time understanding exposure for other “Pure O” intrusions, such as harm and scrupulosity, like the following:

• “I’ll be responsible for my child’s death.”
• “I’ve picked the wrong person to be with.”
• “Maybe that bump I heard in my car was a person.  Should I check to see if they’re okay?”
• “Was I just attracted to a dog?  Did I just get turned on?”
• “I must not believe in God because I feel numb when I say His name.”
• “What if I just get up and run into oncoming traffic?”

The above are examples of intrusive thoughts; they are counter to what a person holds as their overall value and pursuit, or “ego-dystonic.”  If you want to know all about treating these thoughts through imaginal exposure, check out the article “Flip the Script- A Guide to Imaginal Exposure.”  And yes, I’ll tell you right now that if a person obsesses on the above or has ritualistic behaviors and avoidances, we are going to work with leaning into the discomfort of these, not ignoring them.  


The clinical rationale.  In all disorders featuring anxiety and fear, there is a problem with the system that signals something is wrong.  It’s broken.  Doesn’t work right.  It’s a fire alarm that goes off when there’s no fire.  A missile alert with no missile.  Depending on fear, a person might feel a range of things: fear, disgust, anger, sadness, loneliness, dread, regret, chest tightness, racing heart, sweaty palms, neck and back tension, and extensively more.  We tend to feel the feelings that a signal dictates.  For example:

• If you have ever thought someone nefarious was following you, you might have felt fear, suspicion, anger.  
• If a child cries after something you say, you might would feel sadness, regret, or shame.  
• When you say something socially that is a ‘miss,’ you might think you’ve totally embarrassed yourself.

When is a time you felt something strongly that turned out to be fine?  

In disordered behavior, people become over-focused (or under) on a narrow set of experiences.  People who are overly vigilant can run into some of the very problems they seek to avoid, or a different set of problems.  Examples: 

• If you repeatedly fear you might say something wrong and avoid talking in social settings, in time others may actually start to avoid you or stop talking to you altogether since they can’t have a conversation with someone who won’t engage them!  
• Overwashing and cleaning the body leads to less resistance to germs, increased cuts and open skin with greater risks of various health problems.  
• Spiritually, a person who compulsively prays that they will be kept safe will be over-focused on small details (saying a certain thing a certain way, fearfully repeating the same thing, or maybe focused on only a narrow scope of safety like driving, contamination, or health).  This will lead to loss of seeing the bigger picture.  

The Biblical rationale.
If we are to change the outcomes for people who suffer from disorders, psychology has developed some very solid tools.  If you believe, like I do, that the Bible is God’s Word and is meant to have authority in your life, then you’ll likely need a good biblical rationale for exposure therapy.  Here goes on my end, but I am going to ask you personally to dig in.  This is your decision.  Don’t rely on some therapist to tell you what to think- talk to God, pray, use the brain He’s given and be open to the teaching of trustworthy others (2 Timothy 4:2).

Truth is very important in the Christian faith (John 17:17; Psalm 145:18; Proverbs 12:22; John 4:24; 1 Corinthians 13:4-6).  If part of being the church of Christ is to speak the truth to one another, including difficult things like anger (Ephesians 4:15, 26), I remind clients often that if you have intrusive, obsessive, or otherwise bothersome thought or feeling, being open about them and calling them out is simply being honest.  It’s being truthful.  God knows what’s going on in your head (1 John 3:20)!

When Philippians 4:8 is brought up, it is sometimes a “proof text” on how you “should always thinking positive.”  That’s a remarkably short-sighted, superficial view.  
“Finally, brothers, whatever is true, whatever is honorable, whatever is just, whatever is pure, whatever is lovely, whatever is commendable, if there is any excellence, if there is anything worthy of praise, think about these things.”  
This clearly can’t mean to not think about negative things, evil, or something terrible.  If so, we’d never be able to ask forgiveness of our sins by calling them out and repenting!  One of the ways that we can think on things like justice, honor, love, etc. is by calling out the opposite: injustice, dishonor, and selfishness.  It is in acknowledgement of problems that the solution can be instilled.  

God knows our hearts (Proverbs 21:2; 1 Samuel 16:7; Jeremiah 17:10; Acts 15:8; Romans 8:27).  If you’re afraid you might do something bad, do you believe God knows that?  And if you’re going to do something bad and be unrepentant, then you aren’t going to repent, right?  And if that’s the case, why are you trying?  If you’re doomed, what’s the point in trying to change that?  If there’s a chance- even if you don’t feel like it in the moment- just a small chance that you can take to God your innermost thoughts and feelings and get love and grace and forgiveness and peace and patience, is it worth it to you?  Would you be willing to try?  

Walking with God means we are “...casting all your anxieties on him, because he cares for you” (1 Peter 5:7).  Nowhere in the Bible does it say you will not feel anxiety or struggle with anxiety.  It tells us how to frame it (1 Peter 5:7; Philippians 4:6-8), that fear is not God’s heart for us (1 John 4:19), and that he loves us in it (each of these references prior reflects God’s gentle, patient love).  The Bible is not a psychology textbook or methods and techniques class.  While we walk with Christ, we learn to depend on God by faith.  Sometimes that’s therapy, medication, prayer, community, repentance, exercise, gratitude, acceptance, rest, or any number of things.  

Obviously, we are not going to find a passage that says, “do exposure therapy”  (and of course, “pay good money for it”, ha!).  

Compassion and Understanding to You
When clients come to me with thoughts and behaviors they are bothered by, the last thing they want to do is to look it squarely in the face or write it down or say it aloud (It’s called exposure for a reason).  But in reality, this is what helps shine the light on it- calling it out in truth.  It calls it to the table to do business.  In the end, you must personally seek the Lord, and I hope through prayer, His Word, and community to determine what steps you will take in anything important in life.  I do hope that if you can benefit from something like Exposure Therapy, you will find, as I have, that it is a tool, albeit human and imperfect, that God has graciously allowed us to discover, maybe like penicillin, insulin, the benefits of exercise, or Vitamin D..  May the created point back to The Creator and show His goodness and love.  

“If you then, who are evil, know how to give good gifts to your children, how much more will your Father who is in heaven give good things to those who ask him! (Matthew 7:11, ESV).  

“For he makes his sun rise on the evil and on the good, and sends rain on the just and on the unjust” (Matthew 5:45 b, ESV).

“...He cares for you” (1 Peter 5:7b).

 

Katherine didn’t understand why this pandemic hit her so hard. In fact, she was embarrassed that it did. “I mean, my routines and orderliness can be a little overboard, but I’ve never had difficulty getting by day-to-day. I cry at the drop of a hat and just don't know what to do." I was so honored that she admitted she was struggling, because in that honest vulnerability, she is now getting help.*

In this time of COVID-19, there is a common expectation: the misconception that "healthy" means we won't feel anxious - or the opposite: success is defined by feeling completely safe, confident, or certain. That's crap.
​
Though it’s nice to feel less anxious, it’s not always reality, even if we’re doing all the right things. I mostly work with clients by helping them learn to stay focused on things of value, regardless of how they feel. Overall anxiety reduction is a result of various factors and is rarely immediate. In time, with supportive factors, anxiety often will go down. Jesus himself felt greatly distressed and overwhelmed, at times, too, if you didn’t know. He wept, sweated, pleaded, was scared, bled, and got angry and frustrated. He understands because he can actually relate - physically and emotionally. He gets Katherine's suffering - and yours, too.
Life involves not only facing bad things that don't happen, but also bad things that do. The question is, are you trained and ready? Can you still keep your focus even when the world around you and inside of you seems to be in chaos? Here are some quick tips to help you stay grounded in reality.


1. Be assertive. Routines have changed. We have to communicate to make the covert overt, like telling your loved one if you need a break to recharge (they can't read your mind!).
2. Be careful of untrue thoughts. Unrealistic thought patterns negatively impact our entire life, like All-or-Nothing Thinking. For example, "Since I’ve been eating poorly it doesn't make a difference if I exercise.” Katherine, mentioned earlier, fell into this trap by believing she was doing a terrible job simply because she felt overwhelmed. Mental health is based on grasping reality to the extent we can. Watch your thoughts and line them up with reality as much as possible.
3. Don't over-consume on substances. Caffeine and alcohol are certainly the most popular substances to monitor.
4. Downtime/Mindfulness/Quiet. The importance of giving our brain pauses and rest cannot be overstated. During a crisis, we need more intentionality to slow down unhealthy processes that are automatic or deeply ingrained. Learn to be mindful, slow down the process, and/or meditate on something beneficial- like how much God cares for you and promises to never leave or forsake you. Benefits range from increased focus and function to decreased stress and disease.
5. Emotions, Thoughts, and Behaviors - Tune In. Be aware of your thoughts, emotions, and behaviors. God gave you these - learn to pay attention to them and discover how to respond - sometimes in ways you might not expect.
6. Exercise. Exercise is highly connected to mental health. If you’re stuck in the house, there are ways to get creative. Make a game with a fitness tracker! Compete with others! Set up prizes for yourself or children! Get outside where possible and get moving.
7. Get Support. Use trustworthy support. Few things in life (if any) are done well without support. One place to get support is through an online or in-person Live Second Group.
8. Have fun! We all need reminding to pursue fun. Even the term ‘recreation’ is based on the concept 'recreate '- “to give new life.”
9. Medication. Medication can play a necessary role in well-being. You don’t need to feel shame if you can use a physiological boost for your brain health. Consult a health professional if this would be the right option for you.
10. Normal structure. Our brains integrate information we don't need to remember and becomes second nature. So when you change your routine massively, you will feel out of balance. That’s okay! Try to make use of old structures while learning to develop new ones!
11. Nutrition/Diet. Be careful not to overindulge on carbs and sugars - the snacky & sweet food you may feel the urge to “pound,”which can offer quick energy and pleasure, but overconsumption won’t benefit you. In fact, it will impact you negatively.
12. Prayer. Open communication and presence with the God of the universe is what we access through prayer! His power is what I need; it's really good to follow a big God who is over all our circumstances.
13. Prioritize. Limit inputs of information and stimulation or your brain will do its best to force limits and push you back into what’s called “homeostasis” (or balance), which can lead to feeling burnout and depression.
14. Serve others. Loving our neighbor as ourselves is beautiful. Not only does it help them, but we also can find much encouragement and joy. Learning and growth is often solidified when we can teach, pass along, and serve. Win-win.
15. Sleep. As one of the most important contributors to all aspects of health, good sleep is a necessary foundation to good health.
16. Spend/Save/Give money. Work from a budget. Spending money can be satisfying. Giving it away is powerful to others and ourselves. Taking on unnecessary debts, overspending and being miserly or hypervigilant all lead to stress in different ways.
17. Socialize. We are social beings. Direct contact releases neurotransmitters! But so can positive interactions in this time where we can’t touch much. Wow! For the time being, technology, phones, letters, or writing on messages on cardboard goes a long way.
18. Spirituality/Faith. What do you live for? What do you believe? And are you living congruently with it? Are you allowing yourself to ask questions and pursue guidance, support, and practices around what is good and true and beautiful and lovely? To discover more about what it looks like to follow Jesus watch this.
19. Sunlight. Not only is sunlight important in Vitamin D production, natural light is linked with numerous processes ranging from sleep to mood and much more. If you must be indoors or have limitations on natural light, find ways to maximize it.
20. Supplements. There is good evidence that several supplements can aid in mental health; some linked most commonly to mental health are Vitamin D, B Complex, and Omega-3 Fatty Acids (always follow your doctor’s advice).
21. Your context is your context. Don't compare. "Comparison is the thief of joy." When we look at where we are, don't let expectations crowd out what you're supposed to be about.
Keep in mind this is educational content and not intended as a substitute for professional advice, treatment, or diagnosis. Any of these tips will come across as too simple for someone suffering highly.

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:

This video and guide below were specially formulated to help you be mindful in an "Exposure-Friendly" way.

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 of the Guide).  So if we need a different set of tools to face fear, here's one of them.  I hope it helps.

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!

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

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

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!