What has worked for rituals?

[Fran]

I need some insight on how to handle rituals.

This is the definition:
"Rituals such as hand washing, counting, checking, or cleaning are often performed in hope of preventing obsessive thoughts or making them go away. Performing these rituals, however, provides only temporary relief, and not performing them increases anxiety. Left untreated, this often chronic, relapsing illness can take over a person's life."

When did you notice rituals and what have you done to help your difficult child to handle them?
What sort of rituals did your child exhibit.

Thanks for any help you can share.

 

[Ephchap]

Fran,

Thinking back, when my son was 2 or 3 years old, my mom mentioned how she never saw a little boy wash his hands so much.

Fast forward to age 13 - we figure puberty was setting in, but my son actually didn't hit the growth spurt, hair growth, etc. until 16 years old (which in my family is common for the boys - his older brother, my brothers, my cousins, etc.)

We began to notice him touching things evenly. If you bumped his arm, you had to touch it with the other. We began to notice then when riding in a car, he would play with the air/heat vents in front of him. He would touch it with one hand, then the other. It always had to be even. That was our first red flag.

When playing hockey, he always had a ritual before the center ice faceoff (he was the center who took the faceoff). He had to stretch one way and then the other before the referee dropped the puck.

At school, he got in trouble for looking out the window during a test. The teacher thought he was cheating - but turns out, he had looked out the window once, so he had to again - to make it even - even though the teacher had warned him not to look out again.

He has a real phobia about germs - still does. He will not hold onto the handrail of escalators, has a hard time using public restrooms, has to have a straw when drinking anything at a restaurant, as he won't put his lips on the glass, etc. Not quite as bad as the movie, "As Good as it Gets", but you get the idea.

One night, when I went to tuck him in and kiss him goodnight, I noticed he was out of breath. When I asked him about it, he didn't want to tell me - but very reluctantly finally said that he says his prayers to himself when he gets into bed. He was holding his breath while he did, or something bad would happen.

The next day, I called the psychiatrist, who suggested a psychologist who specialized in Obsessive Compulsive Disorder (OCD) behavior.

I was very happy with the therapy sessions - which at first, were once a week for the first few months. The therapist worked with him to first of all, become aware of all his rituals and obsessions, and then to work on getting rid of them.

They tried one medication, which I can't be sure - but I think it was zoloft. Then they tried prozac at 20 mg - and we had to keep increasing it each week till he hit 80 mg - which is the dosage found to be a success with Obsessive Compulsive Disorder (OCD) patients. That medication has worked for my son, and he has been on the same dosage since age 13.

Sorry so long - but it was a process we went through, and yes, I have to say he had good results.

Hugs,
Deb

 

[TerriH]

I actually used to do rituals, though I am not Obsessive Compulsive Disorder (OCD).

It started after my Mother spent 2 weeks in a hospital for a nervous breakdown.

Even when she came back things were not the same. It had been tense at our house for quite a while, and my Mother was positively JUMPY for a year after that. It seemed to help for things to come out "even", I don't know why. Gave me a sense of one thing that was under my control, I THINK. I couldn't make the household mellow, but I could make things come out even.

Rituals decreased over the years. I pretty much quit when I was grown. As my inner tensions decreased, the rituals decreased also.

 

[Fran]

up

 

[OTE]

My Pervasive Developmental Disorder (PDD) son has to complete a game- he can't be disrupted in the middle. Maybe it's not a ritual in the sense you mean but it's something like it. Disrupting him in the middle of his game creates anxiety that results in screaming and tantruming.

 

[Fran]

OTE, that is what I mean regarding a ritual. It's like completing a circuit before moving on.

Is there anything you do to help ease the reaction?

 

[OTE]

Honestly, no. we're down to SOMETIMES having a meltdown and those are shorter in duration. But it's in there with not being able to lose a competition. We're fighting it but not winning yet.

As far as I know the only treatments for Official adult Obsessive Compulsive Disorder (OCD) are psychotherapy which has limited success and SSRIs which are successful only for some people. I've heard of hypnotism, biofeedback and behavior mod- all of which I've heard also have limited success.

This is a tough one.

 

[Nancy]

There is an excellent book called Brain Lock by Jeffrey M> Schwartz, M.D. that I bought because my easy child has many of the same ritulas that EphChap's son does. This is how they describe the compulsions side of Obsessive Compulsive Disorder (OCD):

"Compulsions are the behaviors that people with Obsessive Compulsive Disorder (OCD) perform in a vain attempt to exorcise the fears and anxieties caused by their obsessions. Although a person with Obsessive Compulsive Disorder (OCD) usually recognizes that the urge to wash, check, or touch things or to repeat numbers is ridiculous and senseless, the feeling is so strong that the untrained mind becomes overwhelmed and the person with Obsessive Compulsive Disorder (OCD) gives in and performs the compulsive behavior. Unfortunately, performing the absurd behavior tends to set off a vicious cycle: It may bring momentary relief, but as more cumpulsive behaviors are performed, the obsessive thoughts and feelings become stronger, more demanding, and more tenacious. The afflicted person ends up with bothan obsession and an often embarrassing compulsive ritual to go with it. It is not surprising that many people with Obsessive Compulsive Disorder (OCD) come to see themselves as doomed and may even have suicidal thoughts by the time they seek professional help. In addition, years of traditional pyscotherapy may have served only to confuse them further."

The book goes further to describe repetitive rituals such as repeating routine activities for no logical reason, repeating questions over and over, and repeating or rewriting words or phrases, counting rituals, blinking or staring rituals, and the need to touch, tap, or rub certain objects repeatedly.

Schwartz describes a four step process that helps control almost any intrusive thought or behavior. This process is called the Four Step Self-Treatment Method and is a way of organizing your mental and behavioral responses to your internal thought processes. Rather than just acting impulsively or reflexively, like a puppet, when unwanted thoughts or urges intrude, you can train yourself to respond in a goal-oriented manner and can refuse to be sidetracked by self-destructive thoughts and urges. The four steps are: Relabel, Reattribute, Refocus, Revalue.

I saw a report on tv recently on one of the primetime shows on this subject and they have had a lot of success with this type of refocusing behavioral therapy in helping people break the cycle of rituals.

I did many of these rituals myself as an adolescent and young adult. I thought I was crazy in that I continually had to repeat numbers or words and if I touched something once I had to do it again, always an even number. I could go on about all the rituals I performed but then I will start to do them again so they are way back in my memory bank now and I do everything possible to keep them there.

Nancy

 

[SassyGirl]

Fran, my mother has tremendous anxiety and some rituals. She found a therapist who specialized in cognitive behavior therapy and is doing much better at controlling her anxiety.

http://www.cognitivetherapynyc.com/problems.asp?Sensory Integration Disorder (SID)=249

Also, this looks like a great book to get with many resources:

http://search.barnesandnoble.com/booksea...n=9780812931174

Hugs,
Sassy

 

[Fran]

Thanks guys.
If you order the book that Sassy suggests, please order it through our site(amazon.com)
:wink:
http://www.amazon.com/exec/obidos/tg/det...=glance&s=books


What specifically did any of you do or see a parent do at home to help ease the intensity of rituals?

 

[busywend]

Fran, I am loving this post as difficult child is newly diagnosis'd Obsessive Compulsive Disorder (OCD). It is making me think more and more about the rituals and obsessions she has.

I believe there is another post on this that was started in Watercooler - should it get moved here?

 

[Martie]

Fran,

I have heard of the book Nancy mentioned and read a very favorable review of it. (I have not read it myself.)

Like everything else, rituals come in degrees. All children, in my opinion, engage in them because they are essentially helpless in the face of a powerful world. They are so common that we don't think about them in an Obsessive Compulsive Disorder (OCD) way: e.g., "if you step on a crack, you'll break your mother's back," directly addresses a child's fear of abandonment through illness or death.

With Obsessive Compulsive Disorder (OCD) or Obsessive Compulsive Disorder (OCD)-type difficult children, there is much greater anxiety and therefore, many more rituals that can become a central focus. That is why I think that there is a "brain miswire" in Obsessive Compulsive Disorder (OCD)--because it is a common phenonmena exaggerated and it responds (sometimes) to high doses of SSRIs. Cognitive redirection seems to help a lot alone or in combination with medications.

At egbs, MrNo was on such high dosages of an SSRI (for depression) that his Obsessive Compulsive Disorder (OCD) tendencies virtually disappeared. When his antidepressant medications were lowered into the "normal range" the Obsessive Compulsive Disorder (OCD) behavior did not return. I might add, however, that the intervening psychotherapy--tons of it --as you well know, greatly reduced his anxiety so MAYBE, he doesn't need his rituals any more.

I don't think the germ thing will ever go away, however. Some people are just like that. Before he KNEW about germ theory, he wouldn't finger paint because he didn't want to get his hands "messy." Somethings we just live with.

Martie

 

[Fran]

I posted this on each of the forums so that I can get input from a lot of age groups and viewpoints.

The book mentioned has been brought up to me before and was listed at one time in our book section.(will get it out there again). Thanks.

 

[Nancy]

You can order the book I suggested through the amazon link on this site also.

I followed the steps in the book to ease the rituals. I read the book and had easy child read the book but to summarize:

Relabel..you must call them what they really are: obsessions and compulsions. You must make a conscious effort to keep grounded in reality. You must strive to avoid being tricked into thinking that the feeling that you need to check or re-count or to wash, for example, is a real need. It is not.

Reattribute..answer the questions, Why don't these bothersome thoughts, urges, and behaviors go away?. Why do they keep bothering me? What should I attribute them to. The answer is that they persist because they are symptoms of Obsessive Compulsive Disorder (OCD), which is related to a biochemical imbalance in the brain that causes the brain to misfire. Therefore, your brain gets stuck in a gear and it's hard for you to shift behaviors, Your goal in reattribute is to realize that the sticky thoughts and urges are due to your balky brain if you will. One tool in this step is to "staple off" the part of the brain that causes these thoughts. You can learn to do it with your mind.. Recognize the intruder for what it is and fight back using the steps to shift sticky gears in your brain.

Refocus..instructs you to work around those nagging, troublesome thoughts by Refocusing your attention on some useful, constructive, enjoyable activity. The key to refocusing is to do another behavior. When you do this you are repairing the broken gearshift in your brain. Your brain starts shifting more smoothly to other behaviors. The more you practice this step, the easier it becomes.

Revalue..with consistent practice you will quickly come to realize that your obsessive thoughts and compulsive behaviors are worthless distractions to be ignored. With this insight you will be able to revalue or devalue the pathological urges and fend them off until they begin to fade. Don't take the symptoms at face value--they don't mean what they say. Tell yourself it's not me...it's just Obsessive Compulsive Disorder (OCD). As your brain begins to work better it will become easier to see the obsessions and compulsions for what they are. Your brain will function in a much more normal automatic way and the intensity of your symptoms will decrease.

Step three Refocus is probably the most difficult steps. It involves actively doing something when the intrusive thoughts come into your head. The goal is to stop responding to those thoughts in your usually way and to replace that with something else while acknowledging that, for the short term, these uncomfortable feelings will continue to bother you. You begin to work around them by doing another behavior. You learn that even though the Obsessive Compulsive Disorder (OCD) feeling is there, it doesn't have to to control you.

One of the tools they give for those who have to repeatedly count or repeat things int heir head is that every time they find themselves doing that they pick a word and repeatedly say that word instead of what they are recounting or repeating. This shift to replace the Obsessive Compulsive Disorder (OCD) behavior with some other activity, word, phrase, breaks the cycle. The urge to repeat the Obsessive Compulsive Disorder (OCD) activity becomes weaker.

When my daughter begins to have obsessive thoughts she immediately tells herself that is what they are and tries to change her activity. It is not always an easy thing to do, but she has to push out the obtrusive thoughts and replace them with others.

The only thing that I as a parent can do is to read as much as I can about this disorder and fully support her when I see her doing Obsessive Compulsive Disorder (OCD) behaviors or her rituals. I tell her what I am observing and try to redirect her into other activity.

Of course medication to help the underlying anxiety is crucial and when we got that dosage straightened out, she could then at least attempt to work on the other.

I don't know if any of this helps. The person needs to be able to do these steps themselves, a parent cannot do them for them, so it is a matter of us knowing what they can do and encouraging it and reminding them that it is not them, they are not crazy, it is the Obsessive Compulsive Disorder (OCD) that is causing them to behave that way. It is a huge relief when they finally accept that it is something in their brain that makes them do those things and with enough practice they can tell their brain to stop.

Looking back on my own rituals, without having had the benefit of knowing why I was doing it or reading anything to help, I began to replace all the obsessive thoughts I had with other thoughts whenever they came into my head. For example I had to touch everything a certain number of times if I touched it once. Therefore I forced and I mean literally forced myself to run away from the object before I have a chance to touch it again. If I stepped on a crack and had to step on another, I ran over the pavement, not looking at the cracks, so I would break the cycle. If I found myself repeating a word or what someone said in my head I would think of another word and say it enough times until I stopped remembering the first word. If my thoughts became really intrusive and I couldn't concentrate I did a physical activity until my thoughts subsided. It was not easy and it did not happen overnight.

Another thing I did that I just remembered is when I began thinking obsessive thoughts I turned my brain into an eraser and erased them. Sounds silly but I literally made a side to side movement as if I was erasing the thought. Hopefully I did this when no one was around LOL. But by my erasing the thought or ritual I was able to make it go away.

Nancy

 

[Fran]

The whole thinking back is curious to me. This whole thread isn't personal but I can remember getting words and songs and phrases repeating and repeating in my head until I was exhausted. (I seem to think this was between 5th and 7th grade) Eventually, I made a conscious choice to stop it-to change the channel. The phrase would try to intrude into the other thought but I would consciously stop it again and again until I broke the cycle. I also, remember having so many thoughts swirling in my conscious mind that it was stressing me to remember it all and that I made a choice to discipline myself to focus on one thing at a time. I seem to recall being aware that this was more functional but that my "quicker" thinking had slowed down and I wasn't as sharp. I guess at that time I made a trade off.

Weird how all these past life experiences come up when we are talking about disorders. Who would have known?