Think of the following scenario: you have friends over at your place and you serve them drinks. Before they can place their cups on your beautiful coffee table, you exclaim and dart out coasters underneath the ice-cold glasses before the first drop of dew can drip on that expensive rosewood. Your lightning-fast reflexes have intercepted what would have been a disaster. Your friends are startled at first, then they laugh and tease you. They say you have OCD – obsessive-compulsive disorder.
This, or a similar instance, may have happened at some point in our lives before. We tidy up a mess in the presence of others, or when our belongings are organised ever so neatly, and we end up joking about OCD.
But in truth, OCD is far from such behaviours that could be written off so light-heartedly.
A person with OCD will have compulsions – they feel the need to perform certain repeated behaviours to reduce emotional distress or to prevent undesirable consequences. These compulsions are so intense that they cannot carry out other daily routines without acting on them. Some common ones include:
Excessive washing or cleaning – They fear contamination and clean or wash themselves or their surroundings many times within a day.
Checking – They repeatedly check things associated with danger, such as ensuring the stove is turned off or the door is locked. They are obsessed with preventing a house fire or someone breaking in.
Hoarding or saving things – They fear that something bad will happen if they throw anything away, so they compulsively keep or hoard things, usually old newspapers or scraps of papers which they do not actually need or use.
Repeating actions – They repetitively engage in the same action many times, such as turning on and off a light switch or shaking their head a numerous number of times, up 20 to 30 times.
Counting and arranging – They are obsessed with order and symmetry, and have superstitions about certain numbers, colours, or arrangements, and seek to put things in a particular pattern, insisting to themselves that the layout must be symmetrical.
When Does OCD Become Chronic and What Should You Do If That Happens?
OCD is a chronic disorder, so it is an illness that one will have to deal with for the rest of his or her life. It is difficult to tell when the disorder becomes chronic, as it presents the individual with long-lasting waxing and waning symptoms. Although most with OCD are usually diagnosed by about age 19, it typically has an earlier age of onset in boys than in girls, but onset after age 35 does occur.
A cognitive model of OCD suggests that obsessions happen when we perceive aspects of our normal thoughts as threatening to ourselves or to others, and we feel responsible to prevent this threat from happening. These misperceptions often develop as a result of early childhood experiences. For example, a child may experience living in a dirty and dusty environment, while being subjected to some form of trauma at the same time. He associates a lack of hygiene with suffering from the trauma. At a later stage in life, he may start to feel threatened upon seeing the unhygienic behaviours of someone he lives with, be it his parents, romantic partner, or flatmates. This leads to the reinforcement of the association and to the development of his beliefs that suffering is inevitable when unhygienic conditions are present, giving him compulsions to improve these unsanitary conditions through washing and cleaning.
If one is affected by OCD to the extent that he or she is unable to hold down a job and to manage household responsibilities, then there is a need for clinical treatment as the symptoms have become severe. Like in the above-mentioned example, recurrent and persistent thoughts of dirt will give the individual compulsions to neutralise these thoughts, resulting in repetitive washing, and checking behaviours. This causes distress and significantly affects one’s functioning.
When OCD has become a chronic illness, through a formulation of intervention strategies, the psychologist should extrapolate the client’s pattern of behaviour and expect a positive prognosis for functional improvement.
How Can OCD Be Treated?
A person diagnosed with OCD may seek treatment through a treatment plan that consists of cognitive strategies. These cognitive strategies involve consciously implementing sets of mental processes in order to control thought processes and content. Through these cognitive strategies, we can examine and restrict the thoughts and interpretations responsible for maintaining OCD symptoms. This is conducted in the initial stages of therapy.
Thereafter, Exposure Response Prevention (ERP) methods are carried out once a client is able to understand and utilise these cognitive strategies. ERP requires the client to list out their obsessive thoughts, identify the triggers that bring about their compulsions and obsessions and rate their levels of distress on each of these. Starting with a situation that causes mild or moderate distress, the client is exposed to their obsessive thoughts and simultaneously tries to resist, engaging in any identified behaviours that they have been using to neutralise these thoughts. The amount of anxiety is tracked each time the process is repeated. When anxiety levels for this particular situation eventually subside, over several repeated processes, and when they no longer feel significant distress over this situation, the same method is repeated for the next obsessive thought with the next level of distress.
A client who is able to demonstrate strength in coping with the symptoms has a better likelihood for sufficient recovery.
OCD is Becoming More Prevalent in Singapore: How has it Been Accepted in Society?
In recent years, OCD has topped the list of mental disorders in Singapore, with the greatest number of people experiencing it in 2018, compared with other mental illnesses.
The disorder has been found to be more prevalent among young adults than those aged 50 and above. In terms of socio-economic status, OCD is more likely to occur amongst those with a monthly household income of less than S$2,000 than those who earn above that amount.
It has also been found that the prevalence of people experiencing OCD at least once in their lifetime is higher in Singapore than in South Korea, Australia and New Zealand.
In addition to becoming more prevalent, people who experience OCD are also becoming increasingly reluctant to seek psychiatric help or counselling, making matters worse. There is some acceptance of the condition as normal and trivial by society, because people who do not understand the disorder well enough misconceive OCD as a quality of being clean and tidy, as being clean and tidy is usually seen as a good thing. This misconstrual by society is dangerous for the undiagnosed, and their condition will further deteriorate if they continue to put off addressing their disorder.
The disorder will get worse if treatment is ignored, and there is a need to realise it in its early stages through observing how one’s life is being disrupted. Awareness about its onset of symptoms is important.
“Vitality management is provided for organizations that have a vision”. A quote from Pauline van Dorssen, writer of “Vital People in a Vital Organisation”. This is a new successful training (NIP). Positive psychology and the use of vitality are central. The response from Occupational and Organisational Psychologists and Occupational Health Psychologists was exuberant, with all available places booked. In addition, the same question arises from organizations, who often need advice and coaching in the field of vitality.
HMI Institute of Health Sciences in support of the FestivalForGood (organised by raiSE) invites you to join us for hands-on experiences on caregiving through training simulations and fun activities. Some takeaway knowledge include:
Knowing how to create a safe home environment for your aged parents/grandparents
Safe feeding skills for Caregivers
Understanding Caregivers’ stress & preventing/relieving these stresses
Understanding how your aged parents/grandparents feel
Recognising illnesses & emergencies
Simple skills on CPR
-and many more!
Our Career Coaches will also be around to assist you with information on our training programmes and career services.
Date & Day: 05 August 2017 (Saturday)
3 Sessions: 9:00am · 11:00am · 1:00pm
Venue: HMI Institute of Health Sciences @ Devan Nair Institute for Employment and Employability, 80 Jurong East Street 21, #06-03, Singapore 609607
As I mentioned in my first article, the phrase,”reverse roles” was very much what I heard at my first psychodrama workshop. As this was uttered by the group leader, two people on the stage switched places and began playing the opposite role.
“This is it! “, I thought as I began to think of how I could use it in my work. Get people to reverse roles and voila! Well I was sorely mistaken those many years ago. As I began to explore this fascinating form of group work I discovered several techniques that are used in Psychodrama. Here are two key techniques used and an example of how I used them.
Here the Protagonist says a few words in the role of a particular ‘character’ or entity in their drama. The Auxiliary then says these lines to the Protagonist who is in the complimentary role.
In this technique, objects and people are used to represent the scenario the Protagonist wishes to explore.
A Drama using Role Reversal and Concretization
Ken is aged 19, and has a serious problem with drugs and alcohol which he has managed to stop, after going to the alcohol treatment centre. He had just come out of drug rehab in the United Kingdom and was brought to my practice by his concerned father. His father had tried very hard to help him over the years and has now brought Ken to us at Promises. Ken is worried about going out for dinner with his Father and a family Friend, whom we shall call Andy, because he might be tempted to drink again.
I encourage him to enact a scene at dinner with his father and Andy, playing out what he expects to happen. He sets out the chairs and chooses two people in the group to be his Father and Andy. As he greets the two older men rather lethargically, his shoulders slouch and he speaks in a flat voice.
Reversing roles, Ken now plays the part of Andy. He perks up now, smiling and full of energy. ‘Andy’ says, “The last time I saw you Ken, you were a small boy. My how you’ve grown!” Playing the role of his tempter, he urges Ken to “have a drink now as a real man” holding a glass towards him.
Back to being himself after another role reversal Ken’s face reddens and he clenches his fists in agitation. He speaks to me as the Director, saying that he is afraid he might have a relapse. I immediately ask him to take on the role of his father.
As his father, he sits with his arms crossed and says through clenched teeth, “It’s okay, you don’t have to drink. I don’t want to cause a relapse.” As himself, Ken is at a loss for words. I ask the other audience members to do some modeling and try different responses in the role of Ken as he watches.
Ken cheers up as he sees the other group members rising to the occasion. Everyone is animated as they get a chance to act the part and try to tell Andy off. There is much laughter and hilarity as people do and say whatever they think might work. A sort of role training session is underway.
Ken is noticeably inspired by the group and he chooses one response. He stands tall with a cheeky smile and says to Andy, “I’m not drinking today, and I wonder why you are so determined to force alcohol on me!” In role reversal as Andy, he changes the subject and backs down, no longer the magnanimous host. The drama ends. Ken is no longer a deflated doomsday worry wart. Instead he is positive about going out for dinner and knows what he can do later that night at dinner. The group has come to his aid and I once again marvel at the magic of Psychodrama.
In future articles, I shall illustrate more psychodrama techniques with dramas I have directed. It continues to be a privilege to be allowed into the lives of group members and I am continually amazed at the transformations that happen.
At Promises Healthcare, we are committed to helping you through your journey to recovery. Discover a new life and find renewed hope. If you or someone you know needs mental health support, please contact our clinic for inquiries and consultations.
This is a series of article about the Action Method of Psychodrama by Sharmini Winslow.
“Reverse roles!”, the group leader shouted, and two people switched roles on stage and began enacting the opposite part. I was in the middle of my first Psychodrama workshop and all seemed chaotic and yet pleasantly therapeutic. What was going on? My desire to explore psychodrama had brought me here to a large room with a group leader and several very friendly people. Soon I was learning the ropes and I tried to make sense of things. 7 years later, I am still held captive by the magic of psychodrama.
Often people ask me,”what is Psychodrama?”, and I ask if they have 10 minutes to listen. It is a therapeutic action method that usually is done in groups. So here is a short description that will suffice for now.
Psychodrama, is the brainchild of Dr J.L. Moreno. It comes from two words, Psycho and drama. Psycho (not like in the movie where someone slashes you in the shower with a knife), is derived from the word ‘psyche’ which means the mental or psychological structure of a person. Drama refers to the enactment or action that happens in the session.
There are 5 instruments in Psychodrama
In the group, the therapist or group leader takes on this role and keeps the action flowing and gives structure to what evolves on the stage.
This can be any space set aside for the enactments to occur. In a group, the stage is the space apart from where group members are seated. Moreno built a stage in New York specifically for psychodrama which had the audience seated at a different level. I had the privilege of directing a drama on the original stage.
These are the group members who are not involved in the drama but who act as witnesses and can respond to the action on stage as a normal audience would, often yelling encouragement to the protagonist.
This is the person who represents the main concerns of the group. Usually chosen by the group, the Protagonist gets to put into action a concern, a challenge or an event that they would like to have turned out differently. In psychodrama, past, future and present can coexist in the Here and Now.
The Auxiliary or sometimes called the Auxiliary Ego is the group member chosen to be a certain element or person in the drama, for example the protagonist’s Sister or maybe their addiction.
Each session has a warm up, an enactment phase and time for sharing. In the sharing segment, group members get to share something about their own lives that is connected to the drama.
So in Psychodrama the protagonist’s inner world gets “‘concretized” or made real, and the Director helps the Protagonist explore and work spontaneously to create new ways of being that are more helpful in living with whatever challenge was enacted. New perspectives are discovered; insights and conclusions made that bring healing and newness. The Protagonist and group members experience the wonder of being spontaneous and are positively energized!
*Psychodrama is used in group sessions run by Sharmini as part of her practice at Promises.
At Promises Healthcare, we are committed to helping you through your journey to recovery. Discover a new life and find renewed hope. Please contact our clinic today if you or someone you know needs mental health support.