Listening Effectively to Strong Emotions

Listening effectively is hard. Especially when the other person has strong negative emotions. We usually and intuitively do the wrong things.

Let me give you a quick test.

Which of the following is a better response?

Speaker: I’m so depressed about being passed over for a promotion at work. I’m worried that I’m going to be fired, or just that I’ll never get another promotion.

Listener:

  1. Cheer up, it’s not that bad. You still have a job and I’m sure eventually you’ll get promoted.
  2. Wow, that sounds really upsetting. It makes sense that you’re feeling down. Being passed over is a huge disappointment. And it also sounds like you’re worried about the future and your job. Tell me more.

Which do you think is a better response? If you picked a) then you are in good company. Most people think that that’s a better response. It’s a response that attempts to change the person’s emotion to a positive one. What’s wrong with this?

What’s wrong with it is that it is based on what I call the switch-on-the-forehead model of human emotion. In this model, we imagine that there’s a switch panel on our forehead that controls all of our negative emotions. If you feel depressed,  just reach up and flip the depressed switch to the off position. If you feel anxious, do the same with the anxiety switch. I’ve written quite a bit about depression and anxiety in previous posts, and this model of negative emotion doesn’t really work. 

Emotional Toggle Switches

Too bad we don’t have one of these on our forehead! Instead, we need to listen effectively to strong emotions.

Unfortunately, human beings don’t actually have an emotional switch panel. In reality, we are really bad at changing our feelings quickly. When someone we are talking to implies we should be able to switch off our negative emotion we end up feeling the original painful negative emotion as well as an additional layer of shame that we can’t control.

We say things like “I feel so weak that I can’t overcome my depression.” “I’m such a loser to get so anxious about a job interview.” “I should not get so angry.” Notice that all of these statements are trying to negate a strong emotion and shame comes with failing to do so.

It gets worse. There’s actually quite a bit of research on thought suppression and what this research has found is what I call the pink elephant effect. The more you try not to think or feel something the stronger those thoughts and feelings become. Try not to think of a pink elephant and if you try hard enough that will be all you can think about. This is also true of anxiety, anger, sadness, and virtually all negative emotions. Thus when we try to “cheer up” someone who is upset, it usually backfires.

Why do people use invalidating listening responses instead of listening effectively? It’s not out of malevolence. We all want to help. But these attempts to “cheer up” people are usually doomed to failure. People typically push back against the “cheer up” message. If you tell a depressed person to look at the positives in their life, they will push back and tell you about all the negatives, or they will negate the positives. Tell an anxious person that their fears are overblown and they will tell you why their fears are realistic. As they push back, they feel more depressed and more anxious.

What Not to Do When Listening to Emotions

What are the most common “try not to think of the pink elephant” invalidating listening responses?  Why are they unhelpful?

1. Simple negation statements: “Don’t feel sad, don’t feel anxious, don’t feel angry.” These are statements that simply instruct the person to stop feeling the negative emotion. Another version of a negation statement is “cheer up”, “don’t worry”, or “chill out.” Or perhaps the worst of all, “Get over it!”

These are unhelpful because we don’t have that switch panel on her forehead that allows us to simply turn off negative emotions. In fact, because throughout human history negative emotions had more survival value than positive emotions, the brain overweighs negative emotions. On the ancient savanna, fear of being eaten by a lion when you hear rustling in the brush is a survival mechanism. Dismissing this fear could lead to disaster.

2. Problem-solving suggestions: “Maybe you should look for a different job.” “Have you considered ending your marriage or relationship?”

The problem with these kinds of suggestions is that they implicitly dismiss the person’s right to have negative emotions. They suggest a simple solution that will remove the negative emotions. But they are disrespectful because most people have already thought through all of these simple solutions and either they’re not simple, or they’re not solutions that they are willing to take.

Sometimes problem-solving is reasonable, but is best done after lengthy supportive listening. And usually, it’s best to avoid problem-solving and advice-giving entirely. 

3. Look-on-the-bright-side statements: “It’s not that bad, at least you have your health (money, relationship, kids, etc.)” or my favorite one, “At least it’s not cancer.”

These kinds of statements are not helpful because typically they are experienced as dismissive of our right to have these negative feelings. And we often push back and point out that there is no bright side, which can end up in a struggle between ourselves and the listener. This struggle is frustrating for both.

4. Changing the topic entirely: “Let’s not talk about your depression, what are you doing the rest of the week?”

Again, this is usually experienced as dismissive and unsupportive. It’s like saying to the person, “Shut up and stop talking about your suffering.”

5. Get therapy or go on medication suggestions. This is when your friend or family member suggests you may need therapy or medication to deal with your negative emotions. Again, this comes from a helpful place but is often experienced as dismissive. It’s like saying, “I can’t deal with your negative vibe, so please talk to somebody else.”

There are certainly times when it’s appropriate to recommend therapy, but this is best done after using positive listening approaches. Doing it at the front end is another way of invalidating the person’s feelings.

How to Listen Effectively to Strong Emotions

If these are all examples of what not to do, what should we do when someone expresses strong emotions to us?  How should we respond? What skills can we use to listen effectively? 

1. The first step is to listen empathically. What that means is to reflect back to the person what you hear them saying particularly the emotion. This skill is called a reflection of feelings. You basically just paraphrase their emotions, making an effort to be accurate as to the intensity. If someone says I am massively depressed, you don’t reflect back “You’re feeling a little bit down.” Instead, you reflect, “You’re really feeling overwhelmingly down.”

If you accurately reflect feelings,  then the person will elaborate on what they are feeling and you reflect again. Or you ask open-ended questions like, “How did that make you feel?” or “What did you feel then?” This will also expand the responses to their emotions.

Another good option is to reflect back the emotion and then ask the person to tell you more. “Sounds like you’re really mad at your wife about her spending. Tell me more.”

Of course, basic listening guidelines apply. Make good eye contact, use head nodding and nonverbal encouragers like “mmmm”, and “go on.” And of course, turn off your phone or mute it so you can listen fully.

2. Try to avoid the temptation to problem-solve or give advice. Especially try to avoid what I call the narcissistic shift. The narcissistic shift is when you shift to your own experience instead of staying with the other person’s experience. Many people mistakenly believe that these kinds of shifts are actually empathic but they are not. Here’s an example of the narcissistic shift:

Speaker: “Ever since I went off my antidepressants I’m feeling very depressed.”

Listener: “Yes, that happened to me a few years ago. I ended up having to go back on them. That’s probably what you should do.”

Even though it may be true that the listener had a similar experience it is invalidating because typically the exact experience was quite different. Also, the message becomes, “Let’s  not talk about you, let’s talk about me.”

It is like my favorite narcissist joke. The narcissist says, “Let’s not talk about me, let’s talk about you. What do you think of me?”

3. Normalize the speaker’s emotions. Statements like, “Of course you are feeling overwhelmed, so much has been going on lately.” Or, “Of course you are feeling depressed, you lost a job you loved. It makes perfect sense.”

The benefit of normalizing emotions is that it takes away the shame. Just try not to do the narcissistic shift as part of this. Avoid saying, “when I lost my job I got depressed also.” Just remember good listening is not about you, it’s about the other person.

4. Ask questions. Open-ended questions or encouragement to talk more are the best. Examples of open-ended questions are: “What are you feeling?” “How did that affect you?” Try to avoid asking why questions as they often come across as attacking. Example: “Why are you so sad?”

John Gottman, the well-known marriage therapist, suggests some of these questions:

  • Tell me what happened.
  • Tell me everything that’s bothering/worrying you.
  • Tell me all of your concerns.
  • Tell me everything that’s led up to this.
  • Help me understand more about what you’re feeling.
  • What set off these feelings?
  • What’s the thing that’s worrying you the most?
  • What’s the worst that could happen?

Notice that all of these encourage the person to feel safe venting and talking about their most painful emotions.

Some final thoughts on Listening Effectively  

Listening effectively is simple but very hard. Most of us will have a strong temptation to do all of the wrong things when confronted with strong emotion in another person. Fundamentally, we are all uncomfortable with strong negative emotions both in ourselves and in other people. It is a hard practice to learn to accept and tolerate negative emotions in others and in ourselves.

Now you’re probably thinking about a friend or family member who tends to ruminate about things and wondering if this approach would actually be counterproductive with them. I tend to think that much rumination is actually an interpersonal phenomenon that is based on unsupportive listening. A good analogy, although somewhat gross, is training an abscess or boil. When it’s fully drained, a painful process, healing begins. If you just put a Band-Aid over it, it only worsens. Unsupportive listening forces the speaker into pushing back by staying stuck with their emotions rather than fully expressing them.

If you really believe that someone you care about is stuck in rumination, then do an experiment. Listen effectively and fully for an hour. Let them cry, scream, quiver, whatever they need. In most cases, they will feel better and be less stuck in rumination. And you will have given them an amazing gift of love and kindness. Try it sometime, you will be amazed at the results.

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Dr. Andrew Gottlieb is a clinical psychologist in Palo Alto, California. His practice serves the greater Silicon Valley area, including the towns of San Jose, Cupertino, Santa Clara, Sunnyvale, Mountain View, Los Altos, Menlo Park, San Carlos, Redwood City, Belmont, and San Mateo. Dr. Gottlieb specializes in treating anxiety, depression, relationship problems, OCD, and other difficulties using evidence-based Cognitive Behavioral Therapy (CBT). CBT is a modern no-drug therapy approach that is targeted, skill-based, and proven effective by many research studies. Visit his website at CambridgeTherapy.com or watch Dr. Gottlieb on YouTube. He can be reached by phone at (650) 324-2666 and email at: Dr. Gottlieb Email.

How Your Smartphone Is Making You and Your Teenager Dumb and Depressed!

smartphone making you dumber

Your smartphone. Smartphones are very cool devices. You can text, Snapchat, or email from anywhere. You can find your way through traffic using Google Maps or Waze. Find a good restaurant with Tripadvisor or Yelp. Take pictures and send them to all of your friends and family instantly. Nothing but upside right?

Wrong! Multiple research studies show that our smartphones are actually making us dumber, and maybe more depressed as well. Let’s look at some interesting facts. I’ve written previously about smartphone use and happiness but wanted to revisit the subject with more data.

Fact One: The average smartphone user looks at their phone 80 times a day, according to Apple.

Other reports suggest that people look at their phone 130 times a day. That means 30,000 to 47,000 times a year! Each of those glances distracts you from your current circumstances, and if you are trying to do something complex, or learn something, you are getting dumber 30,000 to 47,000 times a year! That’s a lot of time to lose. And since studies show it takes 25 minutes and 15 seconds to recover from distraction, that means you are losing 526 days a year, which is more than a year, which means that you are basically distracted and dumber all the time.

Fact Two: The closer your phone is to you, the dumber you get.

The University of California, San Diego conducted a study of 520 undergraduate students. The students took two tests of intellectual functioning.  The main variable in the study was where student put their phones. Some students put the phones in front of them on the desk, others put the phone in their pockets or purses, and others left their phones in an adjoining room.

The results: the closer the phone was, the dumber the person based on the test results. Phone in front of you, bad, phone in your pocket or purse, a little better, and phone in the next room, best results. And remember, this was with participants never checking their phones!

Fact Three: We don’t realize how much our phones impair our performance.

All of the participants in the UC study later said their phone was not a distraction, and that they never thought about their phones during the experiment. This shows we don’t even recognize the damage our phones are doing to our minds.

Fact Four: Smartphones bring down college grades by one whole letter grade when brought to class!

Researchers at the University of Arkansas found that those students who left their phones at home scored a full grade higher on material presented in the classroom than those who had their phones in class. It did not matter whether the students used their phones or not. In another study from the U.K. found that when schools ban smartphones, test scores go up a lot, with the worst students benefiting the most.

Fact Five: Your smartphone makes you worse at relationships as well.

Another study from the U.K. had 142 people divided into pairs and asked to talk in private. Half had a phone in the room, while the other half had no phone. The pairs then rated each other for affinity, trust, and empathy. “The mere presence of mobile phones,” the researchers reported in 2013 in the Journal of Social and Personal Relationships, “inhibited the development of interpersonal closeness and trust” and diminished “the extent to which individuals felt empathy and understanding from their partners.”

Fact Six: It Is Worse For Teenagers

According to Neilson, teenagers send and receive 3,339  texts per month, which is about 7 texts per hour, or one text every 8.5 minutes. Actually, it is worse. Let’s assume that most teens don’t text during classes. That means outside of class, they are texting about 12 times an hour, or once every 6 minutes.

iphone woman

This can’t be good for learning or memory.  Imagine you are trying to learn something hard, and every 6 minutes someone asks you a question and you have to respond. How’s your performance? And since we know that distraction lasts 25 minutes, that basically means that all teenagers are distracted every minute that they are awake and not in class.

What’s even worse is that smartphone usage also affects happiness. The Monitoring The Future Survey, which is funded by the National Institute on Drug Abuse, has collected data on 10th graders and 12th graders for decades. They asked teens how happy they are and how much time they spend on various activities including non-screen activities like socializing and exercise, and screen activities such as social media, browsing the web, or texting.

The results? All screen activities are linked to less happiness, and all non-screen activities are linked to more happiness! Eighth graders who spent 10 or more hours a week on social media were 56% more likely to say they’re unhappy. Even those who spent six hours a week on social media were still 47% more likely to say that they were unhappy. And even more ominously, the more time that teenagers spent looking at screens the more likely they were to report symptoms of depression. Teens who spent three hours a day or more on electronic devices were 35% more likely to have at least one risk factor for suicide.

Here are a few somewhat radical suggestions:

  1. This one teenagers will really hate. What if parents took away smartphones from their kids, and gave them flip phones, for phone calls only? Turned off texting on the phone. I suspect the average teenager’s grades would go up a grade. Not to mention better learning and memory. Flip phones would allow teenagers to call their parents for a ride, thus having much of the convenience factor without any of the negative smartphone factors.
  2. If this is not practical then I would recommend that parents take smartphones from their children when they arrive home from school, put them in a locked drawer, and only give them back the next morning. Certainly, there should be no access to smartphones while studying or doing homework. When children have finished their homework and are in relaxation mode, they can have limited access to their smartphone, but only until a reasonable hour because the use of smartphones before bedtime is very disruptive to sleep.
  3. For adults, leave your phone in your car trunk when having dinner out. You’ll connect with your dinner partner much better.
  4. For families, all smartphones, tablets, laptop computers go away before every family meal. Unless you are a physician on call, nothing is so important that you can’t put away your smartphone and have a nice family dinner.
  5. Finally, consider a digital device Sabbath. Orthodox Jews do not use any digital devices during Sabbath, which starts Friday night and ends Saturday night. All of us should emulate this, and pick a day on the weekend which is a digital-free day.

I am reminded of the first time I met my friend Fred Luskin, a psychologist who studies stress and forgiveness. I was attending a workshop he led. At the beginning, he asked everyone to take out their smartphones and turn them off. Not “turn off the ringer” or “set to vibrate” but actually power down the phones. Participants were shocked and resistant. It took a few minutes for him to get people to actually turn off their phones. At the time I wondered about this, but now I can see that it makes a big difference. When your phone is powered down, you are not anticipating anything from it, so that little bit of attention that is always focused on the phone is freed up for other purposes.

Now I’m going to turn off my computer and my phone, go outside, and take a walk…

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Dr. Andrew Gottlieb is a clinical psychologist in Palo Alto, California. His practice serves the greater Silicon Valley area, including the towns of San Jose, Cupertino, Santa Clara, Sunnyvale, Mountain View, Los Altos, Menlo Park, San Carlos, Redwood City, Belmont, and San Mateo. Dr. Gottlieb specializes in treating anxiety, depression, relationship problems, OCD, and other difficulties using evidence-based Cognitive Behavioral Therapy (CBT). CBT is a modern no-drug therapy approach that is targeted, skill-based, and proven effective by many research studies. Visit his website at CambridgeTherapy.com or watch Dr. Gottlieb on YouTube. He can be reached by phone at (650) 324-2666 and email at: Dr. Gottlieb Email.

How to Overcome Obsessive Compulsive Disorder (OCD) Using Exposure and Response Prevention and Cognitive Behavioral Therapy: Part One

What is Obsessive Compulsive Disorder (OCD)?

obsessive-compulsive disorder

Check? Check? Check?

OCD is a chronic psychological illness where a person has disturbing and recurring thoughts (obsessions) and compulsive behaviors that they repeat over and over.

OCD is at its core an anxiety disorder. The obsessive thoughts trigger intense anxiety, which the person attempts to ameliorate or reduce by either having compulsive behaviors or compulsive thoughts.

Typical obsessions that people have include:

  • thoughts about harming other people or being aggressive towards other people,
  • inappropriate sexual thoughts and feelings,
  • fear of germs or other types of contamination such as chemical contamination,
  • thoughts about symmetry and order,
  • taboo thoughts about religion or other “hot” issues.

Some typical examples of compulsive behaviors include:

  • Checking behaviors where the person repeatedly checks to see if the stove is turned off or a door is locked
  • Excessive cleaning, hand washing or showering
  • Counting behaviors
  • Arranging things in a particular and precise way
  • I’ve also written about hoarding, which is another type of compulsive behavior.

Some compulsive behaviors are actually thoughts, such as saying a particular prayer to yourself over and over.

There’s an excellent article on OCD at the National Institutes of Mental Health page.

A common type of OCD that I treat in my practice is germ phobia. The typical obsessive thought in these cases is that touching something such as the floor will transfer dangerous germs onto the person’s hands, which will then be transferred either to them or to someone they care about, causing great harm. These people are typically very fearful of public bathrooms and will avoid touching the doorknobs in them. In order to cope with perceived contamination, they will typically wash their hands many times a day, sometimes up to 30 to 50 times. When they cannot wash their hands they will use alcohol gel to sterilize their hands. Often the handwashing is so extreme that the person’s hands will look profoundly chapped and red.

When they feel particularly contaminated they will often take very long showers, washing and re-washing their body very carefully multiple times. These showers can take 30-60 minutes in some cases.

Exposure and Response Prevention Treatment (ERP) for Contamination OCD

OCD that is accompanied by clear rituals such as handwashing is easily and effectively treated using a Cognitive Behavioral Approach that focuses on something called Exposure and Response Prevention (ERP). Let me describe a hypothetical case. (This is a hypothetical case that may include composite aspects of clients I have treated, with all identifiable client information changed.)

Susana came to me because she had developed a very severe case of contamination OCD. Her primary fear was that by touching something that might have germs, she would transfer these germs to her children, husband, or even to strangers, and that they would sicken and die. As a result of these fears, she would wash her hands more than 50 times a day, and take showers that lasted more than an hour during which she would scrub up and wash down three or four times.

She also had developed almost complete avoidances of many situations. Public restrooms terrified her, so she could not leave the home for long periods of time. She was afraid of contaminating her car, which then might contaminate people she loved, so she avoided driving. Work was out of the question since she was spending hours a day on OCD rituals.

The first step was to thoroughly evaluate her OCD. I gave her multiple questionnaires that evaluated the frequency of obsessive thoughts, compulsive behaviors, and avoidant behaviors. The same questionnaires also evaluated the level of anxiety and distress caused by both the obsessions and the compulsions. This gave us a good baseline set of numbers that described the state of her OCD. As part of the same evaluation, I obtained detailed information about all of the things that she was avoiding doing.

The next step was to do some Cognitive Behavioral Therapy (CBT) on her belief systems about germs and contamination. This consisted primarily of a set of conversations where I asked open-ended Socratic-style questions about her beliefs. She showed a variety of common OCD distorted thoughts and beliefs.

Common Thought Distortions in Contamination OCD

  • All germs are lethal and deadly: This distortion is basically the belief that every microorganism causes serious or fatal diseases. It’s actually not true. We are surrounded by bacteria, and most of them are harmless or even beneficial. The most common kind of harmful germs or viruses are the common cold and the flu. Neither these illnesses are particularly dangerous although they are unpleasant. More dangerous germs such as HIV or tuberculosis are extremely rare in developed nations, and the virus that causes HIV is extremely fragile and cannot survive for more than a couple of minutes on most surfaces.
  • Germs live forever on any surface: This is the belief that once a germ attaches itself to a surface it will stay there forever and be capable of infecting you. In reality, most surfaces are fairly inhospitable for bacteria and viruses, and the microorganisms become inactivated fairly quickly, usually within minutes or at most an hour.
  • Things transfer at 100% potency: The law of transfer says that with each transfer the potency of what is being transferred becomes less and less. So if you touch something that has germs on it, your hand will have some germs transfer. If you then touch something, such as a computer keyboard, fewer germs will transfer. Then when someone else touches the keyboard, even fewer germs will transfer to them. The more transfers the less is transferred.
  • Humans have no immune system: This is the belief that every germ or virus that one contacts will cause illness. Humans actually have a very robust immune system. Every day our immune system kills off a variety of germs and viruses we get exposed to. Unless we are exposed to many germs or viruses, our immune system usually does a good job of resisting illness.

The Treatment: Using Exposure and Response Prevention

We did some experiments to test her beliefs. One experiment I like to do is the chalk dust experiment. I have the patient touch some chalk dust, and then they touch my hand, and then I touch my keyboard of my computer, and then I have them touch the keyboard with a clean hand. Thus they graphically see that each transfer moves less and less chalk dust to the next item.

We spent a few sessions discussing and correcting the misconceptions about germs and illness. This began the process of getting ready to start the essential part of the treatment, Exposure and Response Prevention. (ERP)

To prepare for ERP we first made a laddered list of things that would be scary for her. The list went from fairly easy tasks which were a little scary, to tasks that would be terrifying. We rated the anxiety on a 0-10 scale.

I asked her to pick a task that would be somewhat challenging but not terrifying to start with. She picked a task with moderate fear attached to it, touching the floor of my office (which is a carpeted floor.) I also told her that anything that I would ask her to do I would also do with her.

I had her rub both hands on the carpeted floor. Then I asked her to just sit with her anxiety. Initially, her level of anxiety was 10 out of 10. I asked her to narrate her thoughts. “My hands are covered with dangerous germs,” she said.

Over 15 minutes or so her anxiety began to diminish. It went down to about a 7. I noticed that she was holding her hands in the air, so I asked her to put them on her lap. This increased her anxiety briefly, but after a few minutes he anxiety came back down to a 7.

Over another 20 or 30 minutes, her anxiety came down even further. Now it was only a level 4. I asked her to describe her thoughts. “Your carpet probably isn’t really covered with very many germs, and therefore my hands probably don’t have very many germs on them,” she said.

Then I asked her to do something a little bit more challenging – to rub her hands on her face. This made her anxious, but she did it, and after a few minutes of higher anxiety the anxiety subsided again.

By the end of our official face-to-face session, her anxiety level was a 3 out of 10. I asked her if she had any alcohol gel or cleanser in her purse, which she did, and I asked her to leave that in my office. Then I asked her to spend at least another 30 minutes in my waiting room to see if the anxiety level would come down even further, without washing or cleansing her hands. At the next session, she told me that the anxiety level had come down to a level 2, which amazed her given that she had started at 10. I had asked her not to wash her hands for several hours which she did.

At the next session, we tackled another item on her list, the ATM. She was afraid to touch ATMs with her fingers, and either used the back of her knuckles or used alcohol gel after touching the ATM. So we went next door to the local banks ATM, and I had her repeatedly touch the keys with her fingertips. This brought her anxiety level up to about 7, so we kept repeating the task until the anxiety began to subside. Once again I asked her not to wash or use alcohol gel.

A few sessions later after using exposure and response prevention on a variety of other issues, we tackled the top of her list – the public restroom! For many contamination OCD patients, this is the ultimate challenge. We went next door to the building’s restroom, where I put a sign on the door, Closed for Maintenance. Next, I modeled touching the doorknob, the sink, and she did the same. We went back to my office and once again she sat with her anxiety until it came way down.

Once her anxiety had dropped we went back into the restroom and did a harder task. First I modeled touching the toilet seat, and then she touched it. Not surprisingly this raised her anxiety very high. Once again we went back to my office and she sat with that anxiety. We discussed the nature of what toilet seats are made of, and how long germs could live upon them. Gradually her anxiety diminished to about a level of 5, which was a large drop for her.

Between sessions, I asked her to practice these tasks on her own. I explained that the key was to sit with the anxiety for a long enough time for it to subside naturally without any hand cleaning or sterilization. She practiced on a daily basis and made rapid progress on the items we had done together and some other items that were also on her feared list.

By this point, she had lowered her hand washing from 40 or 50 times a day to only several specific situations. After using the toilet, before preparing food, and after preparing food. She had stopped using alcohol gel completely.

A few months later she began to look for work for the first time in several years, as her OCD was virtually completely resolved. I continued to see her intermittently over the next few years, and her OCD continued not to be a problem, although there were some other non-OCD challenges.

In Part Two of this article, I will discuss the use of medications for the treatment of OCD, Thought OCD, Checking OCD, and Health OCD.

 

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Dr. Andrew Gottlieb is a clinical psychologist in Palo Alto, California. His practice serves the greater Silicon Valley area, including the towns of San Jose, Cupertino, Santa Clara, Sunnyvale, Mountain View, Los Altos, Menlo Park, San Carlos, Redwood City, Belmont, and San Mateo. Dr. Gottlieb specializes in treating anxiety, depression, relationship problems, OCD, and other difficulties using evidence-based Cognitive Behavioral Therapy (CBT). CBT is a modern no-drug therapy approach that is targeted, skill-based, and proven effective by many research studies. Visit his website at CambridgeTherapy.com or watch Dr. Gottlieb on YouTube. He can be reached by phone at (650) 324-2666 and email at: Dr. Gottlieb Email.