Obsessive Compulsive Disorder, Generalized Anxiety, Panic Attacks and Phobias
Interview with Rachel Factor, LCSW
We are delighted to welcome Rachel Factor to our team of experts. Rachel made aliyah with her family leaving a successful practice in Monsey, New York. She brings many years of expertise in the fields of obsessive compulsive and anxiety disorders offering relief to children, adolescents and adults.
What is OCD?
Obsessive Compulsive Disorder (OCD) is an anxiety disorder where a person experiences unwanted thoughts which are extremely bothersome or frightening to him. So much so, that he feels a need to engage in a form of repetitive behaviour to alleviate the uncomfortable or threatening thoughts. For example, a person may be getting ready for bed and suddenly think that maybe he forgot to lock the door. This thought is extremely threatening as he imagines an intruder breaking in to burglarize his home. So he gets dressed again and goes to check that the door is truly locked. He may lock and unlock the door several times until he feels comfortable that it is really locked. In the end, he will retire to bed often without the sense of satisfaction that the door is actually locked. There are different forms of OCD. This example is called “checking.” People may repeatedly check that the oven is off or that they have not accidentally hit someone while driving or that their children are breathing in their beds.
The anxious mind says, “As long as I don’t know for sure that my feared consequence won’t happen, it probably will.” This is in contrast to the non-anxious mind which says, “There is probably nothing to worry about unless I’m provided with sufficient evidence that there is.” Individuals with OCD are not nervous about everything; rather, each person has a specific area which threatens them.
What are Generalized Anxiety, Panic Attacks and Phobias?
Generalized Anxiety Disorder: This is when a person regularly worries excessively about day-to-day stuff. There is a general feeling of dread and that the worst is sure to happen. Besides being an uncomfortable way to live, it robs an individual of his ability to live in the present. One’s brain is always somewhere else and never in the current experience.
Panic Attacks: These are sudden waves of intense anxiety and fear. They are often combined with a rapid heart-beat, shortness of breath, lightheadedness and/or a feeling that one is losing his mind and going crazy. While these symptoms are not dangerous, the individual finds them awful and frightening and may avoid any activities associated with them. Furthermore, a person may begin living in dread of when the next panic attack will strike. Almost every panic attack sufferer has a story of shopping in a supermarket with a cart full of groceries when a panic attack strikes and they leave the cart with the groceries and race to safety.
Phobia: A phobia is an overwhelming fear of something that poses little or no danger. The individual usually realizes that the fear is irrational. However, the distress is so great that a person will avoid it at all costs. Common phobias that I have seen are driving, flying, elevators, bugs and insects.
What is your formal education?
I received my Masters Degree from the Wurzweiler School of Social Work and then my certification and license to practice social work. My first job in the field was at Monsey’s Bikur Cholim Mental Health Clinic where I had started my second year field placement. They helped me attend the Obsessive Compulsive Foundation’s nationwide conference where I met top OCD therapists and learned about effective treatments. I also met a significant number of frum Jews suffering from OCD, as well as a rabbi looking for more options to help frum people with OCD. Several months later, the rabbi invited me to attend a training session for treating OCD with two top professionals in the field. I was strongly encouraged to attend as I was told that there was a tremendous need for a frum professional in the field — especially for a woman. Following the training, I developed an interest in the work of Dr. Jonathan Grayson, author of Freedom from Obsessive Compulsive Disorder. I sought him out as a teacher and he taught me how to help people gain freedom from OCD and anxiety disorders. I was amazed at the results. Individuals gradually got back everything they had given up in their lives and more. People began doing things they hadn’t done for 5, 10 and 20 years! They thanked me for giving them their lives back.
Tell us about your private practice in Monsey.
After the very positive experience working at Bikur Cholim, I opened a private practice in Monsey, N.Y. where I treated children, adolescents and adults with anxiety disorders. I worked with all types of Jews — secular, modern, Yeshivish and Chassidic. Most sessions took place in my office but if a person had a particular fear that I felt could be better treated in its actual environment, I took that into consideration. For example, if an individual was afraid of elevators or high places, we would find such a place to practice. If a child was afraid to go upstairs at home by himself, we might practice in the child’s own home.
Did you find many instances of OCD interfaced with Judaism?
I work a lot with religious OCD. Men and women alike obsess whether each word of tefilla is said correctly. Have they touched fleishig with hands that may have had milk on them? Have they heard every word in the megillah? Have they checked food well enough for bugs? And so forth. I work a lot with local rabbanim to establish guidelines for my work. The rabbanim are very supportive of my work as they understand that this is really an anxiety disorder and not a religious issue. These people only want to serve Hashem in the best way possible.
Religious OCD can also manifest itself in unwanted negative thoughts about Hashem or doubts regarding the existence of Hashem. Many clients have told me that they have read every sefer possible regarding emunah and bitachon and nevertheless can’t rid themselves of their doubts. When I asked one seminary student if she had discussed this with any of her rebbeim, she looked at me incredulously. She said, “Last week I discussed with my rebbe whether or not I should marry a kollel boy. Today I’m going to tell him that I’m having doubts about the existence of Hashem? What’s he going to think?” Sometimes it goes further and the individual coming for help is a rebbe or rebbetzin to whom others turn to for guidance with emunah. They feel hypocritical giving advice in emunah when they themselves have these uncomfortable thoughts. Working with OCD, I’ve learned that the intrusive thoughts that individuals get are usually quite the opposite of what they believe and what they truly value. It is because they value a certain idea so much that they get nervous when thoughts creep up that may suggest the opposite. This is just one of the many forms of OCD that I have treated.
I’ve heard that people with anxiety are often quite talented.
With no exception, the clients I treat are bright, imaginative and creative. You need to be bright and creative to be able to wonder “what if?” Most are quite successful, holding it all together while experiencing extreme pain and suffering. Jonathan Grayson describes this as “competence.” Competence is the ability to feel very stressed on the inside yet continue to function very well on the outside. It’s only when the suffering gets too much that people come in for treatment. For the most part, my typical client is a respected member of the community, someone who is kind, warm-hearted and who you’d want to be your friend.
The kids who come for treatment are unbelievable as well. They are extremely talented and have many great ideas. They often have perfectionist standards which are not attainable. Sometimes they are carrying guilt. Kids take very well to treatment. They even start giving advice to friends and siblings on how to face their fears.
What is your therapeutic approach or methodology?
The cornerstone of treatment is “Exposure and Response Prevention.” This falls under the umbrella of cognitive behavioral therapy. If an individual is avoiding certain situations, we want to gradually expose them to them without them performing their unhelpful safety behavior. The individual then gets to learn that although our bodies may sometimes become anxious, our bodies are also programmed to calm themselves down. Before treatment a person will feel that he cannot tolerate the anxiety and look for a shortcut out. The problem is that their bodies never learn to tolerate the uncomfortable feeling and they stay perpetually stuck in this cycle.
There are a couple of themes that run through anxiety. The anxious person always wants to feel just right and exhibits extreme discomfort in the face of uncomfortable thoughts and feelings. The way anxiety works is: The harder you try to push it away, the longer it lingers. I work with my clients on accepting the anxious feelings. Often a client will tell me that if he lets his anxiety stay, he won’t be able to get through the busy day. I ask him to look at his anxiety in the same way as he would look at a bad cold or a headache. You prefer not to have it, but you let it be there. I tell my clients to do the best that they can with how they are feeling on that given day. I compare it to playing a game of cards. You do the best you can with the hand you’ve been given. The more we stop fighting anxiety and let it be, the more it is free to pass. The truth is, people accomplish an incredible amount — even with their anxiety.
Another common theme is the inability to live with uncertainty. With OCD a person wants to know for sure that his worst fear and bad thoughts won’t materialize. He wants to know with certainty that his bad thoughts don’t mean that he is a bad person. A person experiencing a panic attack wants to know for sure that nothing will happen to him and that he won’t embarrass himself publicly. A person with a phobia wants to know that if he faces his fear everything will be O.K. Unfortunately, there are no guarantees in life for any of us. Our job is to take a good guess and live with the results. I like to focus on how Hashem created us strong. If life doesn’t go the way we plan, we will find a way to cope. It may take some time and we might need some extra help, but we can learn to cope with whatever comes our way. Limiting ourselves because of our fears? Now that’s something I like to avoid.
My therapy is short- term. My goal is for my clients to learn the techniques and graduate to become their own therapists. After a few sessions, clients tell me that they ask themselves what I would say and then go on to face the anxiety provoking situation with confidence.
What is your professional experience in Israel so far?
Since coming to Israel, I’ve been working in private practice with children, adolescents and adults suffering from anxiety. I find working with my clients rewarding and I feel privileged to be able to utilize my talents in Eretz Yisrael. I also work with clients over the telephone and Skype which enables clients to work with me from all over the country and from around the globe.
I’ve also worked closely with Nitza, an organization helping women with mental health issues during pregnancy and post-partum. There I facilitated CBT groups and worked individually with women experiencing OCD and depression. In addition, I’ve given talks in different communities on various topics related to stress and anxiety.
How Can You Be Reached?
I can be reached in Israel at: 052-713-4130. My American line is: 845-510-4169 or by e-mail at: Rachel@OCDsolutions.com. I currently practice in Ramat Bet Shemesh and Jerusalem. My website is www.OCDsolutions.com.
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