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1/03/2019

Helping a child with obsessive-compulsive disorder

You’ve heard of mindfulness, but what is it, really? How is it different from meditation? Is mindfulness really helpful? Is it hokey? And can you learn it? Do you need to go to a week-long camp or a psychotherapist or a guru? The answer could be on your smartphone.
What is mindfulness?

There’s no specific definition of mindfulness or meditation, although most writers see mindfulness as one form of meditation, which includes many other activities such as visualization and contemplation. Mindfulness involves focusing completely on what’s going on inside you and outside you — being an observer without getting wrapped up in what you’re observing.

A helpful website to learn about mindfulness is provided by the National Health Service of the UK. The creators of this site suggest that watching your thoughts come and go without getting wrapped up by them is like standing at a bus stop watching the buses come and go without getting on one. You can observe your thoughts or worries come up without getting consumed by them and distracted from the world around you.

In-person mindfulness training typically involves spending a great deal of time in silence, often with eyes closed, learning to note what is going on around you, such as the humming of a light or the sound of cars outside, or the feel of air flowing past your face from the AC. It often involves also noting what is going on inside your body, especially your breath and the sensation of air coming in through your nose or out your mouth. The goal is to be present with these observations, not distracted by worries about your to-do list, your relationships, or some recent event. Often mindfulness sessions are started and concluded with the sound of a chime, which is a tradition that comes from Buddhist meditation practices.

If you learn mindfulness techniques — paying attention to your physical sensations and your sensory perceptions, while learning to observe your thoughts and feelings — you’re likely to manage stress better, have fewer episodes of depression, and less anxiety. Research also shows you may experience a better quality of life and improved health, although less so than for the mental health benefits.
Which app is best, and for whom?

Wearing headphones or being buried in your phone all the time is the opposite of mindfulness. Nonetheless, there are about 280 mindfulness apps in the Apple iTunes app store. These seem like they could be a great way to learn a healthy skill. But how do you pick one?

A recent study by researchers from Lancaster University in the UK examined the most popular mindfulness apps. Of the 280 they found in the iTunes store, they narrowed these down to only include apps that are in the Health and Fitness category, only those with 100+ user reviews, and only those with ratings above 3 on a 5-star scale. This left them with the 16 most popular and potentially helpful mindfulness apps — 14 of which also are available for Android users. (These apps are listed here). Notably, only one of the apps has been experimentally studied — Headspace, which showed decreased depression and increased positive emotions after use for 10 days. However, this does not mean other apps don’t work; they just haven’t been studied yet.

The Lancaster team of two computer scientists reviewed the apps on a number of dimensions to categorize what they actually do and how they do it, and presented its findings at the prestigious Association for Computing Machinery’s Computer Human Interaction (CHI) conference in Montreal this year. They found that apps recommend daily practice of 10 minutes, and they essentially offer pre-recorded audio clips (a female or male voice talking you through mindfulness exercises) or timed sound effects (chimes that sound at the beginning, middle, and end of a mostly silent mindfulness practice session). They also offer ways to keep track of your practice sessions. None of them, however, offer any way of tracking how well you are learning mindfulness or its impact on your life.

Keeping in mind that the crux of mindfulness is noticing what is going on around you, and what is going on inside you, it is striking that only three of the 16 apps emphasized intrinsic or self-directed, silent practice of mindfulness. These three, Insight Timer, Meditation Timer, and Tide, really serve as timers with chimes to start and end your silent practice sessions. The other 13 apps provide audio recordings of someone talking you through focusing on breathing or other physical sensations.

It’s hard to notice what’s going on inside or around you if you’re distracted by someone speaking, even if it is soothing speech, and some reviews of these apps point this out. Research also indicates that the self-directed, silent form of mindfulness practice is more effective than externally guided exercises. Being talked through a breathing exercise is actually a form of relaxation training (learning to release tension from the body), which also has value, but is different from mindfulness training.

The researchers suggest that in the future, tangible objects (like meditation balls or wheels, which are used in traditional practices) could be incorporated into mindfulness training, as well as physiological sensors to track the body’s activity during practice sessions. Look for enhanced mindfulness apps on the horizon.
Which app should you try?

There’s no single best app for everyone. It may be helpful to try a self-guided app first, but if you don’t click with it, then try an app that has verbal instructions or guidance, returning to the self-guided silent app later when you’ve gotten the hang of it.

Even with an app, mindfulness takes practice. Like playing an instrument or a sport, the more you practice, the better you get and the more you get out of it. That’s where the 10 minutes every day comes in. Whatever you try, mindfulness training is considered very safe, and has a good chance of increasing your happiness and peacefulness, and reducing your depression, anxiety, and stress.
Here’s a medical news story that combines a common habit (drinking coffee) with a common skin condition (rosacea) — and it even has a happy ending.
What is rosacea?

Rosacea is probably something you’ve seen plenty of times and didn’t know what it was — or perhaps you have it yourself. It’s that pink or red discoloration on the cheeks some people have, especially fair-haired women. Sometimes there are small bumps that may look a bit like acne. If you look closely (after asking nicely for permission, of course), you’ll see tiny blood vessels just under the surface of the skin. In more severe cases it may involve the chin, forehead, nose, ears, and other skin surfaces. It may affect the eyes, eyelids, and cause thickening of the skin over the nose.

We don’t know what causes rosacea. However, there are theories that it may be, at least in part, a genetic condition, as it can run in families. Because the immune system seems to be involved in the inflammation of rosacea, and because other autoimmune conditions (such as type 1 diabetes and multiple sclerosis) may accompany rosacea, abnormal immune function may play a role. Medications (such as topical anti-inflammatory drugs) and antibiotics can reduce redness and inflammation but there is no cure. Many people seem to be able to reduce signs of rosacea by modifying their diet to avoid foods that trigger it.

Rosacea affects more than 14 million people in the US, including some celebrities, such as Bill Clinton and the late Diana, Princess of Wales. And while it’s not dangerous, it can have a significant cosmetic impact. Caffeine, sun exposure, spicy foods, and hormonal factors are thought to be able to trigger rosacea’s development or make it worse once present. Yet, a new study challenges the connection between caffeine and rosacea.
More coffee, less rosacea?

A recent study analyzed health data from surveys provided to nearly 83,000 women over more than a decade and found that:

    Those drinking four or more cups of coffee per day were significantly less likely to report a diagnosis of rosacea than those who drank little or no coffee.
    Those drinking less than four cups of coffee each day were also less likely to have rosacea, though the protective effect was smaller.
    Consumption of decaffeinated coffee was not linked to a lower incidence of rosacea.
    Caffeine intake from other foods or beverages (such as chocolate or tea) had no impact on the likelihood of developing rosacea.

Why is this important?

These results of this study are more than just interesting observations. If other research can confirm the findings, it could lead to a better understanding of why rosacea develops in some people and not in others. Because inflammation driven by the immune system is thought to play an important role in rosacea, insights into the development of this disease could extend to advances in other autoimmune disorders. Finally, many people with rosacea (or a family history of the disease) who like coffee may avoid it because of the widespread notion that coffee will make it worse. The findings of this study suggest that’s not true.
There are always caveats

As with all research of this type, there are limitations to consider. For example, this study

    only included women, most of whom were white — we’ll need additional studies of men and other ethnic groups to know if the findings extend widely.
    relied on health surveys and study participants’ memories regarding past diagnoses and diet; such survey data may not always be accurate.
    found a link between higher coffee consumption with lower risk of rosacea, but it cannot determine whether coffee consumption actually caused a reduction in rosacea.

The bottom line

Coffee is one of the mostly widely consumed beverages on the planet, and it’s also among the most widely studied. While it can cause problems for some people (such as heartburn, tremor, or palpitations), it’s a source of pleasure and enjoyment for millions. In addition, coffee has been linked with a number of health benefits, ranging from reductions in type 2 diabetes and liver cancer to greater longevity. From this latest research, it appears that you can add the possible prevention of rosacea to the list. If your child has obsessive-compulsive disorder (OCD), you know that this condition affects not only your child but also your entire family. The guidance that follows can help parents gain a better understanding of OCD, learn helpful strategies to support their children, and ease distress all around.
What is obsessive-compulsive disorder?

OCD typically includes uncontrollable, recurring thoughts (obsessions) and behaviors (compulsions or rituals) that a child feels an urgent need to repeat again and again. For example, your child may repeat a grooming routine until he feels “just right.”

A child may engage in compulsions or rituals to temporarily reduce distress. A child also may complete a compulsion because she imagines that doing so will prevent a scary outcome. For example, a child may tap a countertop three times at the start of every hour to prevent a parent from dying in a car crash. Even though the child logically may know that the two behaviors are not linked, the distress caused by having such obsessions can make the likelihood of the car crash seem possible if the child does not perform the ritual.

Unfortunately, compulsions strengthen obsessions in the long run. This sets up a vicious cycle of obsessions, distress, and compulsions.
How does OCD affect the family?

OCD does not just affect children who have the disorder. It can have an impact on the entire family, resulting in frequent conflicts. For example, the insistence on completing compulsions at specified times and places — such as, at 9:00 AM at home — may make you late for work and your children late for school. OCD also may dictate which family members cannot touch certain objects or say certain phrases, which may make family members feel uncomfortable in their own home.

Parents and siblings understandably can feel resentful for the ways in which OCD can interfere with their daily lives. Parents also can feel guilty about not being able to support their child sufficiently.
How can you support a child with OCD?

Looking for help from an experienced mental health professional is a good way to start. Strategies used to treat OCD go against maternal and paternal instincts, so it is important for children and their parents to be involved in treatment to learn how to manage OCD. The tips below may help.

    Pursue cognitive behavioral therapy. Cognitive behavioral therapy (CBT) is a specialized psychotherapy that helps people learn the links among thoughts, feelings, and behaviors, and develop tools to address unhelpful patterns. A special type of CBT that focuses on exposure and response prevention (ERP) is considered the gold standard treatment for OCD. This evidence-based treatment helps a child gradually resist engaging in compulsions while learning that the outcome is not as bad as expected — or, at least, can be tolerated. If your child’s symptoms are consuming more than an hour daily, creating distress for your child or family, and interfering with activities, your child may benefit from CBT with ERP. You can ask your pediatrician for a referral, or search for a provider or a program through the International OCD Foundation.
    Try not to accommodate. As a parent, your instinct is to support and protect your child. Unfortunately, OCD feeds on attention and accommodation. For example, if your child asks you to open a door to avoid coming in contact with germs, you inadvertently strengthen OCD each time you open the door. This is because your child’s brain learns that the door handle is something to fear and cannot be handled by him. Try to resist participating in rituals, even if it feels awful to refrain. Giving OCD an inch only encourages it to demand a mile. Resisting accommodation may make symptoms worse before they get better. Think of OCD as a bully who demands lunch money. A bully usually will not accept “no” as an initial answer. Instead, he’ll try to up the ante until he gets the money. However, the bully will learn over time that it is not worth the effort to get no attention and no money. The situation can improve if you remain consistent.
    Understand that your child is probably not trying to be oppositional. If you view your child as defying you on purpose, you may feel angry. This can prompt you to engage in a futile battle of wills. Try to shift perspectives for a moment. Think about something that terrifies you — maybe entering a cage with a hungry tiger. Your human instinct is to escape, and you might do whatever it takes to do so. Now imagine someone trying to force you to stay in the cage. That is what it can feel like for a child to be told that she needs to stop a ritual. Obsessions elicit tremendous distress. Your child may worry that she will not be able to tolerate the outcome of an incomplete compulsion. Remind yourself that OCD is a very convincing bully. You are angering OCD, not your child. It is not your child trying to disrupt the family; it is the OCD.

Seek support for yourself

As noted above, OCD can affect the whole family. Ask your pediatrician or a mental health professional about OCD peer support groups for parents in your community. The National Alliance on Mental Illness (NAMI) may guide you to one. Some clinicians trained in CBT and CBT with ERP for children with obsessive-compulsive disorder also provide parent guidance. You deserve support, too, and to learn that you are not alone as you help your child manage OCD.

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