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When my clients ask me, following an intensive treatment, how much time they should spend working on their OCD, I give them a scale. At one end of the commitment scale, there are recovering alcoholics who have usually undergone a 6 week detox/rehab followed by a half-way house, plus a commitment to 365 AA meetings in their first year (some of those meetings are hours long), supported by therapy, checking in with their sponsor every day and completing their 12 steps. At the other end of the scale there is zero. Every client is different but my answer is that they need to pitch themselves somewhere along this scale and the further away they are from zero, the more functional their lives will be. The key message is that therapy for OCD isn’t a quick fix. The same is true for most mental health disorders. You’d be surprised, after so much suffering followed by treatment, how many clients walk away with no intention of keeping the work up. The reasons are intrinsic and extrinsic: The default setting of our mammalian brains to avoid discomfort The mistaken idea that they are fixed (rarely promoted by the therapist) The experience of having OCD is so traumatic that any future reminders must be avoided The shame of having OCD or a mental health condition A dramatic change in circumstances, e.g., a new relationship, job, graduation, travel or move A lack of personal responsibility for their mental health The absence of an incentive to manage their OCD or the absence of penalties should they not manage their OCD A change in physical health Continued collusion by carers, families or friends The existence of a co-morbid disorder such as an addiction, eating disorder or depression (which impacts upon a person’s motivation to manage their OCD Managing OCD, like love or physical fitness, is most certainly a verb and a commitment to do something, day-in and day-out. I don’t believe the AA or 12 steps treatment model is appropriate for OCD but some of the philosophies are complementary, particularly the idea that managing life-span conditions with high rates of relapse depend largely upon self-responsibility and commitment in the long term. The AA emphases upon personal responsibility, service and daily support/checking in plus sharing wouldn’t be out of place in a comprehensive OCD treatment model. Our programme includes a whole section on personal responsibility and we have encouraged sharing in the past but we are a rarity. OCD therapy tends to be a solitary, nebulous process where clients have little to no idea of the therapeutic approaches involved, evidence of the therapist’s efficacy and few opportunities for interaction with clients managing their OCD. Over the years, we have sought to build a community but during this lockdown year, it has been our main focus. Our bi-monthly intensive follow up groups in person were out of the question. Therefore, since the announcement of lockdown in March 2020, we have run a free weekly online Zoom with WhatsApp group which has sprouted legs and become its own entity. We wanted it to be supportive, solution-focused and boundaried but it has become so much more than that. The members contact each other, text & share progress updates, anecdotes, support and inspirational messages during a time when isolation is the norm rather than the exception. From this nucleus, online events such as quizzes, escape rooms have developed and something much more than that. For us, it has been both a model and a source of evidence that people with OCD require ongoing support more akin to the AA model of recovery and staying well. The habitual component and high relapse rates associated with OCD aren’t easily managed in the long term without accompanying support. Bearing in mind the average term of therapy in the United States can be 5 to 10 years, here in the UK, differing mindsets towards therapy and financial constraints render that model less feasible. Weekly support sessions for 5 to 10 years are outside the capability of many clients but support in the guise of a weekly peer group plus social media has proved remarkably effective assuming that correct boundaries are in place. It offers a viable solution to the dilemma of social connection being essential to most aspects of health and well-being plus a clinical requisite for solution-based support. It can’t be any secret that a major part of the success of the AA model lies in peer support by experience and the availability of a support group at any hour of the day or night in major cities of the world. Our weekly group has moved us closer to that model and hence, I would like to add a final bullet point to those above: Lack of consistent, solution focused, non-judgemental, accessible peer support Bearing in mind our new Instagram account with daily updates for all plus live interviews with our clients, this has been our year of sharing. We may have been impelled by circumstance but we are now fully signed up. This is, above all, relapse prevention at work. ‘They’ say, that it takes 10,000 hours to become an expert at any given skill and it takes AA members 7 years of being sober to achieve their Bronze Sobriety Chip so we hope we are helping our clients to accept the tricky notion that relapse prevention is the holy grail of OCD wellness. Becoming their own expert doesn’t happen overnight and more importantly, learning the violin or Spanish is one thing, but not managing OCD is quite another. Merry Christmas and love to you all. This blog post is dedicated to the awesome group members for their ongoing commitment to themselves & others. Photo credit Kazuo ota

Amy, a CBT graduate & OCD Practitioner Programme trainee, guest writes on our blog and explains her interpretation of our concept of “AAA” If you suffer from OCD it would be a safe bet to assume you are, or have been, an AAA (anti-anxiety addict). We will do almost anything to get relief from discomfort & it soon becomes a serious habit. Whether you are in the early stages of OCD or have been dealing with it for some time, we become increasingly intolerant to discomfort, i.e., anxiety. We will push our minds & bodies to get rid of it as quickly as possible, but there is one major problem with that. The relief never lasts & before we know it we are repeatedly engaging in compulsions & behaviours to relieve it. As with all addictions, compulsions are a very short fix that offers less relief over time. We become addicted to relieving our discomfort. There are many ways to get relief: rituals, avoidance, checking & reassurance seeking from friends, family, or the internet. Reassurance seeking can be so detrimental to recovery. We quickly develop rigid thought patterns but, we need to ask ourselves: have your elaborate thoughts & safety seeking rituals solved your discomfort? Invariably, the answer is ‘No!”. You can change this pattern & find a lasting solution to your anxiety. You can learn skills to abstain from your compulsions for longer periods of time until you stop responding at all. You can tolerate uncertainty & develop flexible thinking. Instead of black & white, yes or no, you can embrace “maybe”, “possibly”, “might”, “who knows!”. Perhaps start small by abstaining from a compulsion for 5 minutes. Sit with the discomfort. The wave of discomfort is essentially a 15 minute curve that reduces over time. Ride this wave & let those intrusive thoughts flow in & out. As you increase the time you can abstain, you will eventually reach the point where you don’t have to respond at all; the ultimate goal.

Having dealt with this symptom ourselves, we have personal experience around this particularly frustrating aspect of OCD. Ugh, even when you are in a desperate rush, OCD steps in and makes the journey exponentially longer. Here we show the intrusive thoughts and seemingly life-threatening consequences of not getting the steps right.

Here is our recommended daily timetable. A combination of our recommendations and feedback from clients on their ideal lockdown day for managing OCD. For those that haven’t started the recovery journey yet, introducing just a few of these elements into your day will be helpful: AM Wake up, breathe out: look down at your current stream of thoughts & remember they are meaningless traffic Look around you: ground yourself by taking in your surroundings Wipe the slate clean. today is a new opportunity, a new you Remind yourself: ‘You are always good enough. For anyone and anything.’ Get up now: lying there thinking is not an option Turn on some feel-good music: especially if you live alone Stretch 1: spend a cat-like 10 minutes. Ease out the anxiety & prepare your body for the day Remind yourself: ‘you don’t have to be anything other than you are' Make your bed: respect your environment Eat something: as soon as you can. Even if you are very anxious, try hard to eat so that your brain has some fuel to cope Personal hygiene: mornings are tough for OCD. If so, delay inwardly focused cleaning teeth/showering until after midday Work/study/children/projects/admin 1: morning is best spent being focused and mentally active. Manage that anxiety Lunch: don’t skip a chance to give your brain some nutrition. Low blood sugar contributes to anxiety PM Recovery work: breathe, meditate, practice mindfulness, repeat rational statements, behaviour work, cognitive exercises. Choose one or more of these Downtime: take 30 minutes to rest, have a cup of chamomile tea Remind yourself: ‘you can only do the best you can do at any point in time’ Exercise: time to bust out some moves inside or out with family or alone Work/study/children/projects/admin 2 Remind yourself: ‘failure is an important part of growth ‘if you don’t fail, you’re not even trying’ Denzel Washington and 'failure is where all the lessons are' Will Smith Evening meal: nourish yourself and any family with great veggies, lean protein and complex carbs Reach out: audio or video call a family member, loved one or friend to help you feel connected and brighten someone else’s day Downtime: catch up on limited news, limited social media, reading, TV, box sets, browsing (try to avoid OCD researching). Winddown recovery work: breathing, mindfulness, meditation, reading Stretch 2: prepare your body for bed Get into bed: aim to get to bed at a decent hour to regulate your body clock Set your alarm: no later than 9.30am, an OCD mind needs daylight hours Remind yourself and list all the things you are grateful for Well done. Getting stronger every day.

“Crisis doesn't change people; it reveals them.” Eric Walters, The Rule of Three So, we have that rare occurrence when behaviours that appear as contamination OCD are widely encouraged and advisable. However, for people with OCD, it presents a number of problems. The public might assume that people with OCD will cope well, given they’ve had some practice in this area but this is not the case. Not least because contamination OCD is just one of a number of OCD sub-types, many of which have no issues around contamination or hygiene. For those managing OCD, what is happening now represents the possibility of relapse and for those not managing their OCD it represents the possibility of developing contamination symptoms and or any number of obsessions relating to a global pandemic, economic meltdown and widespread fatalities. If you have OCD or are caring for someone with OCD, here are some guidelines to assist you through this difficult time: Catastrophising: or 'awfulising'. Focus away from the problem and towards a flexible solution. Instead of thinking ‘this is terrible’, change that to ‘this is a tough time but with precautions and not panic, I can cope’. If you have had CBT, fall back to your ABC models and rational beliefs. If you are caring for someone with OCD, language can play a huge role, so be careful about using words or phrases that are catastrophic, awful or terrible. Moderate these words and phrases to ones where coping and managing are central. Limit your on- and offline news exposure: people with OCD can find news and information addictive. The media is designed to draw you in and keep you there. Set yourself a limit and check the TV news/news apps once a day or equiv. Unless you are in media, you don’t need to be up to the minute. Focus on your life/work/family and daily routine. For carers, try not to leave the TV on a news channel and limit reporting what you read on your devices. Talk about something else: even though it is tempting to lapse into ‘Corona chat’, try to keep your conversations varied and diverse. People with OCD become very narrowly focused, very quickly, which doesn’t help with mindfulness and remaining rational. For carers, try to steer the conversation towards other topics. Contamination OCD: the relapse rate for contamination OCD is high so if you have this sub-type be careful to protect yourself from relapse. Follow sensible, published guidelines such as washing hands, using sanitiser, not touching face, avoiding unnecessary international travel, etc. It isn’t advisable to avoid all public outings, take prolonged showers, use different clothing for indoors & outdoors, use bleach, boil wash your clothes or isolate yourself without any symptoms. This may be an opportunity to work on some of your other contamination issues, e.g., chemicals, foods, additives, faeces, etc. For carers, if you observe any behaviours that are excessive, raise your concerns without judgment, and if you are both agreed, work together on some mutually agreed exposure tasks. Hypochondria OCD: for those people with OCD health-related concerns Corona represents a huge trigger. In our experience, if health isn’t your primary sub-type, it is often a symptom that exists alongside other subtypes. Focus away from monitoring your body for coughs or cold symptoms and use mindfulness to remain present without judgment or analysis. If you were to develop symptoms, you will cope better if you are calm and mindful. Refrain from googling the symptoms on a daily basis just in case new symptoms are presented. Carers, try not to get involved in any verbal symptoms lists or…… Reassurance: for people with OCD, seeking reassurance is a compulsion and will exacerbate OCD. Try not to seek reassurance regarding Corona Virus online, via the TV or from others. Once you start it will be difficult to stop. It's like scratching an insect bite. Resist! Carers beware of offering it since the reassurance seeking can be covert and manipulative. Be careful with the more obvious questions, ‘When you were at the supermarket today, did you notice anyone with symptoms?’ or ‘Do you think I was coughing in the night?’ and the less obvious, ‘Did you see that sweaty person in the queue just now?'. If in any doubt, kindly decline to answer. Responsibility OCD: if you have responsibility OCD your fears of contracting the virus will be matched or outweighed by those of passing it to others. Regardless of the fact that this situation is evidence that we can’t control our environment therefore infecting others is an unfortunate part of human existence. Corona will be a sizeable trigger. Try not to relapse in to behaviours that involve de-contamination, avoidance of others and mental self-recrimination. If you have had CBT therapy, re-visit your self-acceptance work and rational beliefs. Resist the test: medical testing is very compelling for those with OCD because they believe it offers certainty. In reality, this sense of certainty is temporary and the temptation for further tests will be imminent. Try not to present yourself for a COVID-19 test if you don’t have symptoms or have been exposed. The laboratories will be working at capacity as it is and the impact upon your OCD will be detrimental. Check first with a family member or friend if they think you have valid concerns before calling a health professional. Carers, if you believe that the concerns are OCD-related, offer support and direct them to their therapist or an OCD helpline for advice. Guide your children: if you have OCD and have children or have children who have already been diagnosed with OCD, then your child will have been set guidelines from school. Encourage your child to understand that flexibility exists and work with them regarding excessive anxiety if the guidelines aren’t followed exactly. Children are being encouraged to wash their hands to a particular count or associated song. If a child has OCD, this can quickly become a ritual, so try to build some flexibility. For example, work on in-between washes that have no count, playing in the garden with dirt and use phrases around coping and managing, e.g., ‘whatever happens, we’ll cope.’ Manage your anxiety: for everyone, even without OCD, this is a good time to work on anxiety management. Get back to your mindfulness skills, pick yourself a daily meditation, do some yoga at home, work out at home using videos and your equipment, focus on sleep, practice correct breathing. Thinking time: if you have OCD, self-isolating or restricting your movements can mean more solitary time or less active time. OCD thrives in such times. When you have downtime or are less active or alone, thinking takes over the new found space. Be vigilant and fill that time with good mindfulness practice or projects. Don’t sit and think. Carers, encourage the person with OCD to stay as active and engaged with life as you can. Finally, remember, regardless of the media drama, Corona is not your worst enemy. Living a long life with severe OCD is worse. You are highly likely to survive Corona and the discomfort will be weeks. Severe OCD can last years, tens of years. Be sensible about Corona but be absolutely vigilant about your OCD. Corona may make you sick but lapsing into OCD will derail your life. OCD is still your priority. Stay mindful, stay rational. If you’ve got through OCD, you’ve got this. Carers, thank you.

In the last two months, life has changed dramatically, often daily, and without an end in sight. In my lifetime, I haven't witnessed this level of global panic and surely, in anyone's lifetime, a pandemic coupled with an overwhelming onslaught of multi-format media coverage is new territory. But as I always say, 'let's away from the problem and focus on the solution'. So, we are in unprecedented times and as such, this calls for an extraordinary focus on our OCD. By extraordinary I mean, in the face of a global threat has all the hallmarks of the worst OCD obsession, and guidelines which look very much like OCD compulsions, we need to rise to the challenge. The challenge to work harder on our OCD at a micro level whilst at a macro level, the world is in chaos. We have, and will continue to post individual coping skills here and on our social media, but I wanted to move away from the manual briefly and talk about the philosophy of managing OCD in a global crisis. Our mindset, our approach, our outlook, our system of beliefs, values and principles. In CBT we talk a lot about the mechanics of beliefs and values and it can get pretty detailed, but let's keep it nice and simple here. For those with OCD, absolutely take care of the small stuff and stick to your therapy, but know that mindfulness and compassion will see you through. Naturally they will see you through anything, but if you are struggling and want to use this time as an opportunity, mindfulness and compassion are your best friends. When you are confined to your home (which may be your norm) and the world is in crisis, being present without judgment is your personal path through the mess. Deliberately focusing on projects, other people, pets or your work, and not engaging in the inner scramble of thoughts and feelings, should be your basis. Similarly, observing rather than engaging in the external commotion of chit chat, news and social media, needs to be your follow on. That's not to say that you can't watch the news, post on social media or listen to chit chat but it's helpful to limit your exposure to the inevitable catastrophising that will ensue. You already know that analysis, evaluation, problem-solving and comparing haven't served you well in the past, let alone in a global crisis. Try to do the above with an overriding sense of compassion, for you, for others, for the world. In an increasingly unwell environment where we may be able to attribute our immediate problems to the sale of live animals in markets, the world and it's non-human inhabitants are desperate for compassion. People with OCD tend to feel this pain so let's use this quality for good and find ways to help voiceless animals and the environment. As world pollution takes an enforced dip and the abuse of animals is highlighted, let's collectively drive change, from our bedrooms. Next, let's view others with kindness. Although this is an OCD default setting (especially responsibility OCD), let's change intrusive thoughts, anxiety or guilt into positive action. OCD forces us to focus inwardly, to check how we are feeling, to predict how bad we will feel if something happens. If that's the case, then here's a chance to ask others how they are coping and to really listen and feed back. If OCD makes us self-absorbed, instead, take part in the increased sense of community and kindness we are seeing each day. It is fine to start small. Then later, in a society which has the capacity to be very unkind indeed, let's maintain our compassion in ways which help our OCD and others. If isolation has taught us anything, it has shown that all of us are needed by someone. Finally, compassion starts at home but more specifically, it starts with you. If OCD has eaten away your at your self-worth and self-love, you can't effectively direct outwards what you don't feel inwards. COVID-19 proves that we are all the same. Regardless of wealth, success, achievement, relationships or social media/social life. Inside we are roughly the same delicate mix of cells and biology. No one is better than you (or worse, of course) and you are always good enough, for anything and anyone. If you believe the 'great and the good' are confined to their homes, remind yourself every day that you are one of them. Reinforce the fact that you are valuable and worthwhile simply because you are here. In a level playing field there has never been a better time to realise that it's always a level playing field. So please, don't do your OCD any favours. Now is a unique time to take special care - of the present, of you, of the world. Improve your mindfulness and try our meditation aimed at Coping with the Corona Crisis here Image: Shane Rounce

If this question is familiar to you then you are almost certainly dealing with responsibility OCD on a daily basis. Responsibility OCD far outnumbers contamination OCD in terms of clients presenting for therapy now whereas the opposite was true in 2003 when I first started my practice. And confusingly, responsibility OCD can also be ‘disguised’ as contamination OCD therefore it takes some expertise to disseminate the two and get to the root of the problem. But those who are either spending hours a day online checking the symptoms of OCD or seeking numerous assessments from therapists are trying to reassure themselves that it is OCD and they aren’t ‘bad’ people. They believe they need confirmation that the violent/sexual/abusive images or thoughts don’t suggest something more sinister and/or pathological exists within them. Driving this overwhelming need for reassurance is an underlying sense of low self-worth, a long-standing dysfunctional relationship with themselves which culminates in placing others’ safety and happiness above their own. A history of being bullied, marginalised or abused often exists or there may be a self-imposed sense of not being good enough that has persisted despite achievements or success. Just by having OCD and considering they are a person with a mental health problem can underpin low self-acceptance. The obsessional categories associated with responsibility OCD tend to fall in to these main areas: - Worries about emotionally or physically abusing or harming others, particularly the vulnerable, e.g., children, elderly, etc. (sexual abuse features frequently as a subset of this obsession) - Worries about abusing or harming themselves (due to the distress caused to others) - Worries about stressing or abusing family members, particularly own children - Contamination, more specifically, contaminating others with germs or disease - Committing crimes that impact others, e.g., fraud, theft, arson, etc. - Road traffic offences, e.g., accidents, hitting cyclists or pedestrians - Damaging other people’s property - Damaging their own property (if funded by others) - Being unfaithful or adulterous to partners The moral and ethical dilemma at the heart of responsibility OCD means that treatment must be holistic in nature, with a long-term focus upon addressing self-worth issues. We have developed a category of behaviour work within an overall treatment protocol that looks at self acceptance alone and comprises at least 20% of the therapy content. Without this focus, the very core of responsibility issues will not improve. Or if they do, they are in danger of morphing into another responsibility-based obsession.

It is true that POCD or Paedophilia OCD is widely discussed on the internet by sufferers and their carers. As far as I know, in contrast with other sub-types, it has yet to be dealt with in detail by the media. 10 years ago a national TV company shot a documentary featuring a segment on POCD. A young client was filmed talking about his fears of harming children. He was barely more than a child himself. It was brave for all parties, compelling and ground-breaking. It was also completely cut from the final version. In terms of media awareness, this sub-type of OCD remains controversial and not because the media understand what it involves, but because they don’t. Those that don’t understand have inferred that sufferers are bombarded with alarming images and thoughts of paedophilia and all that might suggest, i.e., latent paedophilia traits. This isn’t true. People with this subtype are obsessed with the possibility that they could be a bad person of any description and this is their core concern. What happens then, is that the sufferer is bombarded by the graphic, often highly judgmental and influential media reporting of current atrocities which become the focus for people with Responsibility OCD. And since the press is currently heavily weighted towards paedophilia, in the wake of recent cases, this becomes a focal point for the person with Responsibility OCD. They will fixate more specifically on paedophilia because it is the worst crime they can imagine, the one that will generate most public disapproval and personal self-loathing. They then resort to frantic attempts to not think violent or sexual thoughts whilst simultaneously avoiding children. Naturally such suppression eventually makes the obsessions more frequent and intensive – ironic process theory. During the last 10 years, being a child-abuser or pervert has become the most commonly presenting sub-set of Responsibility OCD in my practice and has become generally known as POCD. Were the media and society to turn their attention towards animal abuse or tax fraud, the outcome would be the same. In other words, POCD has nothing to do with the sufferer having paedophile intentions, it has to do with them avoiding terrible disapproval, guilt, shame and public vilification – the means to that being irrelevant. Indeed, the ‘P’ or paedophile aspect of POCD is irrelevant and there is no one safer to be with your children since they would rather harm themselves than your child. That is the whole point. Can you imagine how you'd feel if you were 14 years old & it mistakenly occurred to you that you could abuse children? You might conclude that the world is much better off without you (yes, I've heard that many times). What if you were a father of 3 who couldn't bathe his children or a young mother breastfeeding? How many suicides or self-harms have been prompted by this horrific but entirely erroneous worry? This is a cruel and heartless manifestation of OCD and the media would do just as well to man up and raise awareness since they played their own part in its inception. What are they scared of exactly? Disapproval?

1. If you are working, use work to be mindful. Make a big effort to focus outside your head on your environment, the people within it and the daily tasks 2. Take care of your diet. Use Glycemic Index science to steer away from refined carbs/sugar/fruit and get lots of protein, veggies and complex carbs. Don't neglect nourishing fats like olive/coconut/flaxseed oils - great brain food 3. Keep hydrated. It really helps. Dump the fizzy drinks/alcohol for a few weeks & treat your body. Drink lots of chamomile/liquorice/ginger tea - warming, calming & comforting for your tum and your mind 4. Take a look at your supplements. If you aren't getting enough daylight then Vit D might help. Also look at brain supplements such as phosphetidyl serine, etc. Omega's are excellent, as is Vit B & C. Get advice before adding these to your diet. 5. Get as much physical exercise as you can. Walk the dog, get to the gym, get gardening, take children to the park or just walk, full stop. 6. If you aren't working at the moment, have a daily plan. Don't cruise through the days. Make a list the night before of tasks, e.g, household bills, return Xmas presents, DIY, email friends, etc. 7. As above, keep to a daily structure. It's so tempting to stay in bed & avoid the day but set a time to get up! Stick to it as much as you can. Almost as important, set a time for going to bed, even if you don't sleep - read, do a crossword, but keep to a schedule. Your brain will thank you. 8. January can be the lowest month so reach out to friends, family. Email or social media as much as you can but better still, make a social date to see that film, visit the pub, get some supper together. 9. Join a class. Go on! Languages, music, art, even counselling. Find out local college discount rates. 10. Get in touch with your therapist. You may well need them now. If there is a waiting list, start the process now. If a private therapist and funds are tight after Xmas, let them know. Be honest and see what they can offer. 11. Re-read your old therapy notes, you will be surprised at what you may have forgotten. 12. Look our for our cost-effective specialty workshops starting in 2020. They focus on relationship, responsibility, religious and sexuality OCD. We will post dates on here and the website

Post-Christmas is a notoriously tough time for OCD. The reasons are numerous but are connected with: 1. Having less to do for the holiday period. OCD loves an unoccupied mind. Christmas and downtime gives OCD space to create thoughts and obsessions and the time to think about them. Christmas can be an insular time. 2. Less sunlight affects mood and has an impact upon ability to cope with OCD. This is otherwise known as SAD (Seasonal Affective Disorder) and has an impact upon all mental health conditions and people's ability to cope. 3. Christmas can be an emotional time with movies and TV that are nostalgic, sentimental and emotion-focused. The media and advertising worlds use Christmas to generate an emotional response. This can be tricky for mental health. Images, themes and subject matter can make the lonely feel more lonely, the anxious more anxious and the depressed even more depressed. It is a sensitive time. 4. Seeing relatives and friends can be stressful if family conflicts exist. Expectations, responsibilities and self-downing can be a feature of family get-togethers and occasions. The idea that one should be having a good time and enjoying the Christmas can be a pressure. Add to that family conflict and the combination is troublesome. 5. Eating and drinking excessively doesn't help mood and blood sugar balance. Over indulging in drink or food as self-medication is tempting. Even those without mental health issues do it so it is understandable. The traditional foods available aren't necessarily conducive to your mental well being so just be aware that if you over indulge, you may feel the effects. Also remember that alcohol is a natural depressant (so is putting on 5 pounds!) 6. Having to shop and buy presents can be stressful for people with mental health issues. For those with OCD who struggle to get out or order online, this can be a problem. Also OCD can mean that sufferers can't concentrate, select certain items or carry out tasks that trigger their anxiety. 7. Being more sedentary isn't good for managing anxiety and it means that there is no outlet for nervous energy other than the TV or fridge.