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First, you and a CLOC consultant will discuss your organization's needs and desired outcomes. At the conclusion of the contracted series of sessions, progress toward goals is evaluated.
About UsWe are a specialty concrete floor finishes contractor that specializes in concrete polishing and staining. David Adam is a writer and editor at the journal Nature and was a special correspondent at the Guardian, writing about science, medicine and the environment. Originally published on January 14, 2015 9:58 am If you have an obsessive but irrational fear, it would probably be pretty difficult for anyone to talk you out of it.
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The day of reckoning for global total debt – total credit market debt up from $28 trillion in 2001 to $53 trillion in 2012. The compression of generations – 25 million adults live at home with parents because they’re unemployed or underemployed. Coaching is driven by client goalsand outcomes, and usually contracted for and scheduled as a package of six to eight sessions. Because irrational fears, by definition, aren't rational, which is one of the reasons having obsessive-compulsive disorder is such a nightmare. This transition, which once seemed abstract and consumer-centric, has become a reality for the industrial and commercial markets and it’s impacting how the HVAC industry conducts business at the equipment and controls level. Bowers in 1984, The Bowers Group has continued to provide superior mechanical construction and HVAC services to general contractors, high-tech companies, property managers, government agencies and institutional clients.
Leveraging the advancements and growth in machine-to-machine communications, Daikin Applied is launching Intelligent Equipment. This new technology platform harnesses the Internet of Things (IoT) for the first time in commercial HVAC equipment, making it possible for HVAC systems to talk to operators and proactively take action, in order to improve efficiencies and exponentially increase cost savings. His fear that he will catch AIDS — in situations where it would be almost impossible for him to acquire HIV — has been quieted by OCD treatment he's received, but it hasn't gone away. He's not alone when it comes to this disorder, he says, but that doesn't help with the agony. I then became obsessed that there may have been blood on that paper towel, so I had to check on the other paper towels. And so you get trapped in this loop where you're desperate for certainty and you can never get it — you're always checking. For example, I have a small cut on my thumb, right now, today, and I'm very aware of who I shake hands with, if they have a Band-Aid on their finger.
I know this is ridiculous and yet a little, little part of me thinks that maybe they've got blood coming out of their wound and maybe it could get into my small cut on my thumb.
On how he repeatedly called the AIDS hotline I hated myself for doing it and many times I would dial the number and then I would hang up before anyone answered. I know now, that they were getting a lot of calls from people they called "the worried well" at the time. The technology easily interfaces with new or legacy equipment, and the units will intuitively know when to adjust for occupant comfort and energy efficiency. Daikin Intelligent Equipment is powered by an Intel IoT Gateway along with Intel Decision Solutions: Trend Analytics Module that offers users the confidence of predictive maintenance. The solution also includes a Wind River IoT platform based on its Linux operating system and overall security is provided by Intel McAfee. You need to accept it." But what drives OCD, or at least it did in my case, was this constant need for that reassurance. It is humiliating, it's embarrassing, but humiliation and embarrassment were a price worth paying if you get that security, if you get that reassurance, if you get able to put your mind at rest. You can have safe sex, but to be honest, [asking about someone's sexual health] is a rational question, and the OCD mind is not rational. So I can't tell you that I was more worried about catching HIV from sex because I was so worried about catching it from everything else that it just blended into the background.
Some people get an urge just to attack people in the street or when you are in a very quiet place like a church or a library. Those thoughts are everywhere and in most people they pass, but the reaction to them is usually, "Woah, where did that come from?" In OCD, what happens is that they tend to, for some reason, we treat them more seriously than other people. So for example, the intrusive thought about stepping in front of a train, someone might have that thought and they're not suicidal at all and most people would [have the thought and think], "Well, that's a bit strange. So it seems to run in families, which suggests that there is properly some kind of genetic component, although it has been difficult to pin that down to any particular genes. Certainly there is a clinical, psychological explanation, which is if you have a certain mindset, then you are more likely to misinterpret the kind of thoughts that everybody has. There is also a sense that there are particular parts of the brain, which can't be turned off in OCD.
There's a very deep part of the brain called the basal ganglia, which holds patterns for instinctive behaviors — "run away," or "fight or flight" — and those can be activated and then usually have an alert and then you have the "all clear." And it could be that in OCD the message to give the "all clear" doesn't get through properly and so you are reacting to a stimulus that isn't there anymore, which would explain the constant need to perform the compulsions. There's the primary negative effect, which is the anxiety caused by my irrational fear of HIV and that isn't going to be affected by knowledge. Learning about the science and the history helped connect me to other people.Copyright 2015 NPR. If you have an obsessive but irrational fear, it would probably be pretty difficult for anyone to talk you out of it because irrational fears, by definition, aren't rational, which is one of the reasons having obsessive-compulsive disorder is such a nightmare.
My guest, David Adam, is a science reporter who has OCD and has written a new book chronicling his experiences and taking a wider look at how medical understanding and treatment of the disorder have changed over the years.
Adam is a writer and editor at the journal Nature and was a special correspondent at The Guardian, writing about science, medicine and the environment.
It's about the fourth most common mental illness, and it affects pretty much everybody - men, women, children, adults, people of all cultures and all creeds and all races. And a few years later when I was at college - I was 18, 19 - I just started to worry obsessively that I was infected. All of the ways that you are told that you can't catch it, those are the things that I worry about. I am an educated, you know, reasonably scientifically literate person, and yet I have this irrational fear which I recognize as being irrational and being foolish. And I perform compulsive behavior - or at least I haven't done recently - but we can get on to the treatment and that's part of the treatment. But I perform checks, and I change my behavior to try and make sure that I don't become infected with HIV.
And, even more ridiculously, but even more distressing, is since I became a father, I'm very anxious that I might pass the HIV that I believe I might have onto my children. So I describe in the book a number of incidents, one of which was I scraped my heel down the back of a step in the public swimming baths in Manchester, and I became obsessed and that there may have been blood on the step, and so I wanted to check that. I then became obsessed there may have been blood on that paper towel, so I had to check all the other paper towels.
And as - you sort of - you get trapped in this loop where you're desperate for certainty, and you can never get it. So another example would be - for example, I have a small cut on my thumb right now, today. And I know this is ridiculous, and yet a little, little part of me thinks that maybe they've got blood coming out of their wound and maybe it could get into my small cut on my thumb. So, in principle, that could happen, but it's so extremely unlikely that nobody bothers about it.
And it's - I suppose, it's a bit like walking around being frightened that you might be struck by lightning. That does happen to some people very occasionally, but most of us don't let it rule our lives.
GROSS: But if there's going to be 1 in 1 million people to whom this happens, maybe that 1 in 1 million is going to be you. Someone once told me that to catch HIV from a kiss, for example, was like 1-in-1-million chance.


I worked out how many people there were in the world and how many people kissed each other, and if we assume that only, you know, 1 in 2,000 have HIV then that means that - I don't know. GROSS: So there was a period when you were calling - I think you're out of this period, but maybe you're not - that you were calling the AIDS hotline several times a day, seeking reassurance that the thing you were worried was going to give you AIDS was not going to give you AIDS.
And it got so bad that you started to disguise your voice so that they wouldn't realize that you were this repeat caller. ADAM: It was embarrassing, but it was a very impersonal sense of embarrassment because they didn't know me. It was just - that was back in the day when phones were still, you know, attached to the wall (laughter). And if someone answered and it was a voice that I recognized, that's when I started to think, well, I'd better impersonate somebody else because what happens is - I know now that they were getting a lot of calls from people they called the worried well at the time. But what drives OCD, or at least it did in my case, was just this constant need for that reassurance. But humiliation and embarrassment were a price worth paying if you get that security, if you get that reassurance, if you get able to put your mind at rest. Like, say you called the AIDS hotline, and they said, no, really, you couldn't possibly get AIDS from having touched the towel that you just described.
But then you're going to walk outside and do something else that's going to scare you, right? So maybe if I'd explained it slightly differently and I got across to them what actually happened, it would have been a risk because no one can ever tell you that there is zero risk of anything. And then, in seeking that reassurance, because that's the only weapon you have, is external reassurance, because you've told yourself this isn't a problem and yet - it's like if someone else tells it to you, you almost get a little kick of reassurance. GROSS: If you're hyper-vigilant about an obsessive fear, does it mean you're not paying adequate attention to other things in your life?
I had a sort of a parallel narrative in my head that definitely drains attention from relationships and decisions that you make and - but, also, it takes away - it takes away a lot of the everyday emotion, I suppose, because say if you're watching a film and you get really lost in it or you're reading a book and you really want to know how it ends or you really care about the fate of the protagonist or the person in the film, and, you know, you lose yourself. And that's why we read books and that's why we watch films, to lose ourselves, whereas I could never do that. You know, I think - I try and remember the movies that I watched at the time, things like "Pulp Fiction" and there was a Dracula - a vampire movie.
And, you know, all I was thinking about - I wouldn't do that because I might get HIV from it, especially because vampire movies became a metaphor for HIV in the '90s. Let's take a short break here, and then we'll talk some more about OCD and some of the science behind it, what doctors know about it now. But this book is part memoir, and it's also part kind of, like, science-medical history of our understanding of OCD. So I need to ask you about sex, (laughter) not in an explicit way, but, like, if you were constantly worried about getting HIV from cutting your knee on the soccer field or scraping your heel in the swimming pool, what kind of sex life could you possibly have had? I have a feeling, honestly - I don't mean to get too personal, but it's kind of personal, isn't it?
ADAM: Yeah, you know, well, I think the sex life that I had probably started later than it would've done, and it's probably been - how should we put this?
And, yeah, basically the only people I told - I had OCD for - I still technically have it, but, you know, it was really at its peak for 10, 15, 20 years, and the only people who I told were girlfriends because of that reason because it was an issue for me. It's a bit like - you just get used to a certain level of constant anxiety, and the source of the anxiety almost becomes irrelevant.
GROSS: And there's something called intrusive thoughts that you write about, which are - give us a couple of examples of intrusive thoughts, which is another part of obsessive behavior, right?
And these are the kind of thoughts that - for example, a very common one is when you're waiting for the train - the subway or the tube train - and you hear it start to come, some people get a urge to jump in front of the train.
Or when you are in a very quiet place, like a church or a library, some people get a very strange urge just to shout out a swear word.
And in OCD what happens is that they tend to - for some reason we treat them more seriously than other people. So, for example, the intrusive thought about stepping in front of a train, someone might have that thought - and they're not suicidal at all - and most people would think, well, that's a bit strange, but, look, here's the train. And that's the slippery slope because very soon, rather than taking one step back, you'll take two steps back or - Winston Churchill had this. I don't think he had OCD, but he had this urge, very strongly, to jump in front of a train. And he said that when the express train passed through the railway station that he waiting at and he wasn't - the train wasn't going to stop - he would put a pillar between himself and the edge of the platform just to make sure that he couldn't jump out in front of it. And so once you start to treat those strange thoughts seriously, you start to change your behaviors and take a step back.
Then, if one step is never enough, two steps are never enough, then it's not too difficult to imagine people who just think, you know what?
GROSS: Reading your book, I kept thinking what a fine line there is, sometimes, between normal fear and kind of normal obsessions and compulsions and serious OCD or having intrusive thoughts and being, you know, obsessed with intrusive thoughts because, like, don't we all have some of this to some degree, including obsessions?
And I think one of the great myths about mental illness is that there's a firm line between people who have it and people who don't.
As with most physical illnesses, there is a - there's a scale, and people are on the scale. And the way I described it is this - lots of people say, oh, you know, I'm a little bit OCD. And the D is where - it stands for disorder, but it could just as equally stand for disruption if it's starting to really affect your life.
So lots of people come up to after me after I give talks and say, oh, you know, I do this thing when I - is that OCD? And with one guy who was saying, oh, yeah, I have this thing where I have to check the door is locked. But the kind of obsessive thoughts and compulsive behaviors that people have where, you know - I don't know - they might need to knock on wood they say something or they have a lucky color or they have a certain mental routine that they go through before they leave the house.
If you can leave the house without it causing you particular distress then - I think it's a medical issue, isn't it? You know, is there a theory that it's rooted in a certain part of the brain or in, you know, the transmission of signals in the brain? So it seems to run in families, which suggests that there is probably some kind of genetic components, although it's been difficult to pin that down to any particular genes.
Certainly there is a clinical psychological explanation which is, if you have a certain mindset, then you are more likely to misinterpret the kind of thoughts that everybody has. And then there is also a sense that there are particular parts of the brain which can't be turned off in OCD.
So there is a very, very deep part of the brain called the basal ganglia which holds patterns for instinctive behavior.
And it could be that, in OCD, the message to give the all clear doesn't get through properly. And so you are reacting to a stimulus that isn't there anymore, which would explain the constant need to perform the compulsions. And there's some evidence that if you interfere with those parts of the brain, then maybe you can change the outcome.
There are some brain scans which have looked at those parts of the brain and they seem to behave differently in OCD. I'm Terry Gross back with David Adam, a science writer who has written a new book about OCD, obsessive-compulsive disorder. The book chronicles his OCD - he has an obsessive fear of contracting HIV - and examines how the medical understanding and treatment of OCD has evolved. So we were talking earlier about when you were really, really lost in your obsessive fear of getting AIDS in places and from things where there was, like, a one-in-gazillion chance that you could possibly get it.
You kept calling the AIDS hotline, and they occasionally would tell you what you really need is psychiatric help.
And there was one therapist, and he - so CBT, cognitive behavioral therapy - the cognitive bit was, I suppose, explaining to us that everybody has these really strange thoughts, which is actually something of a revelation because nobody talks about these things. And you think there's something really weird about you because you have these strange thoughts. You know, like, people - I want to have sex with a dog, or I want to hit this person with a bat, or, you know, I feel like I'm going to jump in front of a train, or I feel like I'm going to push somebody else in front of a train, which is exactly the kind of stuff that OCD centers around.
But then kind of the punch line was that these were all taken from normal people, none of these people who had OCD. And that is such a sense of relief because then the problem becomes not, why am I having these thoughts? You know, if I say to you now, don't think of an elephant, then of course what do you think of? It was just about education, I suppose, education just about how the mind works, which actually most people don't talk about. And then the B in CBT, the behavioral therapy, that's where it gets a bit tricky because crudely what do is you expose someone to what they are afraid of to provoke the anxiety. And in OCD what usually happens in that situation is you have the obsession, which makes you anxious, and you perform the compulsion, which reduces the anxiety.


So, for example, my obsession would be I may have caught AIDS in this way, and my compulsion would be trying to check that I hadn't, either by making sure there was no blood around or by calling the National AIDS Helpline or whatever. And although that has a - it reinforces the obsession, the compulsion, actually it does reduce the anxiety in the short term, which is why we do it. You expose someone to what makes them anxious, to this source of the obsession, and you stop them performing the compulsive behavior. Now, in the old days, they would actually tie people down so they couldn't, for example, wash their hands. What were you exposed to, and how were you prevented from getting the reassurance that you always seek when you're worried you were exposed to HIV? And what I would do previously would be to look at my hands so that would be the compulsive behavior.
I might even check them again and again and again, but eventually I would move onto something else.
You know, we talk about thought and mind over matter and - but this was - this was just phenomenal. He said, OK, if you're not going to rub your hands, you can't look at them ever (laughter) until you feel less anxious, until you feel like you don't need to look at them. It took me about three days, three days during which I was extremely anxious that I had blood on my hands, but I didn't look at them, not deliberately.
And so rationally any blood that would have been there would have been washed away anyway, but still I wanted to check, I wanted to make sure.
And eventually - and this is the theory behind this kind of therapy - that anxiety has to go down because you just cannot keep it at that level indefinitely. And once it goes down by itself without the compulsive behavior, the theory is that then you become confident that that will happen again in the future. And sometimes there is no rational link at all between the content of the thought and the behavior.
For example, women who have been raped - not a very pleasant subject - but we're very familiar with the idea that they need to have showers, and constant showers, because they want to get themselves clean. But what you don't know is that a lot of these women also develop other forms of compulsive behavior, and they would, for example, like to arrange things in the house in a symmetrical fashion. But equally it could be a thought about - we talked about, you know, parents dying in a car crash. Some people would have this thought, and because they can't make the thought go away by thinking, they'll develop a tick or a routine.
And that can be hand-washing, but it could equally be tapping the wall or saying a magic word to themselves.
Can you talk a little bit about what you've learned about compulsions and how they connect to obsession? So, for example, in my case, if I was worried about HIV getting into a wound from a piece of glass, it makes perfect sense for me to look at the glass to see if there's any blood there.
And they think, that's a ridiculous fear - well, it's not ridiculous 'cause we all fear our loved ones dying - but they take it to an extreme where they think that they might be responsible for their death, you know, by - what happens is you can get into a cycle where the compulsion starts to drive the obsession, and then you need to perform the compulsion again. And so what you can get is - for example, someone who has a fear of a loved one dying, they might just touch something three times for luck. And then they'll find that that parent or whoever it is doesn't die, and they think, oh, well, that must've been because I did that. And then the compulsion becomes what they have to do to stop what they fear happening from happening.
And you get this with a lot of OCD that demonstrates itself as - with symmetry and patterns.
You know, there is no logical way that you could say, by performing a certain action a certain number of times, it addresses any concern about harming anybody. So, for example, if you're waiting for the train, and you get that weird thought about jumping in front of the train, some people might just tap their feet three times as a way to make that thought go away. But it addresses the thought, and so that's why it can become a compulsion because in addressing the thought, it takes away the anxiety. It could be five times, or it could be that someone scratches their nose, or it could be that they turn around.
Sometimes if you get a thought about jumping in front of a train, some people might say a word to themselves, like magic or bananas, and very quickly, because you don't jump in front of the train, you feel that you want to say that again and again. And so the compulsion feeds the obsession, but in no way is that a rational response to a fear to jump in front of a train. My guest, David Adam, is a science writer who writes for Nature magazine, and he has OCD that he says is under control now after therapy.
He's the author of a new book called "The Man Who Couldn't Stop," which is about his OCD, and it's a kind of history of our understanding of the disorder. His new book, "The Man Who Couldn't Stop," is the story of his own OCD, and it's the larger story of the medical scientific understanding of obsessive-compulsive disorder. Children can sometimes be very compulsive about, you know, not stepping on cracks or knocking on the table a certain number of times or only swallowing a certain number of times or - kids have all kinds of things like that. And so in very young children, ritual and patterns and repetition seem to be a source of comfort. So to get control over something, some control over their environment, they like to, for example, line things up. So when you're 3, you know, you're scared of being left alone or not being fed, whereas when you are 5 or 6, you might start to become scared of things like monsters. So social rejection - for example, you know, there are children who feel socially rejected at maybe 6 or 7, and the correct, if you like, response to that would be to talk to their parents about it - whereas some children seem to revert back to their ritual which they found comforting much earlier - is the theory. And so the idea is that ritual, which we know provides some kind of reassurance, then can provide reassurance in situations where it isn't the best, most optimal response.
It's completely natural and normal for some animals to have rituals and routines, and this is why I always stress the D in OCD. But of all the ways that we can identify it - and there are many, and none are particularly easy - a child that has rituals or routines is obviously not one of them because that is normal.
GROSS: So when you first were diagnosed with obsessive-compulsive disorder, it was considered an anxiety disorder. Psychiatric Association, which publishes this every few years - or every 20 years or so, updates this manual of mental disorders which are used to diagnose it.
When that latest - it's called the DSM - came out last year, they decided that OCD would be moved.
And it was taken away from the anxiety disorders, as you say, and it was given a new category, given its own category - the obsessive-compulsive and related disorders. So OCD is now officially linked, if you like, to some other disorders which are characterized by obsessive thoughts or compulsive behaviors, for example, hoarding disorders - this condition where people just fill the house full of stuff and can't throw it out - things like compulsive skin picking, which is its own disorder as well, and compulsive hair pulling. And in reality, it doesn't make a lot of difference to those of us who have OCD 'cause it's all diagnosed and treated it in the same way. What it does is it starts to build bridges with different disorders based around their symptoms rather than the name of a disorder. So, for example, what they might be able to do now if you're a scientist is you can take people with OCD and with hoarding disorder and with those compulsive skin-picking disorders, and you can group them together and try and study them together. GROSS: So now that you've written a book about obsessive-compulsive disorder, has all the research you've done for the book been helpful to you as somebody who actually has OCD? It's based on something that might have a rational root, but it's been so wildly exaggerated.
So reading all the science, reading all of the history, does that help, or is your fear too irrational for that to penetrate?
And I would describe it in this way that there are - with OCD - or at least my OCD - there are two negative effects. There's sort of the primary negative effect, which is the anxiety caused by my irrational fear of HIV. But there's also a secondary effect of OCD - and I imagine other mental illnesses and indeed some physical illnesses - where you're so aware that you have this thing - and in OCD, you keep it secret - that it changes your relationships with people.
It makes you think that you're living a lie, that you're not being honest with people, that you have this parallel narrative that, if only I didn't have OCD, my life would be different and I would be having this very conversation in a different way. And that side of it has gone now because I'm talking about it, I'm being honest about it and learning about the science and the history helped connect me to the people because there are people, you know, hundreds of years ago who had this experience, and there are people all over the world who have this experience, in many cases, much, much worse than I've had it at least in the effect on their life. GROSS: So coming out about it in your book has been helpful and having social interactions 'cause you're not covering up. ADAM: My friends joke about it now, which is a good sign 'cause it just means it's accepted.
And yeah, you know, it took me 20 years to tell my parents what I have just told you and the good people of America. GROSS: And you told them because you had a book contract, and you had to tell them in order to write it.



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