Dearest:    LEE BAER, Ph.D., is an internationally recognized expert in the treatment of 
OCD (Obsessive Compulsive Disorder) and related disorders. He is an associate professor 
of Psychology at Harvard Medical School and the director of research of the OCD Institute 
at McLean Hospital. He is the author of "The Imp Of The Mind: Exploring the Silent 
Epidemic of Obsessive Bad Thoughts," and "Getting Control: Overcoming Your Obsessions 
and Compulsions." 

Dr. Baer, welcome to Power Surge. Palpitations are palpitations, but some are normal and 
others indicate heart disease. Is there a way to determine if one's "bad" thoughts are 
normal, or if they're something to be concerned about the person acting on? 


Dr. Lee Baer:   Thanks for having me. Everyone has bad thoughts, but for some people 
they become disabling.  If the bad thoughts about violent, or sexual or blasphemous 
things cause you a lot of distress, or force you to avoid things you want to do then 
it becomes a problem.  Some mothers are afraid to take care of their newborn babies 
because they fear they might harm them. Some grandmothers I've seen won't babysit 
for their grandchildren for the same reason.  In these cases it becomes a problem 
that needs help. 



Dearest:    Is there some pattern to bad thoughts?  For example, wouldn't anger frequently 
precipitate bad thoughts? 


Dr. Lee Baer:   Yes, for a lot of people anger does bring them on, for example when my 
kids were very young, if I got really angry at them I might briefly think of throwing 
them  across the room!  But I knew I wouldn't do it.  For people who are our patients, 
they won't be able to get the thought out of their head, and then fear they may snap and 
do it.  So yes, anger can be a trigger. 


Dearest:    So, if one can't get the thought, for example, of doing harm to someone out of 
his/her head, that would indicate therapy? I ask because I went through this myself when 
one of my daughters was very small and was home sick from school. It happened a few times 
and frightened me, but then passed and never happened again.


Dr. Lee Baer:   Yes, this is a very common problem -- someone mentioned the empty nest 
syndrome, and one of the things that can trigger obsessive thoughts like this is 
depression, as well. 


Dearest:    My last question for now. Am I correct in assuming these bad thoughts can
include doing harm to ourselves? 



Dr. Lee Baer:   Yes, but I would exclude clearly suicidal thoughts from this.  What I 
mean is that people sometimes can't get images of hurting themselves out of their mind, 
but they are not planning to kill themselves because of hopelessness or depression.  
In that case it could be an obsessive bad thought. 


Dearest:    I see. Thank you, Dr. Baer. Very interesting.  Lovelife, please go ahead.


lovelife:   How do I control my fears of the unknown and going out alone?


Dr. Lee Baer:   I assume that you think it is really unsafe to go out alone.  In this 
case the problem sounds like agoraphobia and gradually going further from your home, 
while getting confidence is usually very effective.  Of course in problems like this 
people have many worries, but we do not usually consider these to be obsessions.



lovelife:   I have fear of something going wrong while alone -- that I can't handle it.


Dearest:    But it would seem that bad or obsessive thoughts can lead to panic. 


Dr. Lee Baer:   First question - you can't stop negative thoughts by forcing them out of 
your mind.  This only makes them worse.


Dearest:    Dr. Baer, isn't that part of Dr. Claire Weekes' theories in treating 
agoraphobia?  To go or "float" with the negative feelings, rather than fight them?


Dr. Lee Baer:   That is absolutely correct! Dr. Claire Weekes was one of the pioneers 
of behavior therapy and we use a modification of it to treat OCD and various obsessions.


Dearest:    She saved my life 20 years ago.


Dr. Lee Baer:   Can I ask the others a question?


Dearest:    Yes, because the more you fight, the worse it gets, right?


Dr. Lee Baer:   Yes, absolutely it does.  We teach people to let the obsessions pass 
through their mind which is similar to the "floating" with anxiety that Dr. Weekes 
taught.


Dearest:    Can you possibly give us an example of a mental exercise to help the thoughts 
pass through our mind?  I am familiar with Dr. Weekes, but not sure many of the women 
are.


Dr. Lee Baer:   Dr. Weekes is a psychiatrist (I believe) who has written several best-
selling books about self-treating panic disorder and agoraphobia.  As for an example of a 
mental exercise we find it is very important for people to understand that *everyone* has 
bad thoughts from time to time about sexual, violent or blasphemous things that they 
would not want to have, so there is no need to feel alone or ashamed.  Even priests and 
nuns and rabbis that we have seen admit to these thoughts!  This helps people to let them 
pass through their mind without fighting as hard just having the thought is NOT a sin.


Dearest:    Yes, she was. She passed away, unfortunately. Thanks, Dr. Baer. Harper, go 
ahead, please.


harper:   Could you please tell us how your two books differ?


Dr. Lee Baer:   My first book "Getting Control"  was about using behavior therapy to 
treat the symptoms of OCD (obsessive compulsive disorder) in general.  However many 
people with obsessions only did not identify themselves as having OCD, or were too 
ashamed to seek treatment when they had sexual or violent or religious obsessions, so I 
wrote the newer book "The Imp of the Mind" specifically about this problem so people 
would not feel so alone. 


lionessdi   Are there any books you would recommend on dealing with low self-esteem?


Dr. Lee Baer:   Low self-esteem is usually associated with depression and one of the 
classic self-help books for this is by Dr. David Burns, called Feeling Good.


Dearest:    Thank you, Dr. Baer. I'm curious, why did you entitle your book, "The Imp Of 
The Mind"? And why a "silent epidemic of obsessive bad thoughts?" Is the epidemic within 
the person? 


Dr. Lee Baer:   Edgar Alan Poe wrote a short story called "The Imp of the Perverse" where 
he talked about the phenomenon that as soon as you tell yourself that there is something 
that you absolutely must not do, it is as if an imp were whispering in your ear that you 
feel you must or might do it - he gave the example of looking out the window from a tall 
building and thinking that he must not jump out the window, and then not being able to 
get the thought of jumping out the window out of his mind.  As to the "epidemic", we 
think that several million people may have these bad thoughts that cause them real 
distress, for example, it may be that 1/2 million mothers of newborns every year have 
severe worries about harming their babies and are even afraid to change or feed them!! 
Some have fears of sexually molesting their babies and won't change them, having their 
husbands do it instead. 



Dearest:    Very interesting. Thanks. NancyV, go ahead, please.


NancyV:   Are negative compulsive thoughts just covers for other underlying belief 
systems we are unable to face? 



Dr. Lee Baer:   In some cases they could be.  We are just beginning to understand this 
problem for a few people, the obsessive thoughts trigger flashbacks or memories of past 
traumas that they have experienced.  


Dearest:    Dr. Baer, is there a particular profile of a person who suffers from OCD or 
bad thoughts? Also, is it familial?


Dr. Lee Baer:   OCD is partly familial, and is also related to other anxiety disorders 
one thing I have noticed is that most of the people I have seen with this problem tell me 
that as kids they were very sensitive to what other people thought of them, and were 
afraid of doing something that would embarrass them. Perhaps this is why they worry about 
doing the absolutely most inappropriate thing they can think of doing - like shouting an 
obscenity in church!


Dearest:    Could it be something associated with a "trauma," such as post traumatic 
stress syndrome, but in this case "bad thoughts" syndrome?


Dr. Lee Baer:   Yes, some of our patients turn out to be suffering from Post traumatic 
stress disorder rather than, or in addition to OCD, and then the treatment must focus on 
helping them process the memories that trouble them. 


cajass:   Hello all :)   My daughter is currently using a technique that involves using a 
moving light.. You follow it with your eyes. I forget the name. It seems to encourage 
talking. What are your thoughts on this? 


Dr. Lee Baer:   You may be talking about Eye Movement Desensitization Reprocessing 
Therapy.


cajass:   Yes


Dr. Lee Baer:   Some people swear by this for treating PTSD, although some studies have 
found that it is probably just a helpful adjunct to other more standard treatments and 
that there is nothing magical about the eye movements themselves.  It is a controversial 
area.  If it helps your daughter that is great - it is not dangerous.


Dearest:    You know, during menopause, many women develop fears, panicky feelings and 
I've seen women become obsessive about the physical changes they're experiencing to 
the point of needing therapy. Do you have any thoughts on menopause and the state 
of mind? 


Dr. Lee Baer:   There are very few studies about this area in particular although we 
know that there are many depressive and anxiety symptoms associated with the menstrual 
cycle, and for example, our patients who pull their hair out, or pick at their skin, 
find this much worse premenstrually.  We have seen panic attacks start during menopause, 
and these make the sufferer very aware of, and afraid of physical sensations.  NIMH is 
trying to encourage research into this area.


Dearest:    Thank you, Dr. Baer. JDCIslander, go ahead with your question, please :)


jdcislander:   What causes panic attacks? Someone may be doing fine, then all of a 
sudden, panic attacks start!


Dearest:    For those interested in sharing, how many of you have sought therapy for
your emotional issues? 


cajass:   Already in therapy

deboc98:   Me

Lori:   Thinking about it

NancyV:   No

MaryO:   Have tried it unsuccessfully :(

harper:  Yes

Newby:   Issues serious enough but therapy has never helped in the past.

MaryO:   I've tried about 5 times

cajass:  Help me cope with my family issues

Newby:   I've tried several over the years also MaryO



Dearest:    Do you find therapy is helping?



MaryO:   Didn't help me :(



Dearest:    Dr. Baer, wouldn't you say that sometimes one has to try different therapists 
until they find the right one? 


Dr. Lee Baer:   There are many different kinds of therapies and research shows that it is 
important that you like and feel comfortable with your therapist.


Dearest:    I agree. Thanks. Harper, go ahead, please.


harper:   I just experienced my first panic attack and feel the need for some concept to 
hold onto to deal with the overwhelming anxiety and obsessive negative thoughts.


Dr. Lee Baer:   There are several very good books on panic attacks besides Dr. Claire 
Weeke's books, Dr. David Barlow and Dr. Isaac Marks have several excellent books that are 
on amazon.com.  Even though you feel like you are dying, or going crazy, it is anxiety, 
and it does pass.  It is normal to have negative thoughts about this because it is so 
unpleasant, but there are coping statements that you can tell yourself that can help you 
deal with it.  These books describe these - good luck!



jdcislander:   What causes panic attacks? someone may be doing fine, then panic attacks 
start


Dr. Lee Baer:   Many kinds of stresses to the body can cause panic in someone who is 
prone to it.  This can include hyperventilation, a traumatic life event, a bad marriage, 
or even drinking much too much caffeine or alcohol.  It usually starts in the late teens 
or early twenties but can start at any time.  Look for any stressful life events or 
illnesses that have been going on. In rare cases, some illnesses can cause panic attacks 
too.



Dearest:    If I might add, during menopause, erratic hormone levels, constantly ebbing 
and flowing can also contribute to the anxiety that leads to panic attacks.


Dr. Lee Baer:   Hormonal changes definitely can cause panic attacks! 


Dearest:    Newby, go ahead, please :)  <It's so nice to see so many familiar faces 
here tonight>



Newby:   Long history of anxiety/panic but had been well for a long time. My 11 year old 
daughter was hit by a jeep in June and i have been struggling since then even though she 
is fine. Is this a possible cause for re-emergence of panic?


Dr. Lee Baer:   Absolutely!! This is a very stressful life event that can definitely 
trigger it.  On the positive side, you should get better much faster this time because of 
your past experience.


Dearest:    Doesn't everyone really experience some degree of obsessive thoughts or 
habits?



Dr. Lee Baer:   Absolutely - we all sometimes think about swerving our car off the road, 
or of pushing someone in front of a bus or train (or at least that it would be easy to do 
these things) and we all sometimes get inappropriate sexual thoughts.  For most people 
these just pass, and we accept them for what they are, but our patients get terrified by 
these thoughts and think they are going to act on them - when in fact they never will!


Newby:   It seems worse than ever this time and harder for me to gain control of. 


Dearest:    Has OCD been used as a defense in criminal cases? For example, a person gets 
this bad thought that they're going to harm someone - push someone in front of a train - 
and does it? 



Dr. Lee Baer:   It probably has but it wouldn't succeed --- in these cases the person is 
either  someone who has premeditated it and feels little guilt, like Susan Smith drowning 
her children in her car, or the person is psychotic and hears voices telling them to do 
it, like the person who pushed someone to death in front of a train in NYC.  OCD 
sufferers don't act on their thoughts so the defense wouldn't work.



Dearest:    Thank you, Dr. Baer. What fascinating questions and answers.
Everyone joines me in thanking Lee Baer, Psychologist, Harvard Medical School Professor, 
expert in the area of OCD and author of "The Imp Of The Mind: Exploring the Silent Epidemic 
of Obsessive Bad Thoughts," and "Getting Control: Overcoming Your Obsessions and 
Compulsions." Dr. Baer, thank you for a most informative and stimulating chat :)



Dr. Lee Baer:   Thank you for having me.


Dearest:   My pleasure.





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