Wednesday, December 5, 2018

OCD A to Z: K is For Kabat-Zinn and Mindfulness

Be Mindful

I had a hard time thinking of a K word, but then Jon Kabat-Zinn popped into my mind. I first came across Full Catastrophe Living about 10 years ago, and what stayed with me was the idea that mindfulness was about focusing on the breath, and if your mind wanders, that is normal, and bringing it back to the breath is all you need to do, even if it only stays a split second. I appreciated the rock-bottom simplicity of this, even in the midst of a very exhausting state of OCD mind.

A few years ago, I also read The Mindful Way Through Depression which comes with a CD of mindfulness exercises, and I listened to them daily for almost a year. For much of my life, depression was intertwined with my OCD, and there are many clinicians researching mindfulness as part of the treatment of OCD in addition to depression. The theory is that the more we fight with our obsessive thoughts, the more entrenched they become, and mindfulness can be an adjunct to Exposure Therapy, a way to practice letting thoughts be there and lessening their charge.

As my therapist pointed out many times, when in the midst of OCD compulsions, I am not in the present moment. I am either in the past, worrying about something that happened, or in the future anticipating "what ifs." He believes the only functional moment is the present one. This is where we make our good decisions, respond to what's actually happening, are most alive. At first I doubted this, because I associated the "present moment" as the one where I was suffering, and compulsing. But slowly I have come to see that in that suffering I am digging into the past or racing into the future. This doesn't mean that the present moment is magical, always calm and peaceful, but it gives a better chance of getting better from OCD. My old rituals don't get me any closer to long term peace.

[Revisiting OCD A to Z from 2011]

Thursday, November 29, 2018

OCD A to Z: J is for Just Right Feeling

"Just Right"

One of the most difficult aspects of my OCD to see clearly is the seeking of a "just right feeling." It pervaded my life. There's a stereotype of people with OCD being driven to straighten crooked photos, but "just right" OCD can attach to things that have no discernible order. Mine most often manifests as "how I started my day doesn't feel right" and moves rising anxiety, followed by the compulsion of freezing in place, trying to undo the feeling of having ruined the day. Its very vagueness is what makes it difficult to articulate even to myself. It's like I have a faulty shut-off switch, and the urge to move on doesn't come, or I'm expecting it to be incredibly dramatic.

When I was in college I noticed how I felt compelled to finish certain things in all one sitting, or I felt anxious. I think some of my procrastination came from avoiding starting tasks that would then need to be done straight through, because the thought of taking a break filled me with apprehension. My feared consequence is that the anxiety would overwhelm me, or that I wouldn't be able to pick up where I left off if I took a break. I did have some self-awareness that it was irrational to require myself to read all the chapters in a book, if the prof had only assigned 3 of them. But I didn't know how to stop.

[Revisiting OCD A to Z from 2011]

Friday, November 23, 2018

OCD A to Z: I is For Indecision

Indecision Stole My Life

Indecision OCD has eaten up a lot of time in my life. I'll get the thought that I might make a mistake, or the wrong decision, and my anxiety rises, and my compulsions consist of checking items closely for flaws, reading labels repeatedly, picking up every item, making sure I look at every rack in the store, plus mental rituals of figuring out which is the best choice, and interminable research.

I am much better at making decision now, after doing exposures, and listening to exposure scripts on my ipod, and the "high tech"(as my therapist calls it) tool of flipping a coin to make certain decisions. If I am tired or vulnerable, I am more likely to start agonizing over ordinary decisions. I was in the consignment store looking for t-shirts, and found myself looking at all the racks twice, even though intellectually I knew that there wasn't anything. For so many years I feared "missing something valuable or important" and it's a hard habit to break.

I remind myself to make at least one decision at the grocery store by flipping a coin--this cereal or that cereal, buy this item, or leave it on the shelf. I remember the days when I'd pace the store for 1/2 hour trying to make one decision, and how if I thought of a criteria for my choice(ie. price), I'd start to debate in my mind if that was the right criteria to use. I'd break into a sweat, my face would get hot, and whatever else I needed to do in my life was put on hold. I hated myself for wasting so much time, and I'd come home exhausted and demoralized.

OCD often is about certainty. I want to know for certain I've made the right choice, in advance, before I ever choose the item, or use it, or whether I've chosen the right action for all time. We don't get that kind of omniscience. Even in the grips of indecision, I knew that sometimes I chose something, and it sucked, even after all my compulsions, but it took encouragement from my therapist and friends to take the leap, and take my best guess, or leave something to chance, or not know an encyclopedia of information for every choice I made. We trick ourselves into believing that we can predict the future with certainty, if only we tried hard enough.

[Revisiting OCD A to Z from 2011]

Thursday, November 15, 2018

OCD A to Z: H is For Hope

HOPE


If there is one idea I would like my Exposing OCD blog to convey, it is that of hope.

Hope that OCD can be treated.

Hope that you can get better.

Hope that you can have a life.

I wasn't diagnosed with OCD until I was 33, and I didn't find a therapist who used Exposure Therapy(ERP) until I was 39. I've suffered with anxiety for much of my life. I had vivid imaginings of what could go wrong from age 8 or 9. I was monitoring my body for any changes in elementary school. I was intelligent, and assumed if I couldn't fix myself with that intelligence, then there was no hope for me.

It can be hard to find a therapist who is experienced in ERP. It can be hard to find a therapist who has even heard of ERP. It can take years to discover that what you suffer with is OCD, not a "fear of commitment" or "relationship issues" or "lack of confidence." But if you are reading this blog, you are a step closer to finding a way to deal with your OCD. Check out the IOCDF, or read Jonathan Grayson's Freedom From OCD, or seek out a support group.

If you can't feel hope, then borrow some of mine to get you through the journey of finding help, of doing exposures, facing your fears, or dealing with the unknown.

[Revisiting OCD A to Z from 2011]

Thursday, November 8, 2018

OCD A to Z: G is for Guilt



Guilt pervades the responsibility form of OCD.

Responsibility OCD involves a magnified sense of what you are responsible for, can prevent, or should prevent.


When I was in graduate school, there was an article in the paper about a guy riding his bike around town and harassing women. I was flooded with panic that it was my responsibility to alert every woman I knew. I spent hours analyzing what I should do.

Part of me knew that this was an impossible task, to warn every woman of every danger, and I felt like I was ridiculous for having this urge. Yet, the feared consequences were so scary in my mind, that I would be held responsible if any woman I knew was harassed, stalked or attacked by this man.

This guilt has a gnawing quality, an insistent agitation of the mind. I believed I was a bad person. I bargained with myself about how much action I would take, in order to relieve my anxiety and protect my friends and yet not seem crazy. OCD thinking can be incredibly inflexible and single-minded.

Finally, I made copies of the article from the paper and put it in the mailboxes of several women I knew at the University. I felt a moment of relief, followed by more guilt that I couldn't know for sure they would read the article, or take it seriously and be cautious. Intense anxiety that I was ridiculous, and also inadequate at the same time--ridiculous for wanting to warn everyone, and inadequate for NOT warning everyone.

Somehow I worked the article into a conversation with one of my friends I'd given it to. She said that she's seen the same article already. I felt deflated and relieved all at the same time. It hadn't occurred to me that others would read the paper. There is a grain of truth in the feared consequences--someone might not read the paper and be hurt--and yet no one person can save everyone from every danger, as much as OCD might insist you can. 

It sucks that we can't keep the ones we love safe under every single circumstance. Yes, we may feel guilt, but that doesn't mean it is in our power to prevent every eventuality. Ironically, the people I've met in my OCD support group and readers of this blog are some of the most conscientious, kind, responsible people I've known, but OCD makes them feel they are deadly.

[Revisiting OCD A-Z from 2011]

Monday, November 5, 2018

OCD A to Z: F is for Feared Consequences

seattle library shelves

Whatever your obsession is, there is a feared consequence that fuels the leap into compulsions. This is useful information for constructing exposures. The irony is that OCD claims to protect you from whatever consequences you fear, but can instead bring on those consequences. I notice this with reading obsessions.

I sometimes get the thought that I might not truly understand what I just read, so I go back and read it again, and again, and get stuck on one page. The rereading is the compulsion, in an attempt to prevent misunderstanding, and yet this makes it even harder for me to understand what I am reading, because I am disrupting the flow of the writing. An exposure would be to keep reading, even if I'm not sure I understand.

This also happens with conversations, and a desire to include every possible detail the other person needs to understand fully. This made my sessions with my exposure therapist a challenge at first, because my efforts to include everything made it difficult to focus on anything. I feared he wouldn't be able to help me if I wasn't absolutely thorough, but humans can't convey every possible fact in an hour, and it actually is overwhelming to be listening to this, and makes it harder for the other person to understand.

Jonathan Grayson has a section about these obsessions and tactics for doing exposures in his book Freedom From OCD.

[Revisiting OCD A to Z from 2011]

Sunday, November 4, 2018

OCD A to Z: E is For Exposure and Response Prevention Therapy(ERP)

Stacy Nichols - Exposure Therapy 20" x 34"

When I first realized I had OCD, about 7 or 8 years ago, I joined the International OCD Foundation and started receiving their newsletter. As much as I learned from the excellent articles, I assumed that Exposure and Response Prevention Therapy(ERP) wouldn't work for mental obsessions, things happening in my head. Thoughts seem like the substance of our minds, unmovable. Another E word that came to mind was "endless," as a way to describe the thoughts that hang on like thistles on your socks after a hike.

But ERP does work as a treatment for mental obsessions, Pure O, intrusive thoughts. I am so much better than I was before I started ERP 4 years ago. Yes, at first it seemed like trying to see through muddy water, and having an experienced Exposure therapist helped me get far enough away to see the patterns and processes of the OCD.

In a nutshell, ERP is exposing yourself to a thought you don't want to have, or situations that evoke that thought, and then preventing yourself from responding with compulsions in order to make your anxiety go away. So if I have the thought that the ache in my side is appendicitis, which strikes fear into my heart, because I need to know for sure, and right now, an exposure could be saying "Yes, I may have appendicitis. I don't know for sure," and response prevention could be staying off google, not researching the symptoms, or calling my doctor, or going to the emergency room, or poking at my side to see if it still aches. And the ultimate result will be less sensitivity to that thought, an ability to let it float in and out, and continue on with my life.

I encourage anyone who suffers from mental obsessions to seek out an ERP therapist. Check the IOCDF's list of therapists, and also their list of OCD support groups. And read Jonathan Grayson's Freedom from OCD. He published some articles in the IOCDF newsletter about obsessing about obsessing which finally led me to seek help for my OCD.

[Revistiing OCD A-Z from 2011]


Related:

History of Exposure Therapy

Exposure Scripts for Pure O and Health Anxiety