Skin Cancer Anxiety: Fear, Vigilance and All or Nothing Thinking

About 10 years ago, I noticed a small bump at the top of my ear, under the helix, and I'd fool with it, and it would bleed and then scab over. With my selective OCD hypervision, since the bump was hidden from my sight, I went at least 6 months before I started to worry about it. I did acrobatics with a mirror, but couldn't get a good view. I'd had several moles removed over the years, none of which were malignant, and I felt ashamed of my vigilance, and sad about the little white scars. But it was bleeding and never completely healed, and this was unusual. This was one of those things on a public health warning poster.

After a deluge of anxiety and indecision, I made an appointment. I'd seen this doctor several times before for anxiety symptoms--a gland I thought was swollen, a bladder infection that turned out not to be one, and had asked for a referral to a psychologist. I will credit him with telling me I'd done the right thing in coming to have him check it out, but then he said, "I don't know what it is, but it's benign. Maybe it's an infection." He put a dab of antibiotic ointment on it, told me not to traumatize it, and said if it changes, come back in.

This only stoked my anxiety, and my OCD need for certainty. To be told "I don't know what it is, but it's fine" was enough to cause a firestorm of fear. I felt too ashamed of my anxiety history to assert myself and say, "It's bleeding. I'm not gouging it, it just bleeds at the slightest provocation. I've had it for over a year." I may have mentioned some of these things, but I don't remember doing so. I decided after much angst to get a 2nd opinion from a dermatologist, but I never went. In the interim 3 months until I could get an appointment, I found a therapist, and my anxiety level went down, and I assumed that it was my anxiety causing me to second guess my family doctor, and rather than risk more humiliation, I canceled my appointment.

For the next 5 years, I kept checking the bump. It didn't change or get bigger. It just kept bleeding and scabbing. I'd go as long as I could without touching it at all, and feel sinking disappointment when it was still there. Finally, I decided that I wanted a second opinion, that it was ok to want this, in spite of my health anxiety history. I'd done massive research, reassured myself that I had very few risk factors. I was young, stayed out of the sun, and the bump wasn't exposed to the sun anyway, hidden in the curve of my ear, but I realized that my research couldn't diagnose it, and the research was sucking up my time.

I went to dermatologist who said, "I don't know what this is. But it's kind of odd and I'm going to biopsy it." A couple days later she called me to say it was Stage 1 Squamous Cell Skin Cancer, and that I needed to have it surgically removed with Moh's microsurgery. She was truly surprised that it was cancer. It's an odd location, and I have very little sun damage. Every follow up appointment she tells me what a freak occurrence this was.

My OCD was all over this in a flash. "See I saved your ear! You have me to thank. Keep obsessing. Don't let up." But after careful thought, I know that it wasn't my obsessing that protected me. My all-or-nothing thinking, common in OCD, said "I must always be right about my diagnosis before I go to the doctor or I am defective. Just keep researching."

It was my struggles with OCD in the past that made me second-guess my decision to get a second opinion. I felt I wasn't reliable, that in fact I was crazy. Part of being human though, is not knowing exactly what is happening in your body, and guessing wrong. And doctors, being human, sometimes assume that anxious patients don't actually have anything wrong with them, even when they do, and there is research that family doctors aren't necessarily good at identifying non-Melanoma skin cancers. I haven't researched my ear lately. The health anxiety kicks up every so often and insists I need to research, but research wouldn't have saved my ear. That is an illusion.

Talking to OCD: The Hazards of Talk Therapy

Before I started Exposure Therapy with my current therapist for my OCD, I had been in psychodynamic therapy for 6 years with Molly. She was a good therapist. I changed my life in many ways while seeing her. I started driving again. I began making art. I became closer to my husband. I began to believe that I mattered, and joy was possible. I wouldn't have recognized myself if I could've seen into the future.

But the OCD persisted. Although Molly was the first therapist, among the 8 previous ones I had seen, to recognize I had OCD, her strategy was to encourage me to avoid my triggers, and to offer reassurance. She had a down to earth grittiness mixed with intense compassion, and enough of this quality allowed her to provide some Exposure Therapy inadvertently by guiding me to do things rather than intellectualize everything. She had no training in Exposure and Response Prevention Therapy, but most therapists are lacking in this training.

There are aspects of my therapy that dragged on in excruciating barrages of OCD. It was like running a race through quicksand, expending great amounts of energy and getting deeper and deeper into obsessing. This can happen with any therapist, but Molly's inexperience with treating OCD contributed to a feeling of hopelessness. If she could help me with so much of my life, but the obsessing remains, then what was I doing wrong? My perfectionism said, "You are defective. Just try harder. Obsessively research OCD."

When I finally joined an OCD support group a couple years ago, I was saddened and angered by the number of people who had been in psychodynamic therapy for years as they progressively became more entangled in their OCD. One woman had intrusive thoughts that she might hurt a child, and after 12 years of therapy, had quit her job as a teacher, was terrified of having a child of her own, and sinking deeper and deeper into depression.

Telling someone over and over that they are not a dangerous person, and feeding the OCD desire for absolute certainty is not benign. Directing a sufferer to dig for the roots of why they are having these thoughts, and what they mean is not benign. The harder the search, the more room for the OCD to escalate as the brain gets the message, "These thoughts must mean I am a bad person, since I am trying so hard to disprove them."

The OCD needs to be addressed directly, or it will go underground and the unraveling of lives will continue. It's one thing as a starting point to tell someone that research shows that people who have intrusive thoughts never act on them, but it's another to expect that that will magically make the OCD go away. OCD isn't about rational thought; it's unalloyed fear.

Recovery Inc., and Dr. Low's Wisdom for OCD Sufferers

A few years ago I came across the writings of Dr. Abraham Low, a psychiatrist who is a early forerunner of Cognitive Behavioral Therapy. He created a self-help program called Recovery Inc., in 1937, to help mental patients reclaim peace of mind and their lives. I subscribed to Dr. Low's Wisdom, which mails a daily quote from one of his books. Sometimes he sounds very odd to my ears with his emphasis on complete trust in the physician, but he eloquently describes much of my experience with OCD, and advocates a form of Exposure and Response Prevention Therapy in his slogan "Doing the things you hate and fear to do."

I found an interesting blogger, Not A Saint--Just an Average Person, who describes his process of working through his anxieties and fears using Recovery, Inc.'s tools of identifying the thinking that leads to aggravation of symptoms.

I have not been to a Recovery, Inc. support group, but I know some people who have had a positive experience attending meetings. If there isn't an OCD support group in your area, consider looking into a RI group.

OCD Has a Mind of Its Own

Sometimes I feel like my mind is a double decker bus. This morning OCD was driving, and I was on the upper level, feeling like I had no way down. I woke up knowing I had a doctor's appointment and a normal "I'm driving this bus" thought was, "I'll eat breakfast, take a shower, and get out of here by 9:00 to get to my appointment on time." But what has happened in the past and again this morning is that I get the stealthy sabotaging thought of "I'll just check my email while eating," which led to "I didn't finish compiling the list of OCD Support Groups yet. I need to finish that." And after an hour on the computer, a sore shoulder from hunching over the keyboard, and not yet having showered, I ran around trying to get myself out the door.

I was late for my appointment and frustrated with myself for repeating the same pattern again. This deteriorated my mood and I started ritualizing to damp down the "I'm worthless" thoughts, looking up "compulsive slowness" and then transitioning into systematically searching for support groups in each of the 50 states. The observant part of myself could see that this had OCD written all over it--anytime I find a way to "make sure" that I don't miss anything, accompanied by a brief hit of relief is a sign that I'm headed further into my disorder.

The OCD craving is to make a complete list, a perfect list, as an end to itself. There is the grain of truth that I learned a lot from going to a support group, and would like to make a useful resource, but the OCD says "Do it now. Do it all at once. Don't take a break. Keep trying harder. Keep looking." The reality is that there are states without any support groups for OCD, and this makes me sad. Feeling sad is another cue for my OCD to step in and anesthetize any troubling feelings. The OCD is always ready to drive the bus.

Support Groups for OCD: Finding my People

In 2007 I had the occasion to join an OCD GOAL group(Giving Obsessive Compulsives Another Lifestyle). A support group using the GOAL model usually has a therapist who helps keep the group focused, and when we break into small groups, any new people meet with the therapist for an introduction to OCD treatment. The format at my group:

1.	In large-group formation, discussion of some OCD-related topic selected by the Affiliate’s board. Each member present will be given an opportunity to share feelings and thoughts on this topic and may elect not to speak if he or she so wishes.
2.	In small-group formation, goal planning. Led by a recovering obsessive-compulsive, each small group will help each of its members formulate a specific and concrete goal whose accomplishment in the interval before the next support-group meeting will advance the member in the attempt to recover his or her life from obsessive-compulsive behavior. The taking on of this goal is voluntary.
3.	Socializing with refreshments.

The thought of attending a support group was second only to medication in terms of scariness in my mind! Especially the third part, socializing with refreshments, since I've had a battle with social anxiety. But the the chance to share my experiences with others who understood, and in turn to hear about their struggles and courage was extremely powerful, and the opportunity to choose a goal for the week of a concrete thing I could do to help fight my OCD was invaluable.

We had a phone and email contact list of members willing to be contacted during the week if you needed support for doing a particular exposure. Making an agreement to call someone before doing an exposure and and then after doing it allowed some members to accomplish tasks they never thought possible. I was still in the midst of my phone phobia, and didn't utilize phone contact very much, but the small group sessions increased the odds that I would find an goal for the week, and actually follow through.

Members showed incredible bravery in attending the meetings in spite of fears of driving there, or saying things imperfectly in front of others, or eating the snacks at break in spite of contamination fears, or admitting they had OCD, or being in a room full of strangers, or saying something that might harm someone else, or taking the slip of paper with the week's discussion question and answering without knowing for sure they really knew what the question meant.

I witnessed enough courage to know that it is possible to face OCD fears. If you think attending a support group sounds like an impossible task, remember that most of the people who come felt the same way. A good support group will encourage you to move forward, at whatever pace you can, and in the right direction.

One place to find a GOAL group is to contact a state affiliate of the International OCD Foundation. Some states have people working to start an affiliate, and are looking for interested folks. If you know of any other OCD support groups, let me know! I will post a list.

Related Pages:
International OCD Foundation Find a Support Group Database


Related Post:
Recovery Inc. Support Groups
Going Back to my OCD Support Group

Listening to Jazz and the Power of the Present Moment

Last night I went to a jazz concert with friends. I started listening to jazz about 4 or 5 years ago, and I am grateful to have found something that fills me with such delight! The musicians almost invariably are enjoying themselves, and listening to each other, responding to each other in the present moment, a musical conversation with many turns down unexplored roads.

When I am in the middle of OCD obsessions, I am not in the room, or in my life. I am slowly building my skill at staying present enough to actually respond to what is happening, rather than catapulting myself into the past or the future. OCD resents the present moment, and would prefer to launch into a barrage of worry about "Am I staying present enough? Am I doing this right? Did I enjoy that last solo completely?" The joy of jazz for me is that it's easier to let those thoughts be there, and still find pleasure in the music.

Part 3: The Limits of Research in Making a Decision about Medication

It's 2002, and the psychiatrist who put me on his waiting list finally called to schedule an appointment. I sat in a leather chair, feeling like a willow trembling with the slightest breeze. He was a soft spoken man in his 50's, and he paused after I spoke as if to absorb what I said before responding. He concurred that I had a diagnosis of OCD, and felt medication could help me, and that perhaps after a year or so, my mind would "reset" itself and I would be able to taper off.

He proposed Celexa because it was new and not supposed to have sexual side effects. OCD thinking had seriously stunted my ability to approach anything near intimacy with my husband, and we had just started making some progress because of working my therapist, who I will call Molly. I was terrified of sexual side effects, and this was a major obstacle to my taking medication. I'd read numerous articles on the subject from the medical literature, plus enough posts on internet bulletin boards to fuel up my obsessing to the flammable point.

His assurance to me was that if I did have sexual side effects, he would put me on another drug, Wellbutrin, and this would correct the problem. As much as I liked this doctor, his solution was like something from a farce. Take one woman who is very afraid of taking medication, and tell her that a drug will solve any problems created by the first drug. . .

But I still knew that I couldn't go on the way I had been, with rituals consuming a lot of my time and energy. I told him I would need to think about it. I believe I did something actual thinking at the time. This is an important distinction. Obsessing and compulsively looking up medical articles is not the same thing as thinking about something, or problem-solving.

I'd read enough to know that some people were helped by SSRI antidepressants, and that the only way to know if they would help me was to try one. This is incredibly difficult for someone who hoards information to accept, that some things have to be experienced rather than researched, that sometimes you need to make a decision, and you will never have enough information to make a perfect decision. But I was on my way to making a decision.

Related Posts:
Part 1: OCD and Medication Decisions
Part 2: Starting Medication While Struggling
Part 4: My First Prescription for SSRI's
Part5: Feeling in the Jaw: Side effects
Part 6: Being on Medication & OCD Weeping
Part 7: Wanting to Get off my Medication
Part 7.5: Built on Sinking Sand: OCD and Health Anxiety

Part 2: Starting Medication while Struggling with OCD and Insurance

I am fortunate to have a job with health insurance coverage, but "behavioral health" was only grudgingly included in any form, complete with a limited network of therapists, and no psychiatrists. I already had a therapist when I started considering medication, but of the sparse list of psychiatrists in my area, many didn't want to do "medication management" if they couldn't also counsel me in some way, others weren't taking new patients, or didn't return my calls. One called me back and had a 3 month waiting list, but at least was willing to put me on it.

Willingness to take medication was already tenuous for me at best, and the maneuvering required by my OCD and social anxiety was a serious challenge to following through. It's hard to cope with:

1)I really don't want to do this.
2)It's going to take quite a bit of effort to do what I don't want to do.
3)OCD is having a field day with all the uncertainty, cultural debates about overmedication, and an intense fear of trial and error.

The only other psychiatrist I'd ever seen was 7 years previously, a requirement by a previous insurance company that to get any talk therapy I had to see a psychiatrist first. He prefaced his diagnosis of generalized anxiety disorder with "You're not going to like this, but I think you need to consider taking medication." At the time, SSRI's weren't generally being used for anxiety disorders or anything else for that matter, and the drug he suggested was Buspar, which got mediocre reviews.

I felt defensive, hearing in his tone that "psych patients don't want to take their psych meds", that he knew me thoroughly after just 45 minutes, and I was a stereotype. At that point, I didn't drive, and he gave me a referral to a therapist remote from where I lived, and only accessible by car, which seemed like sending me to another country altogether.

OCD as a disorder is very adept at latching onto whatever is at hand, and waylaying you with a grain of truth, just enough truth to make itself plausible, needed, useful. It is wise to be an informed consumer, so I felt justified in compulsively reading about Buspar, to the point of exhaustion. OCD will demand an answer in advance to the question: Will this work for me? The psychiatrist was patronizing, and that sucked, and OCD was more than willing to say "Don't do anything. Just keep obsessing."

Ironically, when I was considering medication 7 years later, I was fixated on getting it from a psychiatrist because I had compulsively researched the topic, and was afraid that my family doctor wouldn't choose the right medication or dose.

Related Posts:
Part 1: OCD and Medication Decisions
Part 3: The Limits of Research in Medication Decisions
Part 4: My First Prescription for SSRI's
Part5: Feeling in the Jaw: Side effects
Part 6: Being on Medication & OCD Weeping
Part 7: Wanting to Get off my Medication
Part 7.5: Built on Sinking Sand: OCD and Health Anxiety

Part 1: OCD and Medication Decisions: SSRI Antidepressants

I've been taking the maximum dose of an SSRI Antidepressant for the past 3 years. Before that I was on the lowest dose of an SSRI for 2 years. This was one of the most excruciating decisions I've ever made, and somehow I managed to make it in the midst of a hurricane of OCD symptoms. That is an act of grace! When my previous therapist suggested the possibility of an SSRI, obsessing went to tidal wave. I already had only a scrap of dry land to stand on in the swirling waters of my mind, which is why the therapist proposed medication. My intense revulsion and fear led her to suggest acupuncture, which was not an object of my OCD anxiety.

It took me a year to choose to take medication. A year of compulsive research, and increasingly time-consuming mental rituals of trying to figure out whether I should take them, which one would work, and battling my fear of making phone calls in order to find a psychiatrist who would be able to prescribe them for me. So let's recap:

1)I have health anxiety, so I was petrified by the possibility of side effects
2)I was prone to existential OCD, and ruminated on whether I would no longer be myself if I took medication. I wanted to know how I would feel without a constant barrage of OCD, but I couldn't actually replicate it in my mind, which totally freaked me out.
3)I I wanted absolute certainty, in advance, that I would get on the right medicine, at the right dose, and that I wasn't crazy to consider taking SSRI's.
4)I had severe OCD issues with making decisions, and the decision points kept branching off infinitely--should I take the med? Who should I get the med from? Which med? Which dose?
5)I felt that my therapist was overwhelmed by my obsessing, and after my initial panic when she suggested meds, she didn't know how to help me make a decision.

Here was the bedrock:
Obsessing about medication was leaving me little time to do anything else with my life.

I had the revelation that it was possible that taking medication would stop the obsessing about medication.

I was full of fury about this. I hated this. I felt trapped. I couldn't go on as I was. I was exhausted. But what if taking medication meant I was unredeemable? That I was wrong? I had intense dread, as if taking medication was the equivalent to choosing to go to hell. I don't mean this in any specific theological way, but rather sheer terror.

It's hard to think back to this time. I found the courage to take a chance on medication, which calmed the constant feedback loop of OCD enough to give me some breathing room, and then later, to do Exposure and Response Prevention Therapy. I'll write more about this experience. It's more than fits in one post. But if you are struggling with a decision about medication, know that my heart goes out to you.

Related Posts:
Part 2: Starting Medication While Struggling
Part 3:The Limits of Research in Making a Decision
Part 4: My First Prescription for SSRI's
Part5: Feeling in the Jaw: Side effects
Part 6: Being on Medication & OCD Weeping
Part 7: Wanting to Get off my Medication
Part 7.5: Built on Sinking Sand: OCD and Health Anxiety

Letting the Thoughts and Feelings Be There

I got to the grocery store this morning and started feeling overheated in my winter coat, and very tired, and running behind schedule, and felt a rising panic. I practiced letting the feelings and sensations be there without judging them.

I hate the whole concept, because I judge the feelings very harshly, and I want them gone. It's only because the escalation of panic due to my incessant judging is so painful that I even consider following my therapist's advice.

I'm fortunate that Leonard has worked with me in session to focus on sensations without judgement, asking me to describe to him the heat in my cheeks, or the tightness in my chest, or the pressure in my jaw, and letting them be there without getting into a wrestling match. Then he'll ask me if I can tolerate the feelings, as they are.

Tolerating is different than liking. It's often uncomfortable, unpleasant or painful, but without the interference of my OCD interpretations of "I'm going to die. I can't stand this. What if I am seriously ill? What if I lose it?" toleration is possible. It takes all the strength within me to admit this. But I've seen what happens when I battle the thoughts and feelings. I've seen it consume me, and intensify the sensations, and truly cause me to lose it, and this creates just enough willingness in me to consider there are alternatives.

Indecision at the Library

I loved going to the library as a girl. My father was willing to take me since he was always reading, and needed his own fix. I'd get 10 or 12 books and line them up along the side of my bed, a wall against anxiety, fear and parents who could barely take care of themselves let alone me and my sister. OCD latched onto this love when I was in my 20's and still reappears, like today, when dh and I went to the library. I'd already started the day with intrusive thought #1, "You've ruined your day by websearching for 1/2 hr while eating breakfast." I'm savvy enough to recognize that this is a thought, not necessarily reality(though it could be, who knows), but still scared enough to want to do a thorough autopsy and determine if I have indeed ruined my day.

At the library I started strong, but then moved to the fiction section and couldn't find the right book. I started the "searching without cause" dance of indecision. Look at every book on a section of the stacks. Pull multiple books off the shelf and flip through them trying to decide if they will be disappointing. Pull some of the same books off again. Scan the titles slowly, in case I missed something. I believe if you mapped out my footprints like do with dance instruction, the ground would become obliterated with all the repetition and retracing. It seemed an eternity, but according to my dh it was about 10 minutes.

He came over and asked me if I was done, and I took my out, and said yes. I was on the verge of saying, "No. I wasted 10 minutes and didn't find anything, so I need to rescue those 10 minutes by searching for another 1/2 hr." I think this is referred to do as "sunk costs" and you can't get that back, although OCD would like me to think it is entirely possible and I am defective in giving up.

Trips to the library work best when I go in ready to flip a coin if I am stuck on a decision, and to randomly pick a few books without knowing for sure that they are "right" and generally taking my chances. OCD takes a lot of energy. I was ready for a nap when I got home, and had some OCD backwash about my imperfections, but I'm on to the idea that I can spin straw into gold by looking at the same books over and over.

Trying to figure out how to comment on my own blog!

Thank you to those who have commented on my blog! That means more than you can know! I am still trying to figure out why blogger appears to eat my comments. Hopefully I'll have an answer soon, or perhaps someone is familiar with this problem.

Telephone Phobia: Fear of making phone calls

I thought I'd have to call someone today to get some information, and I got that old familiar dread. I was relieved when the person emailed me before I had to pick up the phone, though my anxiety is a fraction of what it was even a few years ago. My phobia started in highschool. Calling someone meant an ache in my chest, tightness in my stomach, and delaying dialing as long as possible. It evolved into sitting staring at the phone, and doing nothing else in my life, while trying to work up the courage to call, and mentally rehearsing what I would say.

When I started ERP therapy, I realized that when making a call for information or to ask someone a question, I wanted to be certain that I would know how the conversation would proceed. My mental rehearsal could go on indefinitely, because I was attempting to predict the impossible. I couldn't know exactly what the other person would say, and the anxiety I felt about this put me into a suspended state. It wasn't so much that I expected the phone call to go badly, although at times this was the fear, but that not knowing the script in advance created a storm of anxiety.

I remember when an extraverted friend of mine told me she loved making phone calls and connecting with the person on the line, and delighting in having a phone interview for a job; I thought she was crazy! My mantra when calling was always, "don't answer. don't answer. don't answer." It was a revelation when I realized that I was not going to feel "just right" enough to call--that in fact setting it up as an exposure, dialing the number and letting the anxiety be there until it dissipated was the way to break the prison of dread that could engulf a day if I needed to make a call.

One time in session with my therapist, I told him I'd been avoiding calling my doctor about my elevated blood pressure numbers. He challenged me to call right there in his office. My adrenaline surged! But I recognized the opportunity to face the fear head-on. He also said it would be helpful to let myself stumble through what I had to ask, rather than trying to rehearse and talk with omniscient knowing. My heart was pounding. The receptionist freaked, and said I had to talk to the doctor on call, even though the numbers were not dangerous, just trending higher. But I survived it. And I glimpsed the possibility that lurching through a call could be less painful than spending weeks of avoidance and rumination about making a call.

My heart goes out to anyone who has difficulty making phone calls. It truly sucks to have this phobia. I didn't even call my friends or people who I really wanted to make contact with. People who loved me and didn't expect me to give an Oscar winning performance on the phone. I am grateful for the lessening of this anxiety as I practice tolerating the dread and calling anyway.

Unhelpful Strategies for my OCD: Reassurance Seeking

There is an interesting article on reassurance seeking by Jon Hershfield on the blog of the OCD Center of Los Angeles. OCD is about unwanted thoughts and intrusive images, and the desperate desire to make them go away. Reassurance is, as Hershfield argues, like crack cocaine. There's an immediate hit of relief when getting reassurance that the thoughts aren't dangerous, you aren't dangerous, the world is not dangerous, but it is short lived.

The brain goes "Whoah. This must be serious if I need this kind of reassurance. I need more of it. I need it now." And the OCD desire for certainty feeds the craving for reassurance. I used a lot of Self-Reassurance, which also overlaps with my Research Reassurance.

When I have body symptoms, and OCD is active, I will check to see if they have changed, or check both sides to see if they are the same, or poke and prod at something. It's taken an long time for me to realize that the reassurance makes the anxiety worse and puts me on red alert. Ultimately, I am gaining no useful information when I keep monitoring my body. The mole will probably look the same in 2 minutes, and this neither proves nor disproves its actual danger.

I have also conducted what Hershfield refers to as the "Mental Review"--on getting an intrusive thought about saying the wrong thing in conversation, I would go over it, retrace it, try to figure it out.

Finally, Research Reassurance is a bugger. By age 17 I was looking up medical symptoms in the health section of bookstores, and then in the reference section at my college library. This was before the modern internet, and when graphical browsers went mainstream in the mid 90's, my research took on warp speed. Researching provides the promise of finding an answer, but in the process turns up other scary things, and adds even more to obsess about. There is no website labeled "Exposure Woman: This is exactly what the problem is, and here is the solution."

I also researched my own life experience, by re-reading my old journals, diaries and correspondence, whether letters or email. One of my first Exposures in ERP therapy was putting my journals in a box on a high shelf, and learning to cope with the desire to figure out if I've always had OCD, or if I didn't try hard enough to get help, or learning to make decisions without all the "background information" my OCD thinks I need to make a fully informed choice.

Hershfield ends with a sentence that is a true sign of his clear understanding of OCD cravings to have certainty:

Finally, when it comes to resisting the wealth of information (and misinformation) available from the web and other sources, it’s best to turn the computer off altogether when you find yourself just wanting to know something “for sure.” In fact, there’s no time like the present…so let’s see if you can move on from this blog without knowing for sure if you fully understood it.

(Partially) Unhelpful Strategies for my OCD: Brain Lock

I read Jeffrey Schwartz's Brain Lock: Free Yourself from Obsessive Compulsive Behavior 8 or 9 years ago. I appreciated the author's understanding of that deep rooted dread that can come with an obsessive thought, and the urge to do a ritual to make it go away. Schwartz is a psychiatrist at UCLA, and a proponent of Cognitive Behavioral Therapy. His method consists of four steps:

• 1. Step 1: Relabel “It’s not me – it’s my OCD”
• 2. Step 2: Reattribute “Unlocking Your Brain”
• 3. Step 3: Refocus “Wishing Won’t Make It So”
• 4. Step 4: Revalue “Lessons Learned from OCD”

Step 3 had the most value for me, in that refocusing meant acting against my ritual of freezing and doing nothing else but "figure out" my obsessive thoughts by actually doing something relevant to my life for 15 minutes. Unfortunately, the revaluing step was harder than it seemed. My OCD was very tenacious and good at constantly questioning whether what I was observing was actually OCD. It's like those Russian nesting dolls, one inside another, inside another, inside another.

Ultimately, part of what worked for me was using Grayson's method of listening to scripts I'd recorded of all that I was afraid of, while refocusing and doing things that I valued, and practicing my ability to live with uncertainty. Schwartz appears to expect that I can become very certain "It's not me, it's my OCD" when in fact the OCD continually questions this.

OCD Toolbox: Freedom from Obsessive Compulsive Disorder by Jonathan Grayson

This book, Freedom From Obsessive Compulsive Disorder: A Personalized Recovery Program for Living with Uncertainty by Jonathan Grayson, was very important in moving me to get help for my OCD. I'd spent a lot of time reading about OCD, but assumed that because much of what I dealt with took place inside my head, rather than physical rituals, Exposure and Response Prevention Therapy wasn't really for me.

Grayson went right to the heart of this by identifying mental rituals, and describing how to write scripts that expose you to your "Pure O" fears, and learn to habituate to them, and live your life. He gets the "obsessing about obsessing" quicksand of the OCD mind. And even more importantly, he introduces the concept of learning to live with uncertainty. I recognized myself in his descriptions right away, a compelling desire to have absolute certainty that a feared consequence will not happen.

OCD makes a lot of demands for omniscient knowing, for complete understanding, for predicting the future and insisting that questions be answered that no human gets answered. It sucks to accept the reality of our tenuous existence, but Grayson points out that we tolerate uncertainty in many aspects of our lives, if it is not one of our OCD triggers. He has an example of how someone who has no fear of driving takes the risk of crashing their car just go see a movie. Last week, I thought of this example when I heard that some people I know from choir were in the hospital because they had a car accident on the way to see a movie.

We take risks everyday, but often we don't think about it, because life is in itself risky, and if we wish to experience the joys that life offers, we have to keep moving. On a bad OCD day, I really hate this revelation, because the OCD insists that I can have certainty of safety if I just ritualize, and it's hard to let go of the fantasy. But the fantasy is at the expense of having a life, a kind of living death.

Another Good Book:
Rewind, Replay, Repeat: A Memoir of Obsessive Compulsive Disorder

Unhelpful Strategies for my OCD: Relaxation Exercises

When I was in graduate school, and had a blast of anxiety that the numbness in my hand was Guillain Barre Syndrome, and went to see a psychologist at the Health Center, she gave me a cassette tape of guided progressive muscle relaxation. Tense each muscle group and then let it go. Later, I had a therapist that wanted me to imagine a relaxing enjoyable scene and invoke it when I felt anxious. This didn't offer me much relief though.

I do believe that the body and mind are intricately intertwined, and I know that I carry a lot of tightness in my muscles, and am hypervigilant about uncomfortable sensations, which seem to speed me into obsessive thoughts at quite a clip. But undoing the tension in my body doesn't undo the thoughts in my mind. I could get into a deeply relaxed state, and then a thought would pop up, and ruin it, and I'd try to wrestle the thought down, and keep checking whether I still had the thought, was it still bothering me? Was it still there?

I also tried weekly massage sessions for a couple years. My mind would run around like a twitchy squirrel while the massage therapist worked on my knotted muscles. I'd leave reeking of lavender and criticizing myself for not enjoying the massage enough, that I was defective for being unable to relax.

Exhaustion and OCD

I went through several hundred possible images to start this post off. My frustration with myself is mammoth right now, since the part of the point of this blog is to do it as an exposure, and not do it compulsively "perfectly." But I am regrouping now, and starting this post without an image, even though there's still 3 or 4 pages of images that I left midstream, and the temptation to look through the rest to finish it and feel done is big. Of course, I probably wouldn't feel done. I'd probably go look at more images on a different site.

The irony here--and OCD seems to bring lots of irony with it--is that I wanted to write about exhaustion. . .this is progress to just start writing, before the point of complete exhaustion. Jon Grayson says something in his book about sometimes someone with OCD stops ritualizing because they are tired, completely drained, exhausted totally. We haven't met the demands of the OCD yet, but we stop because we don't have the energy to continue.

There's a small window of opportunity at this point to wedge a bit of myself back into my mind and heart. Often I will just pick up where I left off at a later time, but sometimes I have a moment of understanding the futility of satisfying the OCD. No amount ritualizing is going to completely satisfy the OCD. It's like the games of jump rope I played as a kid--we'd all shout out rules, arbitrary, goofy, and the favorite one was making the rule of "no more rules."

It feels imperative when I'm in the OC anxiety to do whatever it says, but I've survived doing my ritualizing inadequately, and even if I met all the requirements, OCD would escalate it to the next level.

CBT: Emotional Reasoning

Emotional Reasoning means assuming that if something feels a certain way, then it is a fact. If I feel bad, then I must be bad. Or this exposure feels dangerous, therefore it is dangerous. CBT includes identifying a range of thought distortions, including Emotional Reasoning, and it's the hardest one for me to deal with.

I tend to feel defensive when Leonard says I'm doing this, but he's always careful to emphasize that it's not pretend, that it takes bravery to feel that fear and still choose to do an exposure.

Right now I feel stuck. It's Monday afternoon, and I've been websearching. My shoulder hurts. I've sidetracked into many useless links, and I feel contaminated, as if once I start searching, the whole day is lost, cannot be repaired or changed. OCD in its self-replicating mode likes this feeling.