Sunday, August 29, 2010

The Lonely Pilgrim: The Isolation of Relationship OCD

Stricken with Self-doubt
Today I found a quote from the lyrics of Bruce Springtsteen's "Brilliant Disguise"
which encapsulated the sadness of the "Lonely Pilgrim's" voice:
God have mercy on the man
Who doubts what he is sure of.
I know this song, and have the album, but I haven't listened to it in awhile, and today it struck me as an achingly accurate description of OCD, particularly what some call Relationship OCD. The character in the song wants to make a real connection with the woman he loves, and yet cannot be certain of what is in her mind, or even in his own. He doesn't trust himself.

It is part of the human condition that we can't read minds, we can't really know what someone else is thinking, and this can be very lonely, but OCD grabs hold of it and intensifies the suffering with demands of knowing for sure what the other is thinking or feeling, or wanting to be sure of loving someone.

We are feeling creatures, but OCD has no mercy and erodes essential feelings of love and trust by putting the burden on the mind to figure it all out, get reassurance, guarantees, documentation and checking to make sure the feelings are still there. A quick way to lose connection with someone you love is to get lost in an OCD loop of verification within your own mind. I did this for many years in my marriage, wanting to know what physical connection "meant" and how it was supposed to feel, and compulsively going over any touch in my mind, trying to establish if it felt good, was I sure, how did I know, was I doing it right?

And when the circumstances and history of your life seem to confirm the OCD fears, that makes it even harder.
Well I've tried so hard baby
But I just can't see
What a woman like you
Is doing with me
I grew from girl into woman into the belief that no one would ever love me because I was essentially defective, and the OCD latched onto this with a vengeance, and ever increased the rumination and fear. A whole string of compulsive questions about what was wrong with me, and why couldn't I change it, and analyzing my every thought and sensation.

My husband and I actually were in a kind of "brilliant disguise," not really telling each other what we were thinking or feeling, but my OCD couldn't protect me from that, and in fact made us even farther apart. He could be in the room, right next to me, and I was far far away in my compulsing. We both found the courage to actually know each other, with the help of a therapist, and this helped immensely when I began Exposure Therapy for my OCD, since I could talk to him about how I was struggling, and at the same know that if he needed a break, he would tell me.

I've included a video of a cover of the song, done by the band The Reason. The lyrics are included. Are there any songs that are meaningful to you in dealing with your OCD?

Monday, August 23, 2010

How do I know when I'm done? OCD and the Desire for Complete Assurance

Light switch noir

OCD affects aspects of human experience that most people don't think about, or only fleetingly. It's not that OCD is totally alien, but it is more severe than what people without OCD experience. I have OCD but don't usually check switches and such. But when leaving on vacation, a few years ago, I was halfway out of town and couldn't remember if I locked the door, and went back to check. Everyone has had a day where they aren't sure, and go back to check. Sometimes special circumstances like vacation will make you more aware of the consequences of an unlocked door.

Usually someone without the compulsion to check doesn't need to remember if they locked something or turned off a switch or a knob, because they do it, and move on without even thinking about it. It feels "done" but it's barely conscious, and they flow into the next actions of their day. OCD can disrupt every aspect of the flow of life. Someone with OCD can turn off the light switch, and stand there in the dark and still not be absolutely certain they turned it off, because they get a surge of anxiety that is gut wrenching, and a host of possible feared consequences, ie. "If I don't turn this off, a circuit could short and burn the house down. So I'd better keep checking."

The other day I watched my husband search for a muffin recipe online. He looked at a couple, one fit his ingredient list, and he hit print. He knew he was done. I could even say he "felt" done, but it's so a part of him that he doesn't really feel it as much as keep moving in the momentum of what he wants to get done. Part of my OCD is not feeling finished, not feeling I've fulfilled my goal, and I'm well into page 10 or more on Google when looking for a recipe. It's like I don't have an "off switch," and I am very likely to feel anxious if I don't feel "just right" or "done" and ironically, my OCD pretty much guarantees I won't get that feeling, no matter how much compulsive searching for the perfect thing.

Even when I find something that fits my criteria, I don't believe it, because I want to be certain that it's the right thing, and I'll feel anxious if I take the chance of printing something from page one. OCD isn't about logic. This can frustrate both the person with OCD and their friends and family. There is a tendency to assume if you explain the illogic, that this will solve the problem. "You are standing in the dark. Of course the light switch is off." "You've checked 5 review sites, and they all recommend the same product--why do you have to keep looking?"

I've always been fascinated by phenomenology--the attempt to understand what someone's experience is from the inside, the lived sensations of consciousness. OCD is that moment of wondering if you locked the door, and thinking you probably did, but having dire visions of thieves in your house while on vacation. You feel anxious. You don't want to ruin your vacation worrying about this. You drive back to check the door. But OCD will keep generating those moments of stabbing fear, even after you've checked. Did I really check? How can I be sure? There's no stopping point.

Cognitive Behavioral Therapy can get hung up at this point if the instruction is to guess the probability of something bad happening, and how much of it would be your responsibility--it could be .00001% and the OCD is still going to be clamoring about no risk being acceptable. For me Exposure Therapy has involved choosing something off the first page of Google, even if I break into a cold sweat, to help retrain my brain recognize that I'm done and can move on. I spent years waiting for fanfare and illuminated signs that a decision was right so I wouldn't have to feel anxious, but I am learning that most decisions don't get that kind of certainty, and that I can actually live well in spite of this.

Friday, August 20, 2010

Email and the OCD Fear of Saying the Wrong Thing

I must be getting old...

Email was like a miracle. I went to graduate school in 1993, and one of the perks was an email address. Since making phone calls filled me with dread, email was like getting released from jail, or pardoned. I loved its asynchronous nature whereby I could send a message and the other person would read it without my having to witness it, or respond to it in real time, and vice versa, when I received an email I could spend as much time as I needed to get my response right.

Of course, my OCD loved email, because I could delay actions that caused me great anxiety, like spontaneous speaking, but slowly I began to realize that email had its own set of anxieties. Email didn't erase my compulsion to making sure I didn't say the wrong thing, and most likely strengthened my fear of making a mistake. Writing email consumed a lot of time, because the using the "Send" command began to feel full of trepidation. Once I sent my email, I couldn't take it back. Pieces of messages would pop into my head, as I retraced all the nuances. I dreaded this reconstructive process, because it aggravated all my fears of saying something wrong, every time I listened to my own message in my head.

Responding to email was exhausting. The written word has a permanent quality, an inflexibility, especially in email where there isn't tone of voice(I certainly didn't know anything about "smileys") or facial expression, and I interpreted emails as if they were a holy text. What does this mean? What should I say in response? Will this correspondent think ill of me? But I chose email to communicate 90% of the time(7% consisted of real paper mail, which in a pre-computer era, involved lots of rewriting, and discarding whole pages if I made a mistake in expression, and the other 3% was on the phone under duress).

I chose email even when I started to realize that in some cases I would save a lot of agonizing by calling the person, but even though I could see that the email would turn into a convoluted dance of "Did I say the write thing? Have they gotten it yet? Why aren't they responding? I really need to know the answer to this question. Am I going to have to call, and then they will think I'm weird for emailing and then calling?" I started fearing opening my email, because of anticipating negative responses to my messages, and the longer I left a message unopened, the worse the anxiety became, until I assumed that it must be dangerous to open my emails, or why would I be so scared?

One of the exposures I did in OCD therapy was opening messages right away, especially ones that I was afraid of. I gritted my teeth the whole time, but I'd seen how my anxiety escalated the longer I waited. I also practiced writing "inadequate" responses--short, quick, unrehearsed. Which, actually is what email is--somewhere between formal letters and phone calls. I'm never going to be a person who enjoys talking on the phone(unlike my friend J. who enjoys phone calls so much that even if calling was less efficient than looking up info on a website, would still call, just to talk to people), and like Miss Manners I do agree that the phone ringing is not a "command" to pick it up--I can decide when to take calls--but I need to keep an eye on the OCD which will find a million ways to avoid saying the "wrong thing" as if we can definitively ensure that, as much as we might want to.

Related Posts:
Telephone Phobia: Fear of Making Phone Calls
Ritualizing in my Head: Retracing

Monday, August 16, 2010

Unhelpful Strategies: Thought Stopping for OCD

Stop and Think

This strategy has been around a long time, and never seems to go away. The premise is that you snap a rubber band on your wrist, or imagine a giant stop sign, or shout "stop", whenever you have an intrusive thought.

I have an early memory of being 8 or 9 and trying to stop thinking. I held my breath. I stood still. But I couldn't stop. I was baffled by this phenomenon. No matter how much I tried to make my mind blank, I could hear my thoughts of "Stop thinking. Have I stopped yet? Why am I still thinking?"

Thought Stopping sounds logical on the face of it. You have an intrusive thought. It makes you anxious. You want it to go away. You stop it. Except that I couldn't stop. It wasn't that I didn't try hard enough. It was that I tried too hard. Every time I jumped in to push the thoughts out, through figuring them out, rationalizing, analyzing, confessing them, researching them, websearching and other forms of distraction, cueing my relaxation exercises, my deep breathing or reassuring myself that it would be ok, the thoughts rebounded and came back even stronger.

If Thought Stopping worked, would anyone have OCD intrusive thoughts? We could just make them vanish with the snap on the wrist. Our minds are immensely creative and generative. All sorts of thoughts pop in, and if we just let them alone, they tend to pass. But if you have OCD it's a struggle to let them pass, and the initial wrestling with them does give a hit of anxiety relief, but then it's like signaling your brain that this thought is truly dangerous, so if it comes back, try to kill it, and the cycle continues.

I reclaimed a lot of my life back by doing Exposure and Response Prevention Therapy. I recorded scripts of the thoughts, and listened to them repeatedly until my anxiety level came down on its own. I had a therapist helping me to do this.

For More Information:

Am I Still Anxious? Does this Still Bother Me?
Talking to OCD: The Hazards of Talk Therapy
Freedom from Obsessive Compulsive Disorder by Jonathan Grayson

Hayes and his Action and Commitment Therapy colleagues have been researching the phenomenon of trying to make thoughts go away, and how it doesn't work.
For a useful summary of ACT, Dr. Russell Smith has a good article:
Simple Overview of ACT: To download a simple, non-technical, easy-to-read overview of ACT ( called 'Embracing Your Demons', an article he wrote for Psychotherapy Australia magazine) click here.

Friday, August 13, 2010

Going Back to My OCD Support Group

Sitting Circle
I happened to cross paths with someone from the OCD Support Group I used to attend, and she invited me to come back as I told her about having difficulty with a lot of unstructured time since being jobless. I went this week, and realized I hadn't been there in almost 2 years.

I like the immense practicality of this group. After a discussion, we get into smaller groups, each with a seasoned member to lead, and each person picks a goal for the next 2 weeks until the next meeting. The group can help generate ideas for exposures, which can be hard to do by yourself if you are feeling anxious and sucked into the compulsing.

The key is to choose a goal that you are willing to do, and it's like a secret weapon against OCD. The most innocuous sounding goals often lead to important change, like a catalyst setting off your own self-confidence and self-efficacy.

The defining questions for the goal are:
  • What action will you do?
  • When will you do it?
  • How often will you do it?
OCD thrives on vagueness in goals, like "I'll try to obsess less." My perfectionistic OCD gets set off by the idea of small steps--the squawking voice demands "all or nothing at all" but that leads to being stuck in the OCD, because if I don't do a small step, I usually do nothing at all. My goal is to write some of the tasks I actually want to get done(as opposed to what my OCD wants, ie. reduction in anxiety at all costs)on index cards and once per day randomly pick a card and do the task. I've practiced avoidance for so long that it's quite an exposure to get something done, without ruminating on whether it's the right thing at the right time. The other goal I chose was to pick one day a week where I will delay getting on the computer until after noon, to give myself a chance to get other things done.

What small step can you choose to take this week?

Challenging OCD One Step At a Time
List of OCD Support Groups for Adults in the US

Monday, August 9, 2010

OCD Squawking

There's not a lot of room between noticing something, and being alarmed by it when you have OCD. I was checking my email this morning, and noticed an achy feeling in the vicinity of my bladder, and suddenly it's red alert, squawk, squawk, squawk.

An early strategy at a young age was I would stop everything and focus on the sensation, which soon would lead to not feeling anything else but that sensation, and then despair that that's all I could feel. I have a diary from when I was 11, with Holly Hobbie on the front cover, a tiny lock and key and gold dusted page edges, and several entries are descriptions of things I've noticed in my body, and trying to reassure myself, "Not to worry."

By the time I was an adult, I was convinced that if I had any pressure or awareness of my bladder, then I couldn't focus on anything else, couldn't enjoy whatever I was doing at the time. As soon as my internal conversation plunged into "I can't enjoy this vacation, this movie, this walk, this concert. . .because this sensation in my body is intruding, and it's all I can think about," I would plummet into hopelessness.

Part of this is simply being human and having consciousness--we are aware we are going to die, we remember sad things from the past, we can ask "what if?" But OCD wants to control what we are conscious of, either by making certain thoughts go away, or insisting the future be know-able. Squawk. Squawk. What sucks is that some painful sensations and memories never go away, and OCD gets locked into combat with them, making them even worse, but lying and saying, "No, really, I can make this go away. Just stick with me. Don't give in. Don't do anything until I solve this with compulsions."

I do have a lot more freedom since I started doing exposures in therapy, and outside of therapy. For a couple years I would drive by a fabulous Mom and Pop donut shop on my way from therapy to work, right around the time I started to feel pressure in my bladder from the long drive, but I wanted those donuts, and I'd stop to get a couple. At first I'd tell myself to wait until I got to work, so I could hit the bathroom, and then enjoy the donuts perfectly, but they were so good, I'd end up eating them on the drive.

What I discovered is that although I preferred not having the bladder sensations, I could still enjoy other things(like donuts!) at the same time. This may not seem like rocket science, but when you have OCD, this was like knowing how to turn straw into gold, or water into wine.

What we practice we tend to get better at. My therapist likes to say this, and I sometimes find it irritating, but it took a year of practice to distance myself from bladder panic, which can sound daunting, but after 30+ years of being limited by my need to find a bathroom at all times, I am very grateful for my new freedom.

Do I have to go? Bladder Fears and OCD

Friday, August 6, 2010

Doing OCD Homework and Fear of Failing

Wednesday in therapy, Leonard had me record a description of the moment at which I feel the compulsion to ritualize, followed by my values list. My homework is to listen to it 12 times a day. The idea is that I will start building new connections to my values, so that when my anxiety spikes, my values have more of a chance of coming to the surface. I've had 15 years of a job where if I started to feel anxious, I could distract myself on the computer, and the habit is deeply ingrained. Now I have all this time at home since I lost my job, and the old critical perfectionist voice is getting loud. "You have all this time now. Why are you wasting it being compulsive?" Which then gets the OCD ramped up, because I don't want to have the thought that I am wasting time, or doing things imperfectly, and I get back on the computer to distract myself and waste more time.

Leonard's idea makes sense to me, but it almost seems to make too much sense(if that makes any sense!!) Some convoluted OCD logic, "This could work, but what if you try it and it doesn't work? And this proves you are a worthless failure. You'd better avoid doing it." I see the irony in the fact that there were many times I wanted to quit my job, because the OCD was so tied to walking into my office, feeling immediately incompetent and scared, and seeing the computer, sitting down and then wondering where the day went. Part of me hoped that if I didn't have the job, my OCD would go away. I remember starting on an SSRI, and having a bad dream that I was starting to feel better, but this meant I would have to stay at my job forever.

I suspected that quitting my job wouldn't eradicate my OCD, and that what I really needed was treatment for the OCD, before reevaluating what to do with my life. OCD isn't very sophisticated, and spent its time screaming, "You are wasting your life at this job," which sent me into a frenzy of compulsive distraction, but OCD couldn't give me any other alternative. And of course, it was the OCD that was mostly responsible for whatever wasting of my life I was doing at work. If there had been a video camera in my office, the film would've shown a woman sitting very still, moving the mouse barely perceptibly with her left hand(because she injured her right hand, and in order to keep websearching, had to switch to her left).

Today has been a lurching through various forms of perfectionism, but I listened to my recording 3 times today so far. I will give myself credit for that.

Tuesday, August 3, 2010

What do you want your life to be about? Acceptance & Commitment Therapy for OCD

Circle of Life Values, part 2
My friend J. came over today for coffee, and I told her I was avoiding doing my therapy homework for tomorrow, writing down my values. Her eyes lit up and she said, "Oh, let's do it now, together." I think she would've made an excellent Exposure Therapist in another life! At first I was like "Crap." But enough of the healthy part of me said, ok, let's do it. J. lost her job just before I lost mine, and we are going some similar re-evaluations of our lives.

My therapist is having me work through "Get Out of Your Mind & Into Your Life: The New Acceptance and Commitment Therapy" by Steven C. Hayes, PhD. Some of the ideas of ACT are really useful for dealing with OCD, especially learning to observe your mind and let the noise be there, but doing what you really value in spite of it. At times the scientific language bogs me down, especially with an OCD desire to understand it perfectly, and I'm glad I'm working on it in the context of therapy, so I can get help with the perfectionistic tendencies.

My homework for tomorrow was to write down what I truly value in 10 different domains of my life, such as friendship, relationships, family, parenting, work, recreation, spirituality, citizenship, personal growth and learning, physical health and well being. J. set the timer for 1 minute for each category and we started writing what we want our lives to be about in each of these areas. Then Hayes asks us to re-read what we wrote, as if no one else would ever see it, and whether these are things we really value or whether they are things we think we are supposed to value. All of this is ripe for OCD over-interpretation, but framing the exercise as an exposure helped--writing things down in a minute, without knowing for sure if they really *truly* are my values, not to mention judging whether these are things I *should* value.

OCD only values reduction in anxiety--there isn't much else it cares for except certainty. When I do what my OCD demands, I get a temporary drop in anxiety, but I don't get to live much of my life. I value connections with people, and making art. I don't want my life to be about my rituals. The temptation is to fall back into my perfectionism OCD, and berate myself for ritualizing, as if somehow this will help me change. But one of my values is compassion, and persecuting myself for having OCD is not compassionate, and I am slowly learning how to have compassion for myself.

Sometimes the motivation to do exposures is hard to find because the anxiety is so gripping. My therapist is arguing that my values can help guide me, and help give me courage to face the OCD. What do you value? What motivates you to do exposures?

You can download the full 2-page version of the values chart here.

For a useful summary of ACT, Dr. Russell Harris has a good article:
Simple Overview of ACT: To download a simple, non-technical, easy-to-read overview of ACT ( called 'Embracing Your Demons', an article he wrote for Psychotherapy Australia magazine) click here. I read this article several years before getting any treatment for my OCD, and it stayed with me.