OCD A to Z: W is for Worry

Worry is like leaving your headlights on, and draining the battery. Worry is exhausting and stalls you in the middle of nowhere. The saying that "most of the things you worry about never happen" has circulated for many years. I remember seeing it over 25 years ago when I was in high school. Worry is used as a talisman to ward off disaster. The first time I saw a psychiatrist in the early 90's for my anxiety, he diagnosed me with Generalized Anxiety Disorder(GAD), which involves worrying about several different areas of life.

You worry too much.
If only you would stop worrying. . .
There's nothing to worry about.

The word worry comes from the Old English wyrgan, which meant to strangle, and evolved to mean "to cause mental distress or trouble." For all the stranglehold worry has held in my life, I couldn't imagine being without it. I felt that it somehow protected me, and that if I stopped worrying, something bad would happen. I hated worrying, but it was a compulsion.

I also felt like I had a responsibility to worry, since if something bad would happen if I stopped, then it would be my negligence. This can conspire with the OCD, and especially with intrusive thoughts, and the fear that if you stop worrying about the meaning of the thoughts, then it says something about your moral character, and so the worry starts up all over again.

What is worry actually doing? I once read that some researchers believe it damps down strong feelings and fears, and even though noxious, serves a function to buffer the fears. But can worry actually ward off danger? Will it guarantee I'm a good person, not a danger to others or myself? If worry can motivate me to actually do something constructive, I can see a use for it, but most of my worrying led to more fear, more exhaustion, more erosion of my life.

Revisiting OCD A to Z from 2011

Google Doesn't Have the Answer for Every OCD Fear

This photo is called Uncertainty by Rieke Photography.  From the time I had access, over 20 years ago, I was searching on the internet for answers to my uncertainty.  I know the feeling of the keys under my fingers, the gentle give of each key when I depress it, the hope that I will get THE answer for my fears.

For a long time, I was glad I had dial-up because at least I was thwarted in compulsive web searching at home, even though I still had it at work.  The fact that I have high-speed internet at home now, and do not spend all my time searching, is quite amazing to me.  

In the thick of my OCD, before I got any treatment, I couldn't imagine stopping my searches.  If I had a health symptom, I searched for answers.  If I was trying to figure out an unanswerable question, I searched for answers.  I remember when Google first appeared.  I was a librarian, and word spread fast that there was this new search engine with a magical algorithm that worked exceedingly well.

But even Google couldn't solve my OCD, because the reassurance I was seeking was a mythical oasis that vanished as soon as I got close.  I will grant though that it was through Google that I found the International OCD Foundation.  I joined, and started receiving their newsletter.  The irony is that I subscribed to the newsletter for 5 years, all the while compulsively searching about OCD, instead of seeking treatment.

Eventually, when I reached my lowest point in 2006, I finally put it together that Exposure Therapy might work for my mental obsessions and health anxiety, and found an Exposure Therapist.

Part of my Exposure Therapy involved stopping a search before I felt "done" and staying with the wave of anxiety until it ebbed.  There are still days when I am feeling stressed, and search Google as a way to dull the anxiety, but it is not my default position, hands poised on the keyboard.

Finding a therapist for "Pure O" OCD: 5 Things to Watch Out For

I was in psychodynamic therapy for 6 years with a therapist who said I had OCD, but who didn't have a plan to treat my OCD beyond having me avoid my triggers. Previous to that I had several other therapists who didn't really have a clue about my OCD. Here are some things to watch out for--hopefully this will help you find help more effectively and not have to go through the delay I experienced in finally getting Exposure and Response Prevention(ERP) therapy.

1. Affirmations. If a therapist tells you to repeat affirmations about being a good person, good father, good teacher, good Christian, good whatever, in order to counteract scary, violent, disturbing thoughts, this just feeds the fire, prompting ever more desperation in trying to prove it to yourself that you are not a monster or a danger to others. This is different from having a compassionate therapist who asserts your value as a human being and encourages you to take your life back from the OCD and any other negative deeply held beliefs about your worth, by doing exposure therapy.
2. Deeper Issues. If a therapist tells you there are deeper issues you need to deal with, and then somehow your OCD thoughts will resolve or disappear once you've dealt with the issues, you can be in for a long long stint of therapy. Yes, there may be deep issues in your life, but resolving them is not a treatment for OCD, since the compulsions often complicate any attempts at resolution, and even if you gain a deeper understanding of your psyche, OCD can be incredibly resistant to magically disappearing.
3. Thought Stopping. Snapping a rubber band everytime you have an unwanted thought, or imagining a giant stop sign will sensitize you to the thoughts even more. Mental compulsions, on the other hand, can be stopped(even if it seems impossible), which leads to the next point.
4. Confusing obsessive thoughts with compulsive thoughts. Pure O isn't pure. I discovered with the help of my ERP therapist, that I have mental compulsions for trying to "undo" my intrusive obsessive thoughts, like freezing(and doing nothing until I solve the issue), retracing my thoughts or actions, analyzing, figuring out, avoiding all reminders of the thought, or researching.
5. Disputing the thoughts ad infinitum. Cognitive Behavioral Therapy(CBT) is the larger category that ERP belongs to, but CBT applied to mental obsessions without an understanding of the nature of intrusive thoughts, perfectionism and "just right" feeling can turn dysfunctional thought analysis into compulsions. I would get sidetracked into figuring out whether I'd done a thought record thoroughly enough, and even if I disputed all the errors in my thinking, it didn't seem to stick.

Related Post
Finding a good therapist for OCD in the US and Canada

Unhelpful Strategies: Thought Stopping for OCD

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.

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.

Related:
Do I have to go? Bladder Fears and OCD

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.

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.

Unhelpful Strategies #2: Acupuncture

About seven years ago, my mind was such a deluge of OCD intrusions, that when my previous therapist suggested I try acupuncture, I actually did. It's not that she had ever tried it herself or recommended it to anyone before, but she was desperate. There was a Western trained doctor nearby who had added acupuncture to his practice. He'd never used it to treat OCD, but he was more than willing to go ahead.

I was in the middle of a massive storm of fixating on whether or not I should take SSRI anti-depressants, and acupuncture hadn't yet been contaminated by obsessive panicky ruminations. I wanted relief, wanted some space in my head for other things besides retracing and researching every aspect of my life.

I did a typical exhaustive search of the medical literature, and didn't find evidence of acupuncture working for OCD, but neither did it appear that it would harm me. It was an exposure of sorts ultimately, because I look back now and wonder how I tolerated someone applying needles to my body, buzzing them, and creating some sort of smoke. Health anxiety is one of my root OCD themes. I once fainted from a finger stick when I attempted to give blood. Giving consent to invasive treatment was not my norm. Plus the doctor's attempt to give me reassurance that the moles on my back were ok had the rebound effect of stirring up all previous mole anxiety.

After the doctor recommended I take a Chinese herbal tincture to correct my "imbalance," OCD began waking up, and gnawing away at me. I researched every ingredient, and after becoming intimately acquainted with the industry, I reluctantly tried it, because I would do just about anything to avoid having to say no to someone with authority. It tasted like bitter tea, and was just vile enough that the healthy part of myself flashed an SOS, and I dropped out of my acupuncture treatment.

I was disappointed that the seas in my mind did not part and reveal a path on dry land. I don't think I expected acupuncture to help, but I had the vengeful critical voice saying "If you don't try it and it would've worked, you are negligent and a bad person."

Related Post:
Unhelpful Strategies #1: Setting a Timer

Unhelpful Strategies: #1 Setting a Timer

I'm going to start a catalog of strategies that were not helpful for me in dealing with OCD. Last night's post about getting stuck at the computer reminded me of the advice a previous therapist gave me, "Set a timer." Essentially this results in adding the extra motion of resetting the timer repeatedly every time it goes off, but does nothing in helping me actually move away from the computer. It also results in a cascade of "What is wrong with me? Why can't I get up when the timer goes off?" The answer of course is that I have OCD.

On occasion I have used a timer as an exposure, and that is a whole different approach. That involves intentionally choosing to do something imperfectly, "wrong" or "badly" by limiting the amount of time spent on it. This can be effective, but I have to be in Exposure Mode so I don't slip back into "What's that beeping sound? Maybe it will go away so I can keep ritualizing."