The Questioner Tendency and OCD

I just finished reading The Four Tendencies by Gretchen Rubin, and her telltale sign of being a "Questioner" is that you dispute the validity of taking the quiz to find out what your tendency is. . .Yes, that would be me. In fact, it was an exposure for me to take the quiz, and tolerate the anxiety that the framework might not be valid. To be able to still learn from Rubin's observations is part of the flexibility that has come through doing Exposure and Response Prevention Therapy.  Rubin's quest has been to find the motivations for habit change, whether you meet inner and outer expectations.

Questioners question all expectations; they’ll meet an expectation if they think it makes sense--essentially, they make all expectations into inner expectations.

The desire to research can cause decision paralysis in Questioners, and I believe that OCD can take this to an extreme in the theme of indecision and perfectionism. As I've written on this blog, indecision was a struggle because of the fear of making the wrong decision and being haunted by anxiety. My research consumed much of my time. My librarian training only added to this desire for more and more information.

Rubin notes some ways to help overcome analysis-paralysis.

• Setting an action deadline
• Following the advice of someone you respect
• Limiting information sources

These ideas echo what Leonard, my ERP therapist advised. Because he was willing to answer my questions initially about OCD treatment, and point to the research on the success of ERP, I learned to respect him, and be willing to follow his advice. He knew I was a Questioner, and in addition to providing that initial information, explained that a pattern of continual questioning becomes reassurance and makes the anxiety worse by reinforcing it.

Flipping a coin was one strategy for setting a deadline, which I practiced at the grocery store.

Leonard would ask me to imagine what someone without OCD would do in a particular situation, and take my best guess as to the action to take. Yes, it is scary, but OCD promises perfect knowledge and perfect results and never delivers. 

Others with OCD might not be Questioners, but Upholders, Obligers or Rebels, and need different strategies to motivate themselves.

For an Obliger who meets others expectations but struggles meeting their own inner expectations, treatment for OCD could be more effective with accountability: exposure homework from a therapist, or attending a support group and having an accountability partner to call when a task is done. 

For a Rebel, who has struggles meeting both outer and inner expectations, accountability can aggravate the "you can't make me" response. Appealing to values and identity can help free up the oppositional pattern, as can framing exposures as a choice, not a demand. Jeff Bell has written about how focusing on what you value can give the impetus needed to face uncertainty and move ahead in spite of anxiety.

For an Upholder, who readily meets both outer and inner expectations, reading a book like Jonathan Grayson's Freedom from OCD and following his suggestions for Exposure and Response Prevention Therapy could make more sense to them than support groups or even therapy. 

Four Tendencies Quiz

RELATED POSTS

I is for Indecision

N is for Need to Know

An Imaginal Exposure Script for Indecision OCD

Indecision at the Library

Just One More Search: Information Overload and OCD

Compulsive Googling

In November, 2016, Amelia Tate interviewed me for an article on compulsively searching the web. It was moving to read the article, and feel like I had been heard and understood.

Here is a link to the article in theThe New Statesman, November 7th, 2016.
"It is like stepping into the storm: How OCD can affect your online life" by Amelia Tait

Doctors Can be Anxious Too

Doctors can be anxious too.  I have assumed that I am always the anxious one, and most other people are calm.  A month ago I went to see my family doctor about some body pain, and she gave me some medicine and told me to call her the next week to check in.  When I did, and I wasn't 100% better, she said to make a specialist appointment just in case it still wasn't gone the next week.  When I checked in again, and told her that my specialist appointment was October 21, she freaked out and said that was completely unacceptable, and I needed to be seen in the next 2 weeks.  This in turn ratcheted up my anxiety!  She also ordered a test for an ailment that would manifest pain in a different location, "just in case I had an atypical presentation."

My husband said, "Your doctor is anxious.  I don't know if that is good for you."  What we decided to do was have him do a search for treatment guidelines, rather than have me search, which is my primary compulsion with health anxiety.  I felt blessed to have someone who would help me get more information, but who would stop long before I would ever feel "done" if I was searching myself.

I got an earlier appointment with the specialist, who said the medicine hadn't had enough time to work, and that we could set aside the test for the unlikely ailment.  She did schedule a different test for October, but it was one my husband had found as the next step in the diagnosis process.

It's been a long week, with a dental appointment and a gynecology annual exam.  Preventive healthcare is important, but my OCD gets all stirred up.  Not to mention that I still don't feel good.  The challenge is to keep doing things important to me, even if I don't feel 100% or know what's wrong with 100% certainty.  Maybe my family doctor is right, and I have something unusual going on.  Maybe it's just that I live in a malpractice prone part of the country.  Maybe she lost someone to a disease and she never wants to lose someone again.

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.

Wordless Wednesday: Too Much Information is As Bad as Not Enough

Delaying Compulsive Internet Searching: Hard and Yet Rewarding

Thursday I didn't get on the computer until 10:30 am. It was one of my goals from my OCD support group to pick a day this week to delay sitting down in front of the computer. It was definitely an Exposure. When I start websearching, I am in a kind of groggy trance. Searching the internet distracts me from anxiety and fear and is a compulsion. Spending 3 hours on my own time was a challenge.

In the past, I've regarded any improvement in my OCD or a "good day" as a fluke, and have a desperate sense of wanting it to last, and fearing that it won't. It's as if I see OCD as the weather, a climate that can change capriciously. But if I turn on the computer, I am stepping into the storm. It feels like I'm in a calm place at first, but it's actually the eye of the hurricane, and deceptive in its stillness. I go into a zone of deeply ingrained habit and muscle memory, into stiffness in my back, shoulders, neck and hands, and by the time I get off the computer, I am sapped of energy and my anxiety level rebounds back up, as I see how much time I lost. Then it starts all over, getting back on the computer to numb myself again.

So Thursday it was me alone in the house, wanting to flee this Exposure, wanting to turn on the computer, and at the same time marveling at how much I can get done when I don't turn the computer on. The OCD wants to seize hold of this and berate me for not doing the Exposure sooner, or more often. It's amazing how contradictory my OCD is--advocating for both complete compulsive immersion online, and for perfectly doing my Exposures. If the OCD wasn't intertwined with the whole apparatus of my anxiety, I'd call it out right away, but it has a secret weapon, my nervous system, my feelings of dread, nausea, and panic, but I'm learning to question the OCD's credibility.

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.

Just One More Search: OCD and Information Overload

There's a discussion that threads through the OCD-Support group on Yahoo about providing information and changing beliefs as a way to treat OCD rather than doing exposures. When someone asks about a particular feared consequence in the OCD-Support group, there is almost always several people writing to reassure the person that what they fear won't happen, and sometimes a defensiveness about the basic human need for accurate information and compassion. What unfolds in many cases is that the person already knows the information(ie. how HIV is contracted), has had repeated tests, and asked the same questions many times.

A compulsion is usually the tip of the iceberg, with a lot of suffering underneath, and there are always people who will say, "That's not a compulsion, that's a good idea." At age 27, I once told a doctor I was anxious about skin cancer, and she said "Good, you should be." She didn't know that I was checking my moles constantly, researching skin cancer, and that none of this actually made me any better and identifying moles that might be abnormal. It's not compassion to encourage life eroding rituals.

In my experience, I could never get enough information. I've earned my living doing research, and I'm good at it. I read 12 books on OCD the first month I started treatment with Leonard, but it wasn't helping me since I was trying assuage the part of me that was afraid I didn't have the perfect treatment, and that I wouldn't get better.

Fortunately, I was able to be honest with my therapist about all the reading I was doing. He didn't fit the authoritarian stereotype of an Exposure Therapist, and he did give me some information, but it was information about the nature of the disorder, about the constant desire to have 100% certainty, and that his clients get better, but he couldn't give me an absolute guarantee, and asked me to consider taking the risk and doing the treatment, and not reading more books. He wasn't asking me to follow him unquestioned, or demanding I do what he wanted. He was appealing to the healthy observant part of myself that wanted to get better. We all have this part, no matter how buried under OCD.

I am the Keeper of My Time

I've had a lot of time of my own this week, because my job is gone. I've been avoiding blogging here, in part because my whole routine is a mess, but also the OCD sneaks in quickly and says, "Well, now you have time to do everything *exactly right* so don't mess it up" and then I avoid posting at all. But today I'm here, because the support I've received from this community of readers and bloggers has been wonderful, and it's important to me to continue to share my experience of dealing with OCD, and sharing what I've learned.

An expression my therapist uses floated into my mind when I sat down to write, "I am the keeper of my time." As in, there is the possibility in my human-ness to keep my own time, independently of what the OCD demands. I struggled with this concept at my job in the past, because of my fear I would do the wrong task or do things in the wrong order, and even though I worked independently, I was not the keeper of my time much of the time, but rather my OCD was. The anxiety about making a mistake would come like a wall of water knocking my chest in, and I would divert immediately into compulsive web searching to distract myself.

The irony was that I would inevitably find something on the internet that caused me additional anguish, but the initial hit of anxiety relief kept me coming back. In 2001 I started therapy with Molly, who was instrumental in helping me find compassion for myself, and starting to create my own life, but who didn't really understand the nature of my compulsive searching. I started reading sites that left me feeling even more defective and unredeemable than when I started. When I said something about it to Molly she was alarmed, and told me to "draw a boundary" and stop reading the multitude of sites that were telling me I was going to hell.

My secret hope was that I'd find a site that said I was ok--the compulsive search for comfort. I was not the keeper of my time. My time was like a stretched out sweater that couldn't bounce back into its original shape, and one of my OCD fears was that once I started websearching I couldn't recover any of the day, that it was all ruined, and this meant just about every day was ruined.

My challenge now, while unemployed, is to claim my time. My well ingrained habit, my overlearned skill, is to start drifting on the computer, and making a schedule stirs up all the fears of choosing the wrong things to do, but there is true delight in actually doing things that are important to me, like writing this post. What ways has OCD interfered with keeping your time? How have you reclaimed bits of your life? My OCD says that it's all or nothing--either I claim it all, or none at all, but that's just another sneaky way for it to perpetuate itself!

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.

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.

Introducing my ERP Therapist

He's going to show up quite often in this blog, so I'm going to call him "Leonard, " and introduce him as my wise, sharply observant Exposure and Response Prevention therapist. To go with the metaphor of an owl, Leonard has spent enough years treating people with OCD, that he can hone in on a rodent-like obsession scurrying through the fields and snap it right up. He likes to tell me he's helping me become my own therapist, and encouraging to trust my own thinking--which the OCD vehemently opposes!

His ability to hunt the feared consequence of any given obsession, and uncannily predict the kinds of protests the OCD will make to any given challenge, is truly invaluable. He doesn't get mired in the mud of obsessional thinking. He's not a mind-reader; he's just had 7 or 8 years with the bulk of his clients having OCD.

This is the difference between him and my previous therapist, who though she helped me with everything but the OCD, thought my continuous websearching at work was because I was bored. Yeah, I'm bored at work, but I was also avoiding doing even the most basic of tasks because I might not do them perfectly. OCD tends to form around a grain of truth, and a therapist who doesn't understand ERP therapy, or the ways of OCD, will get sidetracked pretty quickly.

OCD the Perpetual

I'm back at the computer, same scenario, fairly random websearching when there are other things I want to be doing. I still get surprised when this happens. My ERP therapist says it's OCD's job to perpetuate itself, that it will show up.

I may need to write a script for this, because OCD is getting free reign, and I still fall for its promises that if I just look at one more email, one more link, one more site, then it will leave me alone and I will *feel* ready to get up and do something else.

Any phrase beginning with "Just one more" can't be trusted.

One more sentence.
One more minute.
One more time.
One more page.
One more word.

The Pointless Ritual

Ok. I am at the computer, and I have slogged through my google alerts, did a survey for Preserve Toothbrushes, checked my email, and now my fingers are itching again to just keep looking at stuff on the web.

This is where I get frustrated, because it appears so pointless. There are things I'd rather do. I'm home from work, I ate dinner, and I have actual tasks that in another context I'd be happy to have the time to do. It's banal, minor, inconsequential appearance makes it easy to slip in under my radar. I'm Exposure Woman. Exposures should be BIG. Right?

I'm writing here to get some momentum to go upstairs. I know I need to identify what my feared consequence is. I usually short circuit that with "there isn't one. I'm just hopeless and/or a bad person." Sometimes I go with "I don't feel done yet. I am afraid of feeling anxiety when I get up and leave the computer," and then promptly start working through weeding bookmarks or looking at every message in my email, some of which I have looked at many times, and still not done anything with.

And then OCD gets clever and says "Keep trying to figure out why you are afraid to get off the computer. You really need to know the definitive answer on this." In the past this would be followed by an lengthy search of the psychological literature.

One of my therapist mantras is,"I don't need to know the answer to this right now," combined with recognizing the exposure material in the very fact that I don't want to get up, so therefore the best thing would be to get up. Bleah.

Some rituals feel important, like they have a point, that they protecting me from doom(even though of course they are not). The pointless ones suck up a huge amount of time though, and often get through unscathed by exposure. Ok. Writing this down helped. Here I go.

Related Post:
Unhelpful Strategies: Setting a Timer

OCD and Living in my Head

I tend to go awry on new projects. The OCD is opportunistic and latches onto anything new with leech-like vigor. My intention was to find an avatar for this blog and several hours later I was past the time I needed to leave my computer, looking for an image that "felt just right."

Perhaps you have had this experience of not feeling finished, even if you can't articulate exactly what finished would mean.

OCD is seductive and says, "Just search another minute, or 15 minutes, or until the top of the hour or until you've looked at every single link in a list. . ." and before you know it, you are oblivious to your life, and completely in your head.

I did find an illustration. I still had misgivings, but just enough self-awareness to know that it would be good exposure for me to go with it in spite of this. It is an etching by George Cruikshank from a series he did of human capabilities, in this case ironically illustrated by a snail. Inhabitiveness resonated when thinking of the old habits I inhabit, like compulsive researching. My fingers are itching to do some major research of who this author was, and etymology of the word, but for this blog to be about Exposure Therapy, I am practicing just writing.

OCD steals the present moment. I had no real sense of what was going on around me while I searched for an image. I was firmly in my head. I'd like to move into the rest of my body. The snail at times also seems like my totem animal. I feel like I am moving very slowly in moving beyond OCD. But I am moving, and to acknowledge that is a big step.

Embodying a Life Beyond OCD

I had the idea to create a blog about OCD, and my ongoing experience in facing it through Exposure and Response Prevention Therapy(ERP). The idea floated into my mind this evening, and here I am writing something. This is definitely an exposure! One of the phrases that tipped me off to my OCD was "information hoarding" in an article by Renee Reinardy about 3 years ago in the OCD Foundation Newsletter, which sparked all sorts of recognition of patterns in my approach to life.

Don't do anything without extensive research, or a long complicated mental analysis of the best way to do anything. My computer was littered with bookmarked sites and downloaded articles which I usually never revisited in my quest for the perfect knowing of how to proceed. I lived in a state of exhaustion within my head, my hand molded to the mouse and my eyes fixated on the screen. Even now, I want to research what to say next, but here I go.