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.