all about CBT

Some people have been asking for more details on cognitive-behavioral therapy, the incredible tool that God used to set me free from obsessive-compulsive disorder.  It is my pleasure to share with you about CBT!  Please note that I am not a mental health professional– but I did have a wildly successful experience with CBT and am a huge advocate.

This is the preferred method of treatment for OCD; specifically, it is called Exposure and Response Prevention (ERP).  Long name, but actually, it is exactly what it says!  The patient is exposed to something that triggers an obsession and then the response (the compulsion) is prevented.  This therapy actually re-wires the brain– the brain physically changes in this therapy– and it helps an OC to live with uncertainty.

CBT either works or doesn’t in 12 weeks.  My psychiatrist, national OCD expert Dr. Suck Won Kim, told me beforehand that it would be worthless to meet with a CBT therapist longer than 12 weeks and that Dr. Chris Donahue wouldn’t ask me to meet any longer than those 12 weeks.  Three months.  You can handle anything for three months, right?

The first couple weeks were most intake.  Dr. Donahue asked lots of questions to help assess what my obsessions and compulsions were, and what triggered the obsessions.  He was basically probing to find what buttons to push later: “How much would that stress you out if you couldn’t do XYZ after ABC happened?” and that sort of thing.  I knew it would all come back to “haunt” me, but I was all in.  This honestly felt like my last hope for a normal, happy life.

I took the YBOCS (Yale-Brown Obsessive-Compulsive Scale) test and found out that I was a moderate case, which surprised me.  But then again, there are some people who can’t leave their homes, can’t touch a loved one, people who wash their hands with Brillo pads and bleach.  

Dr. Donahue outlined the measurable goals of my treatment plan: a fifty-percent reduction in distress when focused on upsetting stimuli and six consecutive weeks of no avoidance or rituals.  Three months was starting to sound like a long, long time.

Then Dr. Donahue and I wrote a story together.  Well, he started it and it was my homework to finish it.  Since my obsessions were primarily focused around hell, we had to do imaginative therapy (since, obviously, there is no way to really, literally expose me to hell).  So I wrote this story about an imagined worst day ever (I mean, really bad– I go to hell in it).  If you’d like me to share with you the story, I will.

My therapist recorded this story (along with his own additions to it) digitally, and I was sent home with an 18-minute recording from the pit of hell.  My job was to listen to it four times a day– two times through, twice a day– every day and record my anxiety levels when prompted.  And I needed to do this consistently until my anxiety levels reduced by 50% from what they were the first time through.  Oh, and I couldn’t perform my compulsions either to make myself feel better.

It. Was. Awful.

I won’t lie to you, listening to that recording– that exposure– was like torture.  It was being triggered left and right and not being allowed to do anything to ease my anxiety.  Doesn’t this sound like some type of cruel and unusual punishment?  It’s what it felt like, and I honestly wanted to quit at about week 8 or 9 when my anxiety levels weren’t dropping.

I hated it.  It made me sick to my stomach, made my heart race, terrified me.  I tried to listen to the recording right away in the morning, in order to get half of my required listenings out of the way early in the day, but eventually, I couldn’t do it that way anymore– the weight of beginning my morning in such misery made it hard to get out of bed, and I had to push it all back later in the day just so that I wouldn’t dread waking up.

But something clicked around week 10 or 11.  Praise. The. Lord.  It clicked, and all of the sudden, I was in the driver’s seat again!  I controlled my OCD and not the other way around.  One day I was listening to the recording– this device of torture and grief– and I thought, This is so annoying.  And then I smiled and thought, Finally.

This, of course, is a brief description of my experience.  I could tell you so many more things– about how hard it was, about what other exposures look like for other kinds of OCs, about the tools Dr. Donahue gave me for success.  It’s all detailed in my fictionalized account of it, my novel Lights All Around, which you can read here.

It was one of the hardest things I have ever had to do– but not as hard as living for 20 OCD-riddled years without help.  I hated to go through CBT, but I loved to have gone through it.  It rescued me and those twelve weeks are a defining period of my life.  I remember being so angry and upset with my therapist, absolutely despising him and the exposures, and feeling certain that I was going to fail at this, my last shot at freedom.  I very nearly quit.

But that moment came right before everything changed.

If OCD is ruining your life, you need to undergo cognitive-behavioral therapy.  It will be hard.  It will be hell.  But it will be worthwhile.

Questions, anyone?

To read a stark account of my life before and after CBT, check out this blog post!

26 thoughts on “all about CBT

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  15. Hello, Jackie! It’s been awhile, huh? 😀

    So I’ve been attempting self CBT and ERP therapy for a number of months now, and despite having some great moments of clarity where everything seems to be resolved, I’ve still run into snags along the way. For one thing, I’m still not quite sure how one is supposed to approach the whole “exposure” technique for those with Pure-O, despite reading numerous articles on the subject. I’ve read some OCD help articles that say you’re supposed to ignore the thoughts when they pop into your head by practicing mindfulness and not attending to them (I’ve taken to trying to think “Yeah, whatever” when a distressing thought pops up) or putting off attending to them until later to prolong the anxiety, but then there are others who say you’re supposed to confront and agree with everything until it doesn’t bother you anymore at all? I don’t know, I’ve tried both, and I’m just a bit torn on how best to proceed with my treatment so I get permanently (or as near to permanently as I can get) better ASAP.

    So in your experience, should one constantly agree with the thoughts without trying to convince yourself of the contrary? I.e. “Yes, I am totally gay,” or “Yes, that book is awful and it’s wrong to enjoy it,” or “Yes, I really want to murder my spouse”? Or should you just go “Yes, I just had that thought” and say nothing for or against it? What is the best method you’ve found that helps you consistently conquer the thoughts?

    I totally understand if you’re busy, or if this falls under the sort of question you don’t answer anymore, but I thought I would check with someone’s who’s gone through ERP and come out the other side first before trying some other avenues. Any advice or tips you can give about how best to beat the OCD as quickly and thoroughly as possible would be greatly appreciated. 🙂

    Thanks so much for your time! ^-^/

    • Hi friend! I’m not an expert or a therapist at all, but in my ERP, I had to fully embrace the “bad thoughts.” For me, it was “I am going to hell, and I have to accept that.”

      For someone with HOCD, it would be more of “I’m gay, and I accept that.”

      For someone with harm OCD, “I’m going to hurt someone. I want to.”

      Did you read any of the books I suggested?

      • But if you embrace the thoughts… isn’t that rather counter-intuitive? I mean, I know it’s not, since you seem quite at peace with yourself and from what I read of your blog posts, you don’t sound like you think you’re going to hell. So why tell yourself something you don’t believe? Is it to condition yourself to no longer be scared of the thoughts anymore?

        Let’s see… I’ve read “The Doubting Disease” by Joseph W. Ciarrocchi, “The Obsessive-Compulsive Trap” by Dr. Mark Crawford, and “Stop Obsessing!” Edna B. Foa and Reid Wilson (before I found out that all the techniques in the book were already available online. Could have saved myself 10 bucks if I’d have realized that sooner…). I have tried the techniques in the books – particularly the “try to make yourself anxious without reassuring yourself” ones – and either they don’t seem to work for me (the Worry Time exercise in particular), or sometimes they do work, at least for a little while, but the doubts always come back in some form or another. I’m not sure if I’m missing something, doing it the wrong way, or giving up just before I have a breakthrough because my obsessions will occasionally flip flop from my main obsession to a lesser one and I think I’ve solved the main issue when I really haven’t.

        The issue might be that I think that there should be some tangible progress that I can follow, that I won’t always have a stomach ache and the feeling that something’s wrong always hanging over me if I’m actually making progress. And so I do the trigger exercises for weeks and weeks but there’s no change in my overall anxiety levels (even if I’m not actively thinking about it it’s still there niggling in the back of my head), and in the meantime I’m miserable because I’m intentionally causing myself anxiety and the books say I should be feeling better, but I’m not. At least, not that I can see. That’s why I wanted to speak to you and see if you had any tricks or tips to help with the therapy, or if it all boils down to “Stick it out, just accept all the unacceptable thoughts that come your way without changing your routine, and you’ll have a breakthrough eventually. Someday.” And I guess if that’s the case it’s just something I’ll have to do. Just, you know. If there’s something I can do to get better sooner rather than later, I would want to do that instead. XD

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  18. Jackie,
    Are you saying I should find a CBT therapist over an OCD therapist? And will they do ERP as the CBT therapist? Ive just been struggling with HOCD for about three months now and really don’t know what to do. Ive been reading books, blogs , seeing therapists and I feel like I’m improving but I still need help. If you could provide me with the route I should take please let me know. Thanks so much you’re story is inspiring.

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