Category Archives: CBT

How to Care for the Obsessive-Compulsive in Your Life

Posted on by
3

hugMy friend Amy recently requested that I write a blog post about how to care for an obsessive-compulsive friend or family member.  I thought it was a great idea!  Here’s my best advice:

1. Get them into treatment.

The best, most important thing that you can do for the obsessive-compulsive in your life is to do whatever it takes to get them into a treatment program.  OCD is treatable with Exposure and Response Prevention (ERP) therapy.  Don’t balk at the cost or make them feel guilty about it.  A co-pay in exchange for their freedom and joy?  Throw yourself 100% into the task of getting your beloved OC psyched about therapy.  Read success stories online and share them.  Educate yourself.

2. Find out their compulsions and don’t aid them.

Ask your OC what his or her compulsions are.  Ask again after they’ve started ERP.  And then steer clear of enabling those compulsions.  This is difficult to do, especially if one of their compulsions is seeking reassurance.  With all your heart, you are desperately going to want to reassure them that X won’t happen, or that Y is okay, or that Z won’t end badly.  Don’t do it.  Doing so is siding with OCD against your loved one.  To side with them, you have to stand strong against OCD and not enable their compulsions.  It’s okay to say, “I don’t answer OCD’s questions” or “we can’t know that” or “I’m not going to aid your compulsions.”  Set up a standard answer with your OC ahead of time and then stay strong.

3. Find out their exposures and help them practice.

Ask your OC what their exposures look like and– if possible– help them practice.  Keep your eyes open for opportunities for your OC to practice their exposures, and encourage them to do so.  Stay in the room if they need you to.  Hold them afterward while they cry.  Continue to starve the enabling bug inside of you!

4. Be a cheerleader.

Encourage, encourage, encourage!  Think and speak positively.  Stay excited about ERP, even when your OC feels like a failure.  Don’t let them entertain the thought of giving up.  Remind them of all the ERP success stories.  Believe that hope and health are just around the corner.  Remind them that freedom is so close and so worth it.

5. If you’re the kind of person who prays, pray hard.

A Metaphor for Obsessive-Compulsives

Posted on by
19

A new friend came over to my apartment the other week, and we got to talking about Exposure and Response Prevention (ERP) therapy, and I shared a metaphor with her that I’d like to share with you now.

We put out fires, but what we need to do is shoot the arsonist.

arson

The problem with attempting to “solve” an OC’s obsession is that, as soon as it’s solved, a new obsession will take its place.  In that way, you’re only putting out fires, not dealing with the root issue, which is an inability to handle uncertainty.  For years and years, I watched my obsessions hop from one thing to the next.  My compulsions– and even my talk therapy sometimes– were shortsightedly stamping out the flames in one corner of my mind while OCD set a new fire in another corner.

How can you possibly manage to keep up that way?  It’s not sustainable.

That’s why I agree with so many of the OCD experts in this country that the best way to fight OCD is with Exposure and Response Prevention therapy.  ERP is so very different from most standard therapies.  In it, obsessive-compulsives are exposed to a trigger that prompts in them deep anxiety; then they are not allowed to respond with an anxiety-easing compulsion.  Instead, they are forced to sit in that discomfort.  Doing this repeatedly actually re-wires the obsessive-compulsive’s brain in a way that they learn to live with uncertainty and their quality of life improves dramatically.

It’s been four years since I turned my attention from the bonfires to the disorder that was setting them.

It’s been a good four years.

ERP & Imaginal Exposures

Posted on by
47

I’ve written elsewhere on this blog about Exposure and Response Prevention therapy (ERP) and how different my life is after I underwent an intense 12 weeks of this type of cognitive-behavioral therapy.  ERP is exactly what the name says it is: you are exposed to something that will trigger your obsessions and then you are prevented from responding with a compulsion that will relieve your anxiety.

For example, someone who has contamination obsessions and hand-washing compulsions might be made to touch garbage and then is not allowed to wash her hands.  Instead, she sits with that anxiety, feeling it intensely.  If someone has HOCD obsessions and seeking reassurance compulsions, she might have to look through a Victoria’s Secret catalog and is not allowed to ask, “Am I gay?  Am I straight?”

So, what happens when you have Pure-O obsessions?  What if your obsession is that you will kill your newborn daughter and your compulsion is to stay away from her crib?  What if your obsession is that you’re going to blaspheme God and go to hell and your compulsion is repeating a prayer in your head?

Then what?  You can’t really kill your daughter (um, big DUH there, but you get it!) and you can’t really go to hell, so how in the world are you able to practice an exposure then?

"little sad song" by *TrixyPixie on deviantART

“little sad song” by *TrixyPixie on deviantART

Imaginal exposures, baby.  Brilliant and brutal.

In situations like these, what you might be expected to do is to write down all the ways you could kill your daughter, read it into a digital recorder, and then listen to it over and over.  Or maybe you’ll create a story in which you go to hell, where you’re forever condemned, and you read that story again and again.

If you’re an obsessive-compulsive, trust me, these imaginal exposures are going to FREAK. YOU. OUT.  They will be so triggering and so terrifying that your anxiety is going to spike, no problem.

Meanwhile, no compulsions allowed.

Meanwhile, ERP is re-wiring your brain.

Meanwhile, you’re stepping toward freedom.  And “all” you had to do was listen to a story.

This was my particular brand of ERP actually.  I had to listen to my recording for about 80 minutes a day until my anxiety levels (self-measured at the beginning, middle, and end) decreased by 50%.  For the first ten weeks or so, my anxiety levels were NOT dropping, and I very nearly gave up.  I mean, why put myself through this misery and terror every day if it was doing no good?

But then.

Sometime during week eleven, those anxiety levels started to drop.  I developed a whole new way of looking at my intrusive thoughts.  I tiptoed up to OCD.  I can still remember the day when I was listening (again) to that horrid recording, and instead of feeling anxious, my thought was, “This is getting so annoying.”

And then I laughed … because … because finally.  You know what I mean.

Hope Begins in the Dark

Posted on by
5

hopeinthedark

 

I love when my worlds collide.  This quote from Anne Lamott’s brilliant book Bird by Bird can be seen through every lens of this blog: faith, OCD, creativity.  Here’s the full quote:

“I heard a preacher say recently that hope is a revolutionary patience; let me add that so is being a writer. Hope begins in the dark, the stubborn hope that if you just show up and try to do the right thing, the dawn will come. You wait and watch and work: you don’t give up.”

Satan is the accuser; Christ is our defender.

Posted on by
30

Recently, one of my blog readers asked me how I could tell when a thought came from OCD or from God, especially because one of my formerly intrusive thoughts was of a Bible verse that seemed to condemn me.  She wrote, “I keep reading that Bible verses spontaneously popping into one’s head is a prime way God speaks to people.”

What a great question.  One I’m not entirely sure I’m qualified to tackle, although I do know that the more I learn about and understand my OCD, the easier and easier it is for me to spot it.  I can recognize its tell-tale voice from a mile away now.  And while I don’t think that OCD = Satan (at all), they are both my enemies and they are both accusers.

Here is the (in flux) conclusion (is that an oxymoron?) I’ve come to:

I guess the big thing is this: when OCD would bring up that Bible verse, it worked like an intrusive thought and brought deep anxiety to me, but with God … his kindness leads us to repentance, not to shame.  The voice of God showers me with kindness, grace, conviction that leads to change … but I don’t think God’s voice is one of shame and accusation. In fact, scripture even tells us that SATAN is the accuser and CHRIST is the one who defends us.

Remember, Satan used and twisted scripture when Christ was going through his temptations, so we know that it’s part of the devil’s arsenal.

frustration4My friend Erica told me something fascinating she’d once heard: “The Holy Spirit does not motivate with guilt.”  Likewise, my incredibly wise writing professor Judy said, “I know the voice of God because that voice invites me to move closer without shame while the voice of Satan fills me with an electric dread that makes me want to hide.”

As always, I encouraged this blog reader to explore Exposure and Response Prevention therapy.  In the four years since my ERP, the voice of OCD has become so easy to recognize.  I finally know my enemy’s voice.

And better yet, I know my savior’s.

 

Life is Risky Business

Posted on by
1

riskyquoteThe sooner we acknowledge this, the closer we are to freedom.

If you’re an obsessive-compulsive who fears uncertainty,
please explore my website to learn about
cognitive-behavioral therapy, your next step.

 

Have More Discussions.

Posted on by
7

I’m participating in an HR initiative at Northwestern in which I’ve been paired up with a mentor, and together we’re going through the book True North by Bill George, the former CEO of Medtronic.  It’s all about “discovering your authentic leadership,” and in addition to reading the book, I’m doing all the exercises found in the accompanying workbook.  The workbook exercises are deep and thought-provoking and quite fascinating.

I had to draw a timeline of my life up till this point, including the ups and downs, and then I had to split it up into five chapters and give each a name.  Here are mine:

1. “She Thinks Too Much”: early childhood

2. “She Smiles on the Outside”: my school years, in which I was well-liked, very smart, and excelling at most things, except that my spiritual life and mental health were in shambles, though most people weren’t aware (hence, the chapter title)

3. “She REALLY Thinks Too Much”: the tumultuous college years and the year afterward, leading up to my OCD diagnosis

4. “Stumbling Toward Freedom”: the 5+ year search for the right medication and therapy … and for peace

5. “Redefining My Goals and Passions”: life right now

So, here’s the interesting part (I think).

I had to fill out this ginormous chart that asked the same four questions about each different chapter.  One of the questions was, “What should I have done more or less of during this chapter?”

"Tate Couple" by Matthew Dartford

“Tate Couple” by Matthew Dartford

The answer to the first chapter was easy.  I knew I needed to have more discussions and less secrecy.  My childhood was full of so much fear, and I wish that I’d been willing to just sit with my parents and discuss those fears.  Who knows– maybe it would have incited our family to help me seek the counseling I needed, even at that early age.

The answer to the second chapter was the same.  More discussions, I wrote.  I remember crying every single night for at least three years in a row, and I warned my sister (who shared a room with me) not to tell our parents.  Now I look back and think, Why not?  Why not tell?  It would have been the first step toward healing.

Chapter three.  I started to discover a theme as I wrote, MORE DISCUSSIONS!!!  At this age, I was frozen in fear of the answers, so I wouldn’t even ask the questions.  (If that makes sense.)  The very thing that had made me cry for three years straight was “solved” in one conversation in one night with my mother.  At this time of my life, around 10th grade, I started to try to share things more, since the secrets I’d kept from 5th to 8th grade had made me so sick.

In chapter four, I had to draw a smiley face next to my answer of More discussions.  And it’s true– the awkward bungling that I survived jumping around from therapist to therapist and from medication to medication was its own kind of discussion, one I very nearly wanted to give up on (after a really bad reaction to Paxil, I almost threw in the towel and just accepted that this is how life is going to be).  Yet, eventually those discussions lead me to cognitive-behavioral therapy, to freedom.

And so it was easy as I thought about chapter five, life as I know it right now, to think about what best suggestions to give myself for current and future success.  Have more discussions, I wrote, because this openness, this sharing, this ability to lay one’s cards on the table is what rescues people.

It’s hard, people.  I know that.  But we need to talk about our issues.  That’s the path toward freedom.

Preparing for ERP Therapy

Posted on by
36

Lately, I’ve been talking to some brave, amazing people who are planning to tackle cognitive-behavioral therapy (CBT), specifically exposure and response prevention therapy (ERP).  I know it’s the right next step, they tell me.  Any advice?

Glad you asked.  Here are my suggestions as you prepare for ERP.

1. Read and research!  Don’t go into this (incredible but difficult) therapy with your eyes closed.  I believe that the more you know about what ERP entails and what will be expected of you, the better.  In fact, I have a friend who had done enough research on it that he realized only one or two sessions in that he knew more about ERP than the therapist did– instead of wasting time, my friend was able to stop meeting with that therapist and find an expert in ERP.

2. Have an open heart.  ERP is not the same as talk therapy.  You will be given homework and made to go through exposures that are intended to spike your anxiety.  Before I started ERP, my psychiatrist gave me this advice: “Think of a mother, Jackie.  A mother would do anything to help her child.  You must be willing to do anything to help yourself.”  By its very nature, you will be expected to do things that you do not want to do (AT ALL).  Do them anyway.

3. Surround yourself with the RIGHT support system.  What you need are cheerleaders, people who will be your biggest fans and encouragers.  What you absolutely do NOT need are enablers– because they will only be hindering the ERP process.  Educate your closest friends about what ERP entails and ask them upfront to not baby you or enable your OCD.  When they offer you reassurance or do anything to enable your obsessions and compulsions, they are siding with your disorder against you, instead of with you against your disorder.  This is going to be hard for both sides.  Tough love is not fun … but it is good.

4. If you’re the kind of person who prays, pray hard.

For those of you who have experienced ERP, what advice would you add?

comfort2

When Thinking Hurts

Posted on by
7

wanttostopthinkig

I remember days when my brain worked like a manic assembly line, working, working, always working– and not in a good way.  Those days, I’d carve out time reserved for obsessions, for list-making, for mental reassurances.  Car rides were killer– especially those long stretches on boring I-90– and could throw me into panic mode.  At night, I’d lie awake in bed, drowning in circular thought.

And that was the thing: my mind was racing, but it never got anywhere.  Ten minutes or an hour or a week later, I’d still be chewing on the same things, exerting so much effort for no gain.

I was programmed.  When there was a moment, a pause, a hesitation, my head would fly to a dark place.  And then it would battle its way back out.  Over and over and over (and over and over and over and over and over …).  So useless, so fruitless, and so much energy spent, so much time wasted.

The by-products of OCD are not worth the efforts.

These days, my mind is still working hard– but in a good, healthy, productive way.  I listen to audiobooks while I get ready in the morning, in my car, while I exercise, as I fall asleep.  I let the wonder of literature engage my mind and thoughts, and it feels healthy, like solving a difficult puzzle or marveling at philosophy.  I write every day– blogging, poetry, my novel– and it’s like climbing a mountain.  My brain is a muscle, flexing and growing stronger.  My conversations with friends are deep and meaningful and far more important than just seeking out temporary comfort.  

When thinking hurts in a bad way, you need to re-wire your brain.