Category Archives: CBT

In the Moment

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It’s one thing for me to declare over my blog to a primarily anonymous audience, “Dear obsessive-compulsives, this is what you should do.”

But then comes the moment when your friend says, “Hey, can you talk to my friend on Facebook?  Here’s her name.”

It’s not that I’ve never been there before, the frenetic chaos of an obsession.  I know what it’s like to feel that furious terror, to need to know that things will be okay.  I get it.  I really do.

But I know the other side now.  I know that reassurances aren’t going to get this girl anywhere.  Know that discussing her obsession is like clipping off the leaves of a weed, when what we really need to go for is the root.

In that moment– those wild minutes of obsessive pandemonium– it’s hard to talk calmly, to keep redirecting someone back to the idea of treatment, to feel like you’re doing them any good.  In fact, you imagine they’re thinking, No, you’re not getting this.  You don’t know what I need.

But I do.  Because I do get it.  Because I was there.  Because I tried for years to put a quick bandaid over the cancer that needed to be cut out.

Breathe, I tell her.  Breathe tonight, and then educate yourself tomorrow.  It’s time to go for the root.

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a confession

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Although cognitive-behavioral therapy threw off my OCD chains four years ago, I have to be honest: sometimes I worry that all the protective walls I’ve built around me will come crashing down.

I know that OCD is waiting just outside.  I see it in the parking lot sometimes.  Every once in a while it sneaks into my bedroom at night and sits menacingly on my dresser, whispering ugliness.

I have the tools to make it leave now.  It has to obey me when I tell it to go.

But what if one night I’m not strong enough?  What if my voice wavers, and it realizes I’m not as powerful as I try to sound?  What will I do if it pitches a tent in my apartment, moves back in with its suitcases of grief and terror?

I speak boldly of CBT and ERP as if they are stories of the past.  I say “freedom” like it’s a permanent thing.  But I can’t see even one second into the future.

Just wanted to share these thoughts with my OCD community.  I have great joy, and I delight in my remission, but I’m a real person with real fears.  As I’ve said before, I won’t tiptoe around my OCD– but I’m not going to provoke it either.

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Resurgence: When OCD Attacks a Freed Mind

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It’s hard to know exactly what caused it, but the last two weeks have been pretty hard for me, OCD-wise.  And this is coming after four years that were, for the large part, obsession- and compulsion-free.

Blah.

I was feeling weak and exhausted for various reasons when the  intrusive thoughts started up again.  I don’t know if OCD noticed a chink in my armor and decided to go for it or what– but out of nowhere, those old intrusive thoughts started up again.

Then, one week ago, I posted about my darkest, lowest days, and in some ways, that blog post worked as a trigger.  On Tuesday night, for the first time in SO, SO LONG, I started to revisit those old doubts about my salvation.  It felt so ugly after such a beautiful four-year stretch of freedom and joy.

But.

I have tools now.  I walked myself through the obsession: It is POSSIBLE that I am going to hell … but it is not LIKELY.  I practiced an old exposure.  I reminded myself of the promises of scripture, and I emailed my girlfriends and asked them to pray and to NOT reassure me.  And they were total rockstars and did exactly as I requested.

And you know what?

Tuesday ended up being an isolated event.  It felt like such a slippery slope, like all I have won was going to be torn from me.  But it wasn’t.  I’d still appreciate prayers and NO reassurances, but this last week was a reminder for me that OCD-in-remission is in some ways just a sleeping giant.

Not that I will tiptoe around it.  I will not fear it again, only fight it.

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my darkest, lowest days

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Tonight, I have been thinking about that deep, dark pit and the moments of my life when I was at the very bottom, nowhere lower to go and my head too heavy to look up.  I have been thinking about the things and places that remind me of those times.

You might guess that it was those months after college graduation, when I would wander from the laundry room to look over the balcony to the pool area two floors below and think about what would happen if I let myself fall.

Or maybe that it would be one of those evenings when I was wild-eyed and manic, scream-weeping in the bathroom while my roommate sat outside the door and prayed.

But when I think of myself at my lowest, I always picture myself in the Caribou Coffee in Long Lake, Minnesota.  I’d arrived to town too early to visit Orono High School, and so I stopped into Caribou off of Highway 12 (which has since been re-routed), ordered hot cocoa, and sat alone at a table.  In my car I had been listening to “Spirit” by the band Switchfoot, letting the chorus hammer into me that all I wanted was Jesus … exactly whom I believed I could not have.

Interestingly, the emotion that I seemed to feel the most was this odd, lonely marvel.  Don’t get me wrong– it was not good, as marvel usually is.  It was this dark, lost, inconceivable wonder that I could be so damned and that there was nothing I could do about it.  I sipped at my cocoa, thinking how there was no joy left available to me, no rescue coming, no prayer I could whisper to make things okay again.  A marvel and a sort of understanding washing over me that this was my reality and there was no way out.

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For years, I could not listen to that song (which truly is a lovely one!) without feeling a stale depression steal over me.  To this day, when I drive by that Caribou, I think to that dark day.  Nothing impressive or strange or particularly triggering had occurred, but it is my lowest, loneliest moment of my life.

I could not have pulled myself out of that pit.  I didn’t even have the strength to lift my eyes.

(Oh gosh, I’m going to start being known as That Girl Who Cries in Barnes & Noble, LOL!)

Jesus Christ rescued me.  He led me to the right medication and the right therapy and carried me out of the pit himself.

In the past couple of weeks, I have gotten several emails from fellow obsessive-compulsives who are in that same pit.  I write this post to say that there is hope– and it’s not in ourselves.

 

 

OCD and my family

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Before my life-changing round of exposure and response prevention …

Me: Sad, guilty, full of continual anxiety and doubt.  I had this amazing family, friends who deeply loved me, and a college degree in a field that I loved … but I was a soul in anguish.

Dad: Upset, frustrated, reluctant to discuss anything OCD-related.  He couldn’t understand how my life could be so good and yet I could be so sad.  I think it was hard for him to see his daughter suffering from a pain he couldn’t fix.

Mom: Sympathetic, sorry, and wondering if she was to blame for this disorder that was ravaging her eldest.

Sister: Confused and scared.  Sharing a room with me, she had fallen asleep to the sound of my tears every night for– literally– years.  And now, all these years later, she feels guilty that she had listened to me when I asked her not to tell.

Brother: Annoyed.  Why couldn’t his oldest sister just be normal for once instead of a nutcase?

OCD affects the whole family.

I am so grateful that God led me to the exact right doctors to help me!  My psychiatrist got me onto the right cocktail of medication and referred me to cognitive-behavioral therapy, which changed my whole life!

These days, my whole family revels in my rescue!  I just got off the phone with my brother, and he said, “I can really only remember the good things.”

I am glad.

© Images by Marguerite

© Images by Marguerite

The Problem with Seeking Reassurance

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For years, one of my biggest compulsions was seeking reassurance.

Do you think I’m going to heaven?  Do you think it was wrong I did such-and-such?  Do you think I hurt so-and-so’s feelings?  Do you think yadda yadda yadda …

My obsessions were like burns, and when someone would reassure me that things were okay, it was like sticking my burned fingertip under cold running water.  The relief felt real … but it was temporary.

Ten minutes later, I’d want to ask again.

(And quite often I would … sometimes to where I would frustrate my family and friends.  They would sigh deeply and look at me with these terribly sad eyes and repeat, “Jackie, no.”)

It functioned just like all compulsions– it provided a temporary relief from my obsession, but then it gets out of control.  I didn’t realize it at the time (and neither did my friends), but all they were doing was enabling my OCD.

What would have been better (although much, much harder for both the OC and the friend) is to say, “Look, there are a lot of things we can’t know with certainty.  What you’re afraid of is POSSIBLE … but it’s not LIKELY.  Let’s look at the available evidence.”  Of course, no obsessive-compulsive wants to hear even an ounce of uncertainty … uncertainty doesn’t soothe the burn like cold water.

At least, not immediately.

But as you introduce the idea of uncertainty into your life, and you learn to embrace it, what happens is that you start to heal.  It is hard for EVERYONE, but it is BETTER.  Reassurance only leads to seeking more reassurance.  Uncertainty leads to acceptance and healing and a new life.

Now, of course this is difficult.  Who wants to say to a crying child, “Something bad MIGHT happen if you don’t organize your locker”?  Or to a terror-stricken young adult, “It’s POSSIBLE you could catch a life-threatening disease if you don’t wash your hands right now”?  Or to someone who is weak with guilt, “We can’t KNOW for SURE that God didn’t heal your mother because of something you did”?  It’s agony all around.

But it is better.  Healthier.

And then you can follow things up with, “What evidence do we have available to help us make decisions?  Other students have messy lockers, and they usually go about their day just fine.  Even if you did get sick today, it probably wouldn’t kill anyone– in fact, lots of people have been sick at your workplace in the last year and no one has died.  It’s more likely that your mom died due to her illness than to your actions that aren’t connected.”  Obviously, these are hard.  They don’t erase uncertainty.  And that is the point.

Remember, uncertainty is the key to healing!!  That is why obsessive-compulsives need to surround themselves with cheerleaders not enablers, people who are willing to do the hard business of tough love, even in the face of tears and terror.  It means anxiety in the short term– but joy in the long term!

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Uncertainty is the Key

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One of my friends has had her obsessions flare up again (she is worried that her brother will die on his spring break trip), and she emailed me for prayer and advice.  I asked her, “Do you want tough love?”

Her response:  “Yes, okay, just hold on a second I have to prepare myself.”
A minute later: “I am ready.  Go.”

I wrote back:

I’m not going to reassure you about this because LIFE IS FULL OF UNCERTAINTY, and we have to learn to live with it.  I’m not saying this to be mean, but the truth of the matter is that he could slip on the Minnesota ice outside and hurt himself that way just as easily as a trip to California.  We DON’T KNOW.  We CAN’T know.  All we can do is make decisions based on the evidence available.  The evidence available suggests he will be fine.  Whether you worry about him or not won’t change anything except for how YOU cope with his spring break.

The best thing that you can do for yourself to keep from spiraling is to repeat to yourself, “I can’t know if he’ll be okay.  He might be.  He might NOT be.  Either way, he knows God, and I have to just live my life with uncertainty.”

I want to reassure you.  But that would be just silly—who am I (who is any mere human) to reassure you of something like this?  Our lives ARE like a vapor!  We have no way of knowing.

The evidence available suggests that most healthy young people live till their 70s, so that’s what I’m going to plan for.

***

My friend thanked me for the tough love; I think I’m allowed to dole it out because she knows about how cognitive-behavioral therapy changed my life.  CBT is really just a giant act of tough love, isn’t it?  We’re put through torture so that we can barrel through the hell of daily life with OCD.  I know I am so glad to have gone through it myself, and that is why I am not willing to reassure someone of something we can’t know.

Life is full of uncertainty, and each obsessive-compulsive wants to eliminate it– which is just not possible.  Still, we go to great lengths to attempt this impossible feat.  Really, our rescue is in learning to embrace the uncertainty.

If it boggles your mind a little, that’s okay.  It still does mine too, and I’m a success story!

For those of you with OCD, is it hard for you to receive tough love from people?  For those of you who love an OC, is it hard for you to dole it out?

Live OCD Free app: my review

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I first learned of the Live OCD Free app when I was in Boston last October, attending an event hosted by the International OCD Foundation.  I was intrigued by the idea of a web app that could simulate or guide Exposure and Response Prevention, so I picked up some handouts to take back to my university, and that was that.

Until I had lunch with Faith, this incredible 9-year-old who is battling with OCD.

Somewhere in the back of my mind, I had stored the memory that this app had a children’s version to it, so I contacted the company and asked if I could have a free trial of the app so that– if I liked it– I could promote it on my blog.  I received a very kind email from Dr. Kristen Mulcahy, who also sent me a promo code.

Live OCD Free app

What it is: 
Billed as “your personal pocket therapist,” this web app allows you to undergo cognitive-behavioral therapy (CBT), specifically Exposure and Response Prevention (ERP), either on your own or with the help of a therapist.  With it, you create a hierarchy of exposures, practice your exposures, and record your progress.  You can even easily email your progress reports to your therapist!  There is an adult version and a child version (both available with just the one purchase).

Child version:
In the child version of the app, there is a video that shares the story of the “Worry Wizard” with the child– in the video, the Worry Wizard happens to be another person (a bad kid, ha!), which I kind of like.  It goes along with the idea of narrative therapy that YOU are NOT the problem, the PROBLEM is the PROBLEM.  By showing children that the Worry Wizard is a completely separate entity from themselves, they are able to treat OCD as the enemy and not themselves.

ERP is then made into a game of sorts.  Children (along with the help of an adult) create a list of exposures (with simple prompts to aid them).  They then can practice their exposure at the click of a button.  If there is a need for an imaginative exposure (creating a loop tape/recording), they can do that within this app as well.  There are also built-in timers to remind users to practice their exposures and to record their anxiety levels (for the progress reports).  It’s really easy to use, very self-explanatory.

Adult version:
The adult version is very similar to the child version except that it just tells it like it is. 🙂  

PROS:
The secret weapons (child version)/toolbox (adult version).
Oh my goodness, I absolutely loved this feature*.  When you choose to practice an exposure, you set the timer for how long you’d like to do it.  While you are practicing an exposure, you can access the secret weapons/toolbox area, which includes:

1. Reasons for fighting (both versions).  A place where you can review and record your reasons for fighting OCD/the Worry Wizard.
2. Uncertainty agreement (adult version).  Where you acknowledge that you cannot know things with certainty.  This records the date that you “signed on” for this!
3. Relaxation (both versions).  Listen to an exercise in muscle relaxation.
4. Motivational messages and inspirational quotes.  You can even add your own!
5. Tips from other kids fighting the Worry Wizard.  Obviously, this is in the children’s version.  Loved it.  The quotes were so good and meaningful and encouraging without being enabling at all.
6. Songs (child version).  This included two songs for children (although there is a whole CD available on iTunes).  I have to admit, one of the songs– “Worry Wizard”– made me cry listening to the lyrics.  It just breaks my heart that children have to deal with this crippling disorder.  They are so brave!

*When I was doing my own exposures, I was told to focus intently on them … I wonder how this toolbox jives with that, or if that was only my therapist’s method.

Live OCD Free User’s Guide
This is wonderfully written, very clear.  If someone is choosing to do ERP on their own and without the guidance of a therapist, this user’s guide will be critical to their success.  Since I have undergone CBT, I now find it fairly easy to recognize obsessions and compulsions– and to identify appropriate exposures.  However, I would not have been able to do this if I hadn’t gone through ERP myself already.  The prompts are very helpful (and OCs often know what things bring them the most anxiety), but this user’s guide will be a huge help in sorting through obsessions, compulsions, and exposures.  I emailed with Dr. Mulcahy, and she said that sometimes people will meet once or twice with a cognitive-behavioral therapist just to set up their exposure hierarchy before attacking the actual exposures on their own.  Even if you don’t have health insurance, I can see where this would be very helpful.  If not, the user’s guide will assist in that matter.

Progress reports
This app makes it easy to see your progress.  I love that.  A visual reminder of how far you’ve come can go such a long way!

CONS:
There are very, very few cons to this app.  The graphics in the video of the Worry Wizard were not my favorite, and (of course) being a writer, I thought the story could have used a little polishing, but all in all, this app is phenomenal.  

The cost is around $80, which at first seemed like a lot of money to me … but it’s really not.  Not for what you get.  An ERP experience for $80 is a bargain (even with awesome health insurance, I still probably paid about $300 out of pocket to meet with my cognitive-behavioral therapist).  And the freedom to be gained through this process is priceless.

I imagine that CBT without the guidance of a therapist would also be more difficult, especially as there is less accountability, but the truth of the matter is that CBT takes a lot of commitment, no matter what.  I have said it before and I will say it again, you know you are ready for CBT when the hell you’re experiencing daily is worse than the hell you’ll have to go through with CBT.

All said, I highly recommend this product.

I cannot say enough good about CBT/ERP and how it gave me back my life.  Whether someone chooses to go the traditional route of seeking out a cognitive-behavioral therapist (note: NOT a talk therapist) or chooses to use this web app … or chooses to use both in conjunction with one another … I am 110% for it.

The important thing is that you pursue CBT.

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