Tag Archives: ERP

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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Tips for Interviewing a Therapist for Your OCD

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Janet from the ocdtalk blog pointed me to the International OCD Foundation’s website for this list.  I hope it will be helpful for you as you seek appropriate treatment for your OCD.  I can’t stress this enough: OBSESSIVE-COMPULSIVES SHOULD NOT WASTE THEIR TIME ON TALK THERAPY.  YOU NEED COGNITIVE-BEHAVIORAL THERAPY, SPECIFICALLY EXPOSURE AND RESPONSE PREVENTION THERAPY.

“What techniques do you use to treat OCD?”
If the therapist is vague, or does not mention cognitive behavior therapy (CBT) or Exposure and Response Prevention (ERP), use caution.

“Do you use Exposure and Response Prevention to treat OCD?”
Be cautious of therapists who say they use CBT, but won’t be more specific.

“What is your training and background in treating OCD?”
If they say they went to a CBT psychology graduate program or did a post-doctoral fellowship in CBT, it is a good sign. Another positive is if a therapist says they are a member of the International OCD Foundation (IOCDF) or the Association of Behavioral and Cognitive Therapists (ABCT). Also, look for therapists who say they have attended specialized workshops or trainings offered by the IOCDF, like our Behavior Therapy Training Institute (BTTI) or Annual Conference.

“How much of your practice currently involves anxiety disorders?”

“Do you feel that you have been effective in your treatment of OCD?”

“What is your attitude towards medicine in the treatment of OCD?”
If they are negative about medicine, this is a bad sign. Medicine is an effective treatment for OCD.

“Are you willing to leave your office if needed to do behavior therapy?”
It is sometimes necessary to go out of the office to do effective ERP.

all about CBT

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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!

slavery and freedom

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Last Thursday and Friday, I attended the Global Leadership Summit through a satellite site, and it was incredible.  This was my second year attending, and both last year and this year were phenomenal.  Essentially, the Willow Creek Association pulls together a knock-out faculty of world-class leaders to speak; it’s like being smacked upside the head (in incredible ways) each hour.

On Friday, Pranitha Timothy of International Justice Mission spoke about human trafficking and about her work with IJM to rescue many from slavery.  It stirred my blood.  It always does, to hear stories about slavery and freedom.  I want my life to matter, want to do something important for the Kingdom.  I could almost picture myself going into dangerous situations to pull children out of slavery and get them safely back into school.

On Saturday, I met with a college student whom I have known for about a year and a half, a young man who is living in his own personal OCD hell and is ready to break out of it by pursuing cognitive-behavioral therapy.  We sat together, discussing OCD and how hard it was and how no one understands– but also CBT and how it can give him the tools to step from darkness into light.  I told him that in just a short time, he could be free from OCD’s reign, and I realized …

I am an advocate for those in slavery seeking freedom.

I may not be rushing into workhouses to confront slave-owners or holding children in the midst of a chaotic rescue, but I am a CBT advocate, telling obsessive-compulsives over and over and over again that this is the way to freedom.

I still plan to support IJM financially (and you can too at http://www.ijm.org/give), but I realized that my personal rescue missions will look a little different.