Tag Archives: exposure and response prevention therapy

OCD torture

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Through my website, I can see what search terms are bringing people to my blog, and this week, the number one search term was “OCD torture.”  It breaks my heart.  But I can completely understand and relate.

For those who are in the throes of such torture:

Welcome to my blog.  I know what you’re going through– I was there myself, only about 5 years ago.  And the torture was long-lasting for me– nearly 15 years of it.  It’s crazy how we can even bear up, isn’t it?  Sometimes I am amazed that I survived, was able to get through school, was able to keep my job.  Every single day, I hurt so bad.  Every single day, I had this feeling that something was wrong, something was off.  I felt frantic.  The weight of the world was on my shoulders, even from when I was young.  Personally, my OCD attacked my Christian faith and made me doubt my salvation, and that doubt is like pure agony to one who loves Christ.  So many evenings I spent weeping, almost keening, because I couldn’t handle the thoughts and doubts that were inhabiting my brain, burrowing into it as if they’d stay forever.

torture

My OCD attacked whatever was most important to me.  It made me think people were secretly against me, it made me think I shouldn’t tell my problems to my best friend, it made me think it was sinful to write (one of my life’s greatest loves), it made me think I was gay when I clearly was not, it made me think I was a sex offender, it made me think it was wrong to meet new people or to talk to anyone I didn’t know (not helpful when your job is recruiting!).  It made me feel guilty if I brought home a STAPLE from work.  It made me feel guilty and sinful all the time.  And TERRIFIED too.  It wasn’t always just a dull agony.  Quite often it ramped into a shrill, turbulent nightmare.  Overwhelming, engulfing terror would swallow me whole.  And then sometimes, to hide itself, it would make me even doubt that I had OCD (tricky bastard!!).

Notice I say it made me feel this way.  OCD, my disorder, made me feel this way.  The guilt and terror were not from God.  The thoughts and doubts weren’t my own.  They were given to me, like the ugliest of gifts, from my disorder.

I remember reading blog post about the unpardonable sin, thinking that is me.  I am in those shoes, and I will never be out of them. Guess what?  I have been delivered from that ugly hold OCD had on me.  I still have it.  But I’m the boss; it’s not.

How?  Cognitive-behavioral therapy, specifically exposure and response prevention therapy, which I’ve explained on my blog here.  Now, after twelve weeks of CBT, I have been in control of my OCD for the last four years.  It’s like another life.  When I feel guilty now, it’s because I’ve done something wrong.  When I doubt something, I don’t freak out– I seek out advice from family, friends, and the Holy Spirit.  I know my soul belongs to God.  I can look at OCD’s silly suggestions and see that they are ridiculous.  I don’t have to entertain them.  I can toss them aside like I never could before.

And my OCD knows it’s not in control anymore.  To be honest, it doesn’t even fight me as much now that it knows it loses every single time.  It knows I have the tools to toss it out the window, so it keeps pretty quiet around me.

Meanwhile, it is torturing you.  I hate that.  I want you to be free like I am.  It is going to be a rough road, but there is help.  Find a cognitive-behavioral therapist, buckle in, and do whatever you have to do to complete your therapy.  And when you want to quit, you can post a comment on this blog, and I will be your cheerleader.  Skip the traditional talk therapy.  You need someone who knows how to do ERP.

Start today.  It’s time for freedom.

Note for those without health insurance: If you can’t afford to see a cognitive-behavioral therapist, and if you’re ready to take back your life, you can try a self-guided CBT experience with an iPhone app like the one at http://www.liveOCDfree.com or by using a book like “Stop Obsessing!” by Edna Foa or “Freedom from Obsessive-Compulsive Disorder: A Personalized Recovery Program for Living with Uncertainty” by Dr. Jonathan Grayson.

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!