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!

what it was like

B.C.B.T. (Before Cognitive-Behavioral Therapy):

I was in bondage to obsessive-compulsive disorder for over fifteen years; I was depressed, overwhelmed, scared, sad, and I felt guilty all the time. I was terrified of thoughts and wallowed in grief and terror for over a decade.

Doubt and this lingering wrong feeling were the normal for me; it was only for small periods of time (sometimes even seconds) that I felt peace.  I worried about ridiculous things– like that I might cause someone to kill him/herself or that I would sexually abuse a child.  I wondered if Jesus was really Satan and if people were really demons, if everyone was pretending to be my friend just so that it would hurt worse when I found out the “truth.”  I woke up in the morning and felt sick to my stomach within a few seconds.

I worried about hell, about my soul, about whether or not my prayers could reach God.  I wondered if writing fiction was the same as lying and if writing about the hard things in life was displeasing to God.

This niggling feeling of unease was constant– sometimes it was at the back of my mind, lingering there in the background, and sometimes it was at the forefront, screaming at me like a siren that SOMETHING IS WRONG.  Peace was fleeting and momentary, and I had to keep asking after it: do you think this is okay?  Do you think this was wrong?  Do you think I’m going to heaven?  Do you think I should worry about this?

I cried a lot.  Sometimes I fell asleep with quiet tears, and sometimes I would WEEP and KEEN while my roommates could do nothing to comfort me.

It was a cycle of horror: I would obsess and stress about A Particular Issue for two to three weeks, until I had completely exhausted myself in every way, and then it would fade into the background.  But only for awhile.  It or another obsession would attack again in a week or so.

I felt alone and scared and not even the gentle hand of a friend on my back could bring relief.  I felt deep confidence that I was condemned and doubted everything else.  At times, I lost my grip on reality and thought I was really, sincerely losing my mind and would end up in a straightjacket or room with padded walls.

I felt hopeless.

A.C.B.T. (After Cognitive-Behavioral Therapy):

I hated almost every minute of CBT and (at the time) thought my therapist was a BEAST, an unfeeling monster.

But twelve weeks later, I was in charge of my OCD and not the other way around.  I knew that I had been a victim and not a monster.

I am living in freedom, I do not suffer from intense intrusive thoughts nor do I feel the need to perform my compulsions to relieve any anxiety, and the quality of my life has improved SO SO SO much.   I don’t have to confess everything all the time or seek reassurance from my friends.  I don’t doubt the tiny decisions I make each day.  I am okay with uncertainty.

And I know it’s not a cover-up!  I know that CBT didn’t work like a band-aid, covering up my problems and making me blind to them.  It worked like an electrician: it RE-WIRED my brain.  Now I can think like a “normal” person.

I still have bad days, just like everyone else.  Sometimes I am sad, bored, cranky.  I fight with friends and hurt because of it. But it’s all in the normal course of life; I experience these the way that others do.  I begin each day at zero instead of at -1000, handicapped so that I have a million miles to make up before I can even deal with things the way others do.

GLORY TO GOD for leading me to CBT, which has UNLOCKED MY PRISON. I am MYSELF now: joyful, creative, secure in my relationship with Christ, and not living behind a mask. My smile is REAL, and I love my life and my God and myself! I give credit to Jesus Christ for such an incredible rescue. Thank You, Lord, for two years of freedom; I am looking forward to an eternity of it.

Would you like to learn more about CBT?  I am happy to answer any and all of your questions with complete honesty.