Thursday, November 4, 2010

The Road to Recovery: Onward and Upward


Whew!!  Clearly I am not used to having daily commitments because I feel super busy keeping up with my daily therapy appointments.  OCD is used to having all the time it wants, just about anytime it wants, and that's beginning to change.  Sorry OCD, don't have as much flexibility in scheduling to allow my entire life to revolve around your whims...

I've been meaning to recap days #2, 3, and now #4, so here goes:

Day #2:  The Protective Shield of Novelty Begins to Wear Off

My second day of intense CBT treatment began with me waking up in a state of confusion, which I wrote about here.  The novelty and exhilaration of breaking all the rules had worn off considerably and I was left to face the reality of the consequences of my actions.   But I survived despite the fact that I felt really "off" and like I needed to somehow undo all the exposures that had taken place the day before.  I didn't do any "undoing" and I went on to get up and go about my day to the best of my ability.  Besides, I didn't have long to dwell on those feelings of unease because I had my second home visit later that afternoon, followed by my usual weekly group therapy session.  During this home visit I did the following, again, in my therapist's words:

  • touched pajamas to bathroom floor, then to bed
  • sat on bed
  • made commitment to wear previously-worn pajamas to bed tonight
  • 20 minute shower with alerts at 10, 5, and 2 minutes (went one minute over)
  • wore previously-worn jeans, put on barefoot
  • walked in room barefoot
  • dove into bed
  • dragged clean clothes along floor before putting away
  • walked barefoot on bed
  • put dirty laundry on bed
  • sat on bedroom floor
  • ate dried fruit with unwashed hands
  • poured water into a cup with unwashed hands and drank
  • washed hands for < 30 sec
  • touched handle of toothbrush, toothpaste tube, an dental floss container
  • touched shoe rack
  • touched garbage/recycling and disposed
Much of this was a repeat from the day before, which is good - that's what exposure and response prevention is about - repeating exposures and gradually habituating to them.  And I have to admit, it was a little easier, I think.  The hardest part was getting started.  I was really anxious about taking a 20 minute shower and was still feeling "off" from the exposures I had done the day before.  Aside from that, just being told to "take a 20 minute shower" felt daunting because I have a lot of showering compulsions that would have to be toned down or eliminated altogether to accomplish this (to give you some perspective...I have been regularly taking showers that have lasted right around an hour or more lately).  But as I have learned from the past - sometimes going to extremes (at least what I consider an extreme...lol) is easier in a way, than eliminating compulsions one by one.  Sometimes it's easier to just scrap it all at once, as best I can, instead of trying to eliminate each compulsion perfectly, before moving on to eliminate the next.  Instead of wading in to the cold water, sometimes it's easier to just jump right in, when you know you can handle it.  When you are determined to adjust.  And I was.  Don't get me wrong, I still have a lot of showering compulsions, but instead of allowing OCD to dictate how and when the compulsions could be eliminated, I tried to just do what my therapist was asking of me (for once) and just go for it.  If I didn't get to something or didn't get to wash something just right, so be it.  That was the point.

And now I have another 20 minute shower planned for tonight - but this one on my own, without someone calling out my remaining time and banging on my bathroom door to get me to stop.  I have to show myself that I can make myself stop, even on my own, as difficult as it is to make that choice without someone really pushing me.  I can do it - I even bought a water-proof shower clock so I could be sure to keep track of my time and really adhere to the limit.  I am committed to sticking to the 20 minute allotment, because if I get started taking a less-compulsive shower but then start letting it balloon out into extended ritualizing, it could get ugly.  No thanks.  20 minutes it is.  It seems so short to me that it's almost like it's not even meant to be a shower - and seeing it that way, like it is some sort of strange sequence of washing behaviors, makes it somewhat easier.  Instead of being a "poor" shower, it's like it's something different altogether that is not meant to be done in the same perfect way as my usual showers.


The other thing that was difficult was the very last item on my therapist's list there - taking out the garbage and not washing my hands until I got back from my group therapy.  I felt pretty dirty.  It's not the first time I've done this, but it's the first time in a long time that I've completed this exposure.  Needless to say I really wanted to wash before I proceeded to do my hair and put on make-up, but I didn't, and I even bought myself coffee before my group session - touching my coffee cup and various items in the coffee shop with my "dirty" hands.

Day #3:  More Exposure Plus New Therapist

The big challenge of day #3 was repeating the exposures I had done with my therapist present on Monday and Tuesday.  Now I had to do them on my own.  When my therapist has thrown out the words "oh, and you should repeat this as much as possible even when I'm not around."  I've usually thought, "um, yeah right."  But in the spirit of my new treatment regimen in which I attempt to push forward and do what my therapists ask of me, I thought I just might comply.  And guess what?  I did it!  Though it was nothing new (I had done these exposures twice already), doing it on my own, voluntarily was a big exposure for me!

Later that day, I had my first office session with the other therapist I will be working with as part of my treatment program.  I was a bit anxious about this (since I really like my "main" therapist), but as it turns out, I really like her.  She definitely knows what she is doing, and I had the chance to express some of the fears that are sometimes more difficult to bring up with my main therapist (like how I'm afraid I might be faking my OCD or somehow intentionally trying not to get better so that I can continue to hang out with my "main" therapist because he is just that awesome...).  I didn't realize how much guilt and fear I had been carrying around from these "what-ifs" until I admitted them to her.  I almost cried - and I almost never cry in therapy!  Talk about weird for me!!  Apparently I need therapy for my therapy, lol...We also did some exposure in the office with me touching my feet and then touching other things like my face and hair.  My hands literally smelled like feet!! (Gross!!!)

One thing I realized in sort of summarizing and explaining my fears to this new therapist was that a lot of the difficulty for me comes from simply making the decision to do an exposure.  It's infinitely more difficult for me, for example, to volunteer to touch my face and my hair, etc., after touching my feet, than having someone say, "Touch your feet!  Now, touch your face.  Do it."  It seems all the more wrong when I make the choice to break all my invisible OCD rules - rules that say things like "you can't touch this if you touch that," or "you have to wash if you do this or before you do that."  Don't get me wrong, I obsess about violating my arbitrary OCD rules even when I am explicitly directed to break them by a therapist.  But deciding to do an exposure without the explicit permission and direction from my therapist is that much harder, even if they are sitting right there, saying "Why don't we go ahead and do that, then?" once I suggest something that would bother me.

Inside OCD is calling me a traitor for giving up such valuable information, for so easily giving away the keys to its demise by volunteering battle strategies that might work well.  Obviously, we would get to these exposures eventually anyway.  But it's like I'm helping the enemy, feeding therapists the information that will speed its destruction.  Passively allowing the gradual destruction of my OCD is one thing, choosing to actually pick up a weapon and start attacking it is another.  OCD doesn't like that.  Not at all.  But it's what I have to try to do if I want to get better.  It's one thing to sort of let OCD fade away, it's another to show myself that I am capable of fighting it and winning.  I can choose to fight back and survive.

Day #4:  A Bit of a Break

And that brings me to today.  It's been an easier day.  I had another office visit, but with my usual therapist this time.  We repeated the foot exposure after which I went out into the world and spread my foot germs onto things that unwitting strangers were likely to touch.  Woo.  Sorry world, but you probably do way grosser things to me that I don't even know about.  Now you have a few of my foot cooties to go along with everything else :).  I haven't done much exposure other than that.  I have been putting off showering but plan on adhering to the 20 minute limit when I do.  And after that I may try to recreate some of the daily exposures I have been doing so as not to initiate a precedent of trying to weasel my way out of having to do them.

All in all, it's been a good week so far.  I feel like I am finally beginning to overcome the inertia that has held me back for so long.  I am finally beginning to gain real momentum in moving forward in my fight against OCD.  I think two of the most helpful things have been mindfulness and the ability to just sort of see this next month as a time of perpetually feeling "off."  Instead trying to make things feel "right," I am just trying to accept that I will probably feel somewhat strange a lot of the time while I am in intensive treatment.  With that in mind, I try to pretend like this is just some sort of completely different universe - one where my former rules no longer apply, one with strange customs like taking only 20 minute showers and walking on my bed with bare feet.  Shocking I know.  What sort of people would live in such a world?  ;)  But if I'm going to get better, I have to get used to living in this world for a while, and eventually it just might feel like my own again.

I may stop writing about each and every day, since I am already having a hard time keeping up and because it is bound to get redundant, if it hasn't already.  We'll see!

4 comments:

  1. I thought it was really wise how you said that often the most difficult thing is just deciding to do the exposure. What a blessing that it often isn't as bad as we thought it would be - more proof of how much all of this is just in our heads!

    Also, that the OCD wants you to hang onto the "valuable information" of what are the hardest things to do. I found the same thing in counseling - I often wouldn't tell the things that were really difficult for fear of being asked to do them.

    Keep up the great work!

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  2. Wow - that's a lot of exposure!!! Great job! Keep the posts coming - I look forward to hearing about your insights and progress!

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  3. OCD is such a complicated disorder. I think the most important thing is to make sure these sufferers have support and a voice in this community since so many people do not understand the disorder. I recently heard about a film, the first to really dive into OCD, called Machine Man the movie. It looks really great and I think getting the word out about this film will only benefit the OCD community in the end.

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  4. Anonymous - sounds interesting! I know there are a lot of misrepresentations of OCD in the public and in TV/film. The world could definitely benefit from more accurate depictions of the disorder and the suffering it causes! That said, there is one movie about OCD I really like - Dirty, Filthy Love. In my opinion, this movie in many ways gives a a much more realistic depiction of OCD than most other media/entertainment sources.

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