Saturday, October 29, 2011

Phone Jitters

Though I probably don't have enough of it to warrant a label, I think I do have some social anxiety.  It's gotten a lot better over the years - when I was a kid it was really so much worse.  Back then, I was often labeled "shy" or "quiet" and hated it because every time someone used one of those adjectives to describe me, it just seemed that much harder to overcome my difficulty of speaking up.  Those jolts of anxiety I got from voicing my opinion were intensified when I discovered that, despite my desire to be talkative and efforts to be outgoing, I was still perceived as being "quiet."   I had a hard time as it was being more vocal when not at ease, but when someone commented on how I was "shy," the self-consciousness would flare up even more, creating an even bigger hurdle to overcome when I wanted to express myself.

Like I said, it's a lot better now.  I think through accidental exposure and repeated confrontation of social situations, I have adjusted.  Just as I have begun to habituate to the fear of "feeling dirty" and other contamination-related concerns, I likewise have habituated to the fear of vocalizing my thoughts (and being evaluated negatively if do) by repeatedly putting myself or by being put in social situations that evoke anxiety.  The thoughts that maybe I'm really obviously "weird" or "different" or "awkward" (or that my comments are somehow "dumber" than those of other people) still linger, but they are less intense and they don't hold as much influence over my choices as they used to.  When I was a kid, I really grappled with insecurity and lack of self-confidence, and I still often do, but these days I am more often able to overcome that fear in order to make the decisions that I want to make and act how I want to act.  In fact, I really like to talk.  I did when I was a kid, too, but back then the fear of being judged and feeling embarrassment just seemed to overpower my eagerness to express myself.

What remains of that social anxiety tends to rear its ugly head when making phone calls for my job.  When I have to make a new contact for the first time, my anxiety shoots through the roof.  I type the number into the phone and just have to press "dial" whether I feel ready or not, because if I waited for the jitters to go away, I would never make that phone call.  I do my best to sound professional and not nervous, but sometimes I get off the phone and still think, "Wow, that was special..."  or "I said that the wrong way" or "I could have explained that better."

I try not to dwell on it, though, or reassure myself in a way that only feeds the fear.  Instead I think:  Maybe I sounded stupid, or maybe I didn't.  Maybe it was a better-than-average phone call, or maybe it was worse.  What's the worst case scenario?  That I sounded unprofessional?  What's so wrong with that?  While it's not exactly the way I wanted to present myself, who cares?  People say dumb things.  People botch phone calls.  People make mistakes.  It happens.  I'm not an exception and can't expect to be.  Humans do things "wrong" sometimes.  What makes me think that I'm any different?  I'm not.

Putting it into perspective helps, as does writing about it here.  I'm still coming down from the anxiety and jitters awakened by a few phone calls I had to make almost an hour ago, but if I have learned anything in treatment for OCD, it's that feelings are just that:  feelings.  They are not always a good barometer for what's a threat and what's not.  I could have made an awesome phone call and felt awful about it, or I could have actually made a phone call that was awful but felt good about it.  It all depends on how I interpret the situation.  To use my feelings as the sole measurement of my performance would be to fall into the trap of  one of those lovely "cognitive distortions" CBT therapists are always talking about - namely, emotional reasoning (i.e. I feel a certain way about something, therefore it must be true).  I know better than believe my feelings all the time, especially when I suspect that my alarm system is a little out of whack.  My body was already pumping with little waves of anxiety before I made the phone calls, so using that anxiety to judge the phone calls as a success or failure would be misleading. 

As with other fears, it basically comes down to accepting uncertainty.  Maybe I did well, maybe I didn't.  I can't be sure and I don't need to be.

Thursday, October 20, 2011

Tired in a Good Way

I'm tired and a little down this evening as I relax after a full day of intensive treatment and then work.  I want to go to bed but I also want to get my exposure work done.  I'm dreading doing the dishes in a way that I haven't normally lately - it probably has something to do with the fact that I have been putting them off several days and have started doing some new exposures that make me feel a bit dirty to be doing them.  Other than that I need to shower - 10 minutes is the current goal.  I took a 12 minute shower the other day and a 13 minute shower this morning.  Those are the obstacles (or opportunities, I suppose) that await me before going to bed.  Last night I put off showering for so long that I ended up not sleeping in my bed and not taking my meds (which make me sleep much better than I would otherwise).  And the night before that I only got about 5 hours of sleep, so I'm a bit run-down and tired.  Mostly I just feel like there's an overwhelming amount of things to do, and I'm running a little low on motivation to get them done.  I like that I am staying busy.  I have treatment everyday in the morning, work everyday in the afternoon, and work on top of it all on the weekends.  There's not really a day off but sometimes that's good - free time leads to compulsive avoidance and compulsivity in general, but then again, taking care of myself and getting enough rest also reduces the amount of compulsions I perform.

I guess what I'm trying to say is:  I'm tired, but in a good way.  I dread the exposures ahead of me for the evening, but that's better than dreading compulsions - at least the exposures provide some benefit.  So I'll take a break for a little while longer and then it's back to work battling my OCD for the evening.  OCD doesn't rest so neither can I.

Wednesday, October 19, 2011

Intensive Treatment Update

It's been an eventful few weeks.  I can hardly believe it, but I have been in my intensive treatment for almost a full month now and am about 2/3 of the way through the program.  Four hours a day, five days a week, I've been in treatment for OCD.  And I think I'm finally getting what I needed to propel me forward - a more aggressive, thorough, and persistent attack on my disorder, a sort of fight that I struggled to make with just one hour a week of therapy.

Perhaps I'll write more in depth on the actual experience of being in the program later, but right now I have another topic on my mind:  what will I do when I am out?  My number one fear:  slipping, losing not only the gains I've made but the forward momentum I've collected.  What I hope to take away with me is not necessarily the ability to face any one specific fear, but rather the willingness and readiness to do what it takes to get better.  It's so much easier to do what needs to be done when you are accountable each and every day of the week for the choices you make.  Can I maintain that and continue to progress when I am again on my own?  I hope so.

As I wrote in a previous post, what is often the hardest for me is breaking "the rules" without explicit permission from my therapist (i.e. I have often felt like I had to continue to perform a compulsion, whether or not it really seemed to serve much of a purpose anymore, until a therapist said the magic words, "This week I want you to work on not doing compulsions x, y, and z.").  I am continuing to get better at breaking "the rules" independently, and if I can hold onto the progress I've made in this area, I think I'll have an easier time applying my therapist's recommendations throughout the week, even with less time spent in therapy, once the program is over.  Though it still seems tenuous at times, I am so grateful to be working on and strengthening my ability to make therapeutically beneficial decisions without getting permission from a therapist for every last choice I make concerning exposure and response prevention.

What goes hand in hand with this is the realization that every compulsion, no matter how mandatory it feels, is ultimately a choice.  This idea has been discussed a lot over the last few weeks, and we also talked about how, at first, there really doesn't seem to be a choice.  OCD appears to have the all control.  But as you begin to make more and more non-compulsive choices, the power starts to feel as if its being transferred away from the OCD and back to you.

I was skeptical at first.  I knew deep down that compulsions were a choice:  I knew that if someone were to hold a gun to my head and threaten to shoot if I didn't stop washing, I could turn the faucet off.  But short of just that scenario, it seemed pretty impossible to choose to forgo so many compulsions.  And it was hard to imagine a space where I wouldn't constantly have to have a frustrated therapist breathing down my neck for me for me to be able to make non-compulsive choices.  But now, more than ever in my life and especially since my big relapse, I feel like the OCD and myself are on an equal playing field.  OCD no longer has me outnumbered a billion to one.  And what's even more interesting to consider is that, in reality, OCD actually has no power but the power I give it.  OCD may seem less threatening than it once did, but the only reason it still holds any clout at all is because I let it have that power when I choose to perform compulsions.

I don't know why it's taken so long for all this to sink in, but it has, and it's incredibly hopeful and freeing.

Wednesday, October 5, 2011

Fighting Like Hell

It's been a long time since I posted and even longer since I've made posts regularly.  But, tonight, well I'm feeling in the mood to write, and goodness, there's plenty to write about.

A couple weeks ago now I began an intensive treatment program.  I'm basically in treatment about 20 hours a week.  And in the time since I started that program, well, I have done things that I am not even sure I would have done BEFORE my contamination OCD flared out of control.  As I write, I feel dirty, but I am also determined to keep going, to resist the urges to avoid and perform other compulsions that would be so easy to give in to.  I feel as though I'm finally making a solid effort to wholeheartedly commit to doing ERP as I know it needs to be done.  I'm finally breaking the rules that, for so long, I felt couldn't be broken, even while I was doing active exposure work in the past.  I am rebelling against my OCD and doing what I know, deep down, I want to do - I want to stop dragging my feet, stop undermining my treatment, and go towards those things I feel a need to avoid.  It has its ups and downs, but I feel like I have finally broken down my fear of fighting back fully.

Before I always felt like I HAD TO self-sabotage, like I had to wait for explicit and specific directions from my therapist to do an exposure.  If I didn't, well, I felt like I was being some sort of hypocritical, negligent individual who "couldn't really have OCD."  Even then, I would find myself pulled away from compliance by urges to hold myself back until someone "forced" me to do what needed to be done.  While self-handicapping is still tempting, it doesn't feel quite so mandatory.  I feel like, for the first time, I can independently make the choice to do exposures and to do them without perfect "permission" from a therapist.  And that feels like the key:  for so long I have desperately NEEDED the self-sufficiency and adaptability of being able to chose therapeutic decisions on my own.  It's still a challenge, but I'm finally seeing and feeling a glimmer of independence that has long been buried deep, tangled amidst the myriad of twisted "rules" and compulsions.

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