How my life has changed after an intensive treatment program for OCD

I’ve been reflecting over the past few weeks on how dramatically my life has changed since I started the IOP program. It seems like every day I’m reminded of something that used to be a “problem” that isn’t anymore.

First of all, a summary of treatment…

I first started OCD treatment in January of this year (2018). At that point my life patterns were untenable. The majority of my days were spent in compulsive behavior cycles. OCD had me in a very angry and frustrated place. I started once-a-week therapy sessions, but my OCD continued on a downward trend. Work was out of hand and preventing me from being able to focus on treatment. I eventually decided to take leave from work. This is when I first started to see marked improvements and a reverse in the trend of my OCD. My therapist and I decided I could see much more dramatic benefits if I were able to get into more immersive treatment. After some long debates with insurance, I finally started the Intensive Outpatient Program (IOP) in late June.

I spent 12 weeks in the program which consisted of 2 to 4 hours of active therapy sessions every weekday. Most of these sessions were administered in my home. I had a team of six therapists working with me.

The results I experienced were nothing short of miraculous. My primary therapist has commented several times that he thinks we accomplished in 12 weeks what would normally take 1.5 years or more in regular treatment. I personally estimate that I’ve experienced a 70% to 80% reduction in compulsive behaviors.

I finally ended the IOP program in mid September after we decided there wasn’t much more that could be resolved in the program. I’m now back to regular outpatient visits.

Now reflecting on what has changed…

The following are all behaviors that used to be, but are no more.

  • Plastic utensils and paper plates. OCD used to prevented me from using my own utensils and plates. OCD also used to prevent me from eating food I touched with my hands.
  • $30+ on cleaning supplies a week. OCD used to demand that I spend this much on cleaning supplies every week. This included 12 rolls of paper towels, a couple canisters is Lysol spray cleaner, 100+ Clorox cleaning wipes, etc.
  • Cleaning carpet with Lysol spray. OCD used to want me to clean my carpets with Lysol spray… every inch of the carpet. It would demand that the carpet be dry before I could step on it again, so I would get trapped in my bathroom for 30+ minutes waiting.
  • Cleaning surfaces with cleaning wipes. OCD used to make me clean surfaces when they got “contaminated.” My my phone got contaminated a lot. OCD demanded that the cleaning wipes be used in a certain way and if the OCD rules of using the wipes were broken, I had to start over with a new wipe. I went through a lot of wipes!
  • Closing my eyes and sitting still on the bus. OCD used to make me close my eyes for almost my entire bus ride to and from work. It also demanded that I not bump into or touch anything during the bus ride.
  • Limiting my vocabulary. OCD used to omit certain words, many of them totally benign for most people, from my dialogue with others. These words were “contaminated” and off limits. I picked my words carefully to avoid using the off-limits ones.
  • Outside shoes not allowed in my apartment. OCD used to be hyper focused on my feet and where I stepped. It didn’t want “contamination” from the outside world brought into my living space.
  • Logging out of computer at work precisely. OCD used to require that I very precisely shut down my computer. This meant adjusting the mouse so it was precisely in the middle of the x to close every program that was open. If this wasn’t done correctly (if my hand slipped while clicking, for example, I had to reopen and then attempt to close the program again. Logging out of the computer sometimes took me 15+ minutes.
  • Only wearing certain clothes. OCD used to limit my wardrobe to a few select items. I had 3 or 4 shirts and about 2 pairs of pants that it would allow me to wear. Everything else was “contaminated.”
  • Not doing basic household chores. OCD used to prevent me from doing basic housekeeping like folding and putting away laundry, opening mail, vacuuming, taking out the trash and recycling, washing my dishes, etc. consequently my apartment was a total mess.

This list is certainly not exhaustive, but it gives a sense of how the IOP program has changed my life for the better.

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I’m back

I’ve been mostly silent for the past two weeks. I’ve been traveling, heavily focused on treatment, and even started transitioning back into work.

Travel

This past weekend I was in Utah for the annual Affirmation conference. Affirmation is a support organization for LGBTQ+ Mormons. I’ve been involved on the leadership team and even chaired this conference in the past. I have many dear friends I’ve made through my involvement and I wouldn’t miss the opportunity to meet up with all of them, even if it meant slogging through some OCD crap.

As I’ve mentioned in the past, travel has been particularly difficult. My trip over the Holidays to London took me 18+ cumulative hours to pack and prepare for. Then whilst (see what I did there😉) I was in London I struggled with a major upswing in obsessive-compulsive behaviors. I brought home a ton of OCD baggage and literally did not completely unpack my baggage (both emotional and actual baggage) until about two weeks ago. That’s six months to completely unpack my bags!

There are a few reasons travel has been difficult. First, it interrupts my OCD routines and rituals. Some of those rituals are difficult to take across the world with me. Second, there is risk in traveling that my OCD has difficulty tolerating. At home my OCD knows where I can go to get the things it needs to function. But in other parts of the world stores, supplies, and foods are all different from what my OCD is used to. Will I be able to get cleaning wipes that allow me to clean my hands the way OCD wants me to? Will I be able to get the foods OCD wants me to eat? I also have a pattern of picking up new OCD baggage on trips. Almost every trip over the last three years I’ve come home with either a new obsession or a new or solidified compulsive behavior. Lastly, I think that the safety learning that I’ve accomplished so far in therapy is relatively confined to my everyday environment (my apartment, my neighborhood, and my city). It hasn’t yet been universally learned and doesn’t necessarily apply in new places like Utah (if that makes any sense).

So, this trip to Utah I was a little nervous, even though I’ve done a lot of work on OCD in the last few months and made a lot of progress. I’m happy to say that packing wasn’t nearly as strenuous. It only took me about two hours. Getting out of the house to the airport was a little tricky though. There were a handful of triggers as I was trying to leave and I couldn’t get the hand cleaning ritual “right.” This added approximately 45 minutes and I ended up getting to my gate at the airport about ten minutes before they closed it.

Once in Utah I was still a little on edge and there were several OCD triggers encountered. Because I was out at the conference and visiting friends for most of the day without the ability to ritualize, there was a surge of compulsive activity in the evenings when I got back to the friend’s house where I was staying. But, I think just being able to travel in the first place was a win so I wasn’t too discouraged.

While in Utah I was able to open up to a couple friends about my OCD struggles. I had a really deep and meaningful conversation with one of my college roommates. His wife has battled eating disorders for 15+ years of marriage and it was interesting to compare experiences. I found his experience with his wife to be very similar to my own experience. She is very much engaged in compulsive behaviors that bring her relief from anxiety and allow her to feel in control. Is what we experience really that different from any other person with addictive or compulsive tendencies? We talked about struggles with insurance, intensive treatment programs, and the challenges of mental health care. It was a great chance to talk and connect in a meaningful way. I was also able to open up to another friend over dinner and again make meaningful connection. These conversations also allowed me to find more self acceptance through the acceptance of others and it helped me realize the value in telling my story.

… I’ll follow up with additional posts about the general progress of treatment and the transition back to work.

Cataloging compulsive and avoidance behaviors – part 1

Cataloguing all of my compulsive and avoidance behaviors will be important because I will eventually need to do exposure to each one of these things. You can think of these compulsive and avoidance behaviors as the “rules” of my OCD, and they need to be broken in order to take back control. I’ve been working on the big stuff in my sessions with Dr. Osborne, but there is also a bunch of little stuff that I haven’t focused on that takes up just about as much time and energy when all combined together. I keep sitting down to record these compulsive and avoidance behaviors in a blog post, but every time I do I get overwhelmed. I think there is too much to record in a single blog post; too many nuanced details I feel like I need to explain. So, what I have decided to do instead is write a series of posts and elaborate on just a few of these behaviors at a time.

So, here goes. Here is Cataloging compulsive and avoidance behaviors – part 1.

  • Exponents of three. There are several behaviors I need to complete in exponents of three, meaning I need to complete them three times to make them feel like they’re done correctly. If it doesn’t feel right on the third time, I need to do it six more times so I’ve done it a total of nine times. If it doesn’t feel right on the ninth try, I have to do it eighteen more times for a total of twenty-seven. After that I usually give up (in the future I’ll indicate behaviors where this exponent rule applies by marking them “(x3)”).

The following are all behaviors that are part of my coming home routine.

  • Backing into my parking spot at my apartment (x3): car must be parallel to parking line, the ring formed by the back-up light must fall between two spots on concrete wall behind me. If I don’t succeed, I need to pull out of the parking spot and reattempt (x3)
  • Getting out of my car: the parking brake must be engaged first, then the steering wheel straightened so that it is perfectly centered, then I shift from first gear into second and back into first again (x3) to ensure the car is in first gear while parked, then I turn off the car and remove the key, then I ensure the lights are off by looking at the headlight knob to confirm it is in the off position and repeat to my self the word “off” three times (x3), I get out of the car and then lock the door manually (x3)
  • Checking the mail: key must be inserted into the keyhole in the mailbox perfectly (x3), and door of mailbox must be opened without any of the keys touching any part of the mailbox (if the keys hits any part of the exterior of the mailbox then I have to go get a cleaning wipe and clean that spot because the default for the keys is that they are contaminated and the keys have just contaminated that spot), I must retrieve the mail without touching any part of the interior of the mailbox (if I do, cleaning wipe), then I shut the mailbox and it must shut solidly without rattling (x3), I turn the key and it must not be concurrent with any sudden noises like a car driving (x3), removing the key has the same rule as turning the key but it also must be a smooth removal without the key sticking (x3), then I must stay and look at the mailbox while I count to nine before moving on
  • Entering my building: similar to the mailbox the key must be inserted smoothly into the keyhole in the front door without touching any other part of the door handle or… cleaning wipes (x3), the door is pulled open with the key and key only (x3), if I touch any part of the door with my hand I must clean that spot with cleaning wipes, the key must be removed smoothly without sticking at all (x3), then I must step in the door without the door touching me at all
  • Riding the elevator: there are spots in the elevator lobby (if you can call it that) where I’m not allowed to step, when I press the button to call the elevator I must press in the center of the button and depress it without the button listing to one side or the other (x3), the door must open and close in exponents of three, I step in the elevator and press the button for my floor (there are also spots in the elevator where OCD says I’m not allowed to step), I must have my eyes shut while the door closes and I must keep them shut for the entire ride to my floor, I must not move at all while the elevator is moving (not even a finger), I must keep my eyes shut and not move until the door opens on my floor, then I can step out
  • Entering my apartment: shoes must be removed outside the front door (there are a few pair that have accumulated there, see Unblock Me! post), my hands cannot pass between my line of sight and the shoes that are outside the front door (if they do, my hands get contaminated with whatever contamination is on the shoe) so I keep my hands high at eye level while reaching for the door, once I slide my feet out of my shoes I must not step anywhere outside my apartment, I can only step my socked foot inside the opened door on the interior floor of my apartment

Can you begin to see why these routine things are taking so much time? I would also note that when other people are around I will most likely break these rules because I don’t want to be embarrassed or look like a crazy person. If any of these rituals is interrupted by another person, I will often go back as soon as that person is gone so that I can complete the ritual correctly.

Two weeks = progress

It’s now been two weeks since I went on leave from work. What have I done with that time? Here are the things I’ve accomplished so far. (Some of these things may seem small to an outside observer, but let me assure you that these have all been monumental for me and represent substantial efforts to take back control from OCD. Most of these were not easy and involved elements of exposure.)

  1. Daily exposures to triggering words. This literally involves writing or typing the words (as well as variations of the words) over and over again and again. I typically do this from ten to twenty minutes a day. Then I read the words out loud while recording myself. Then I listen to the recordings. In the last two weeks Dr. Osborne and I have covered eighteen words. These are all words that have caused me in the past to engage in OCD rituals. The goal from here on out is to not engage in OCD rituals when I come across these words in real life.
  2. Developed a couple more exposure scripts. See Live from EBT post from May 8. This is similar to the word exposure where I record the scripts and then listen to them over and over again.
  3. Almost completely stopped washing my hands in the sink (but replaced with something else). This has been a huge step on taking back some of the time that OCD was wasting. Hand washing has been my primary compulsive and ritualistic behavior and has eaten up so much time, energy, and emotion (sometimes a single hand washing episode could last as long as thirty minutes). It had to stop. So, I forced it by replacing the sink hand washing with decontamination via hand wipes. It’s still a compulsive and ritualistic behavior, but it takes far less time and energy and Dr. Osborne agrees it is a step in the right direction.
  4. Started wearing the new clothes I recently bought. I’ve mentioned that shopping is difficult because things get contaminated especially easily. This is probably mostly because I have conditioned myself to be extra sensitive when I go shopping and I come across triggers that contaminate stuff before I even get it home from the store or out of the bag to use it (a reminder that “contamination” for me means that objects get negatively associated with other unwanted or obsessive thoughts). I’ve needed new clothes for a while and I finally was able to buy some and start wearing them.
  5. Cleaned and replaced the rug on my kitchen floor. This was also a big step for me. About a month or two ago, when work was at its peak and taking all my mental capacity, I had left a single grocery bag on the kitchen floor for several days. Most of the things in the bag were non perishable so I didn’t really think about. Besides, I had my work project to worry about and finish up. Well, in the bottom of the bag was a half-gallon carton of milk. I discovered one day by stepping on a soaking wet rug that the milk had spoiled and burst the container. (Yes! Gross!) I wadded up the rug and put it in the corner because I didn’t want to deal with it and I still had my project to finish up. I knew to get the rug clean would involve a fair amount of OCD compulsive behaviors. This was sort of a catalyst and the starting point of a lot of the messes in my kitchen. This is when more and more grocery and garbage bags started piling up.
  6. Unloaded and disposed of six+ bags of groceries that had accumulated on the floor of my kitchen. See above. It’s such a relief to have these out of the way.
  7. Cleared out and disposed of five+ large bags of trash that had accumulated in my apartment. OCD was making it difficult to get the trash bags out of the apartment (see Unblock Me post from a few days ago). But, with some effort I was able to get rid of them. It was also such a relief to get them out of the apartment. The goal from here on out is to immediately take out the trash and not let any more accumulate.
  8. Went running for the first time in months. There are many OCD barriers to running. The beautiful weather we’ve been having in Seattle has motivated me to break through these barriers and I have now been on two runs. It felt great to get out and exercise in this way once again. I’ve missed this.
  9. Started image exposures. My OCD brain has catalogued a bunch of disturbing images that I’ve seen mostly in movies or on tv. These images surface frequently. When they surface they make me feel “contaminated” and cause me to engage in compulsive behaviors. This week we started exposing to some of these images. There are two levels of exposure we’ve been working on. First is imaginal exposure where I recall or replay the image in my mind and then describe out loud to Dr. Osborne the image in my head. I then repeat this several times with the same image. The next level of exposure is to actually watch or look at the image over and over again. We picked two scenes from a tv show available on Netflix and started watching them over and over. I watched each of these scenes ten times yesterday and ten times today. Today we picked a third image and my homework is to begin exposure to it.

The good news is I can already feel a shift in how I am responding to obsessive thoughts and it has confirmed to me that taking time off of work to focus on treatment was the right choice for me. This is only the beginning, though, and I have a lot of work still ahead of me.

Hello old friend

So, here’s a compulsive behavior that I thought had gone away but came back today…

Picking up trash.

I walked to the gym today. On the walk home I noticed an empty water bottle in the grass between the sidewalk and the curb. My immediate impulse was to pick it up and dispose of it properly in a recycle or trash bin. I caught myself, though, and recognized the impulse as OCD. In the moment I resisted.

However, during the rest of the walk home, the nagging voice that said “go back and pick up the bottle” just kept getting louder and louder. I pictured myself back in my apartment later in the evening being bothered by the image of the bottle back in the grass. Still, I resisted.

After a quick stop at my apartment, I hopped in my car to run an errand. On the drive home, I again pictured myself sitting at home being bothered by the water bottle. “You know what?” my OCD said to me. “You can guarantee the water bottle won’t bother you, and you know how!” So, I drove three blocks past my apartment to where I had seen the water bottle, pulled over, jumped out of the car, and picked it up. After the water bottle I also collected a piece of styrofoam, a blue ribbon, a scrap piece of paper, a napkin, and a cigarette butt, all in the five yards between the water bottle and my car. Then on the brief drive back to my apartment, I stopped the car once to pick up another napkin that caught my eye and a plastic gift card. Hmmm… quite the little collection.

What did I do with all of them? I threw them in my own trash when I got back inside my apartment.

… but hey, I’m not gonna be bothered by the water bottle now. Certainty! Yay! :/