Yesterday was a frustrating day and full of mental fatigue. A bunch of triggers were coming up and they seemed to swing back and forth between categories of obsessions. It’s exhausting to have one trigger come up and to be in the mental space of trying to figure out how to do the response prevention part of ERP, and then almost immediately have another trigger come up and have to pivot to try to figure out how to do the same thing for that trigger. And then again and again. It creates a mental fog. Then when something new and unexpected comes up it feels bigger and more difficult.
This is what happened in my session yesterday. I had been pushing back against OCD triggers all day and was in a general state of mental fog. Then in session we were doing an exposure exercise watching video on YouTube and there was an unexpected image in the video that was disturbing to me. In that moment it felt huge. This happened in the last ten minutes of session and I told Dr. Ravid it was going to be difficult to not ritualize when I got home. But I didn’t. I went home. I went to the gym. I met a friend for dinner. I made it all the way through without ritualizing to neutralize the anxiety from the new trigger that came up in session.
It would have been great if I could have ended the day on that note, but later there was another trigger related to a different exposure to something new brought up by my therapist team earlier in the week. Before I knew it I had been through an entire pack of cleaning wipes and then some, attempting to neutralize that trigger. It was so frustrating because I couldn’t get that ritual right. That frustration turned to anger directed at my therapist team for exposing me to things that I was perfectly fine not knowing existed. My ignorance was bliss. But now I had new disturbing images and concepts that were swimming around in my head because of my therapist team.
I do understand that the exposure work we are doing is in the service of taking the power away from my OCD and making me better, but it doesn’t change the fact that it’s frustrating and exhausting.
I have absolutely no desire to ever ever go skydiving. The thought of jumping out of a plane is terrifying to me; the free fall and not knowing for sure whether or not your parachute is going to open. Well, today I jumped out of a plane… metaphorically speaking. I just wrapped up my IOP session with Dr. Ravid and we tackled a doozy.
The IOP team and I have been inching closer and closer to intentionally spreading higher and higher levels of contamination in my apartment. As a reminder, “contamination” for me has nothing to do with germs or disease, but rather has to do with the spread of unwanted thoughts. My OCD links unwanted thoughts to physical objects. There are a handful of words that are highly triggering for my OCD. We have been working on exposure to these words outside of my apartment. That literally involves writing, saying, and listening to the words over and over and over again. We first did this at the clinic. Then when IOP started we did exposure to lower level words in my apartment. Some of the words that are more triggering for my OCD felt too difficult to start in my apartment. So what we did instead was exposure to these words while walking around my neighborhood.
Yesterday we started to bring some of these words into my apartment, but in a controlled way. It was mostly just listening to a recording we had made of the more difficult words. Today with Dr. Ravid we started with some of the same exposure. These words were in the range of 6 to 7 on the SUDs scale (see earlier posts for definition of SUDs scale… or just google it). The plan was to then step down a couple notches on the scale and intentionally spread the contamination of some lower level words in the range of a 4 on the SUDs scale. The way this is done is by touching as much as I can in my apartment while thinking or saying the level 4 words. I spread it around with my feet on the carpet. I rub my hands on my couch and walls. I even contaminate my self with the words by rubbing my hands on the clothing I’m wearing. While doing this I imagine the possibility that these level 4 thoughts could get linked to what I’m touching and that every time I look at them or touch them I will think that uncomfortable thought.
We had just barely started into this exposure work when I was triggered by something that put my SUDs right back up in the 6 to 7 range. My OCD impulse was to wash my hands and decontaminate. But a key component of the type of therapy I’m doing (ERP) is response prevention; that is, refraining from engaging in the compulsive behavior. I knew we were eventually heading to the point of intentionally spreading the 6 and 7 level contamination. Since I knew that was coming and and in that moment I was already feeling in that range, we decided to intentionally spread it. We started in the kitchen and spread it everywhere we could on the floor with our feet. We then moved on to the rest of the house and basically covered every square inch of the floor that we could by rubbing our feet everywhere, all the while imagining that we were spreading that high level contamination.
This was the first time I intentionally spread something that is this high on my list. It felt like jumping out of that airplane not knowing if the parachute is going to open. I got oddly emotional. I was facing one of my biggest fears head on. I was doing the very thing that OCD had tried so desperately to prevent from happening. I was doing it by choice. The tears started to well up halfway through, and when I finished I collapsed on my couch and let the tears flow freely.
I’m still free falling, not knowing if my parachute is going to open, though I have a great group of experienced therapists working with me and jumping in tandem. I’m putting my trust in them and my faith in myself that there will be a safe landing and that I will once again find solid ground beneath my feet.
Today was my third in-home IOP session. Dr. Tininenko and I were able to do some good work. We were able to take back some space that OCD had claimed. We did some good exposure work.
With about twenty minutes left in our session Dr. Tininenko said something that was highly triggering for me. It was not intentional and I know she felt badly for it. We were making little notecards that we could put up around the house with some mid-level anxiety-inducing words written on them (words that for me have SUDs ratings around 5). We had bought some double sided tape to put up the notecards around the house so that I would have constant exposure to them. As Dr. Tininenko was trying to open the tape she said a word that bumped my SUDs up to 8. I felt my heartbeat go up, my legs get a little weak, and a catch in my throat. I immediately asked if I could go to the bathroom because… well, I don’t know why. I think it was my flight response kicking in.
Once in the bathroom, my OCD started telling me a story about what was going to happen. We were going to put the tape on all the cards and in so doing contaminate all the cards with the level 8 word. Then whenever I see those cards I would imagine and think the level 8 word, not the level 5 word that was actually written on the cards. This would dramatically accelerate the spread of the level 8 contamination in my apartment. It was this thought of littering my apartment with the level 8 contamination that caused me to react with such fear. I’m not quite ready for that.
All of this processing happened in a matter of seconds. But, then I thought “why process this alone. Best to be open and honest with the therapist that is here to help me.”
So, I went back out and told Dr. Tininenko what was happening. She had already put the tape on three of the cards (I had hoped to catch her before she had put the tape on any of the cards). We decided it was best to pause right there and not stir the waters any more. Instead we spent the next ten minutes just sitting in the contamination and listening to one of my uncertainty scripts about the possibility of contamination spreading.
Our time was up and Dr. Tininenko had to go. I asked her to take the “contaminated” notecards with her and she did. I knew that if they were left in my apartment that it would lead to much more OCD ritualizing.
As soon as Dr. Tininenko left I was overcome with emotion. I don’t know if it was anger, disappointment, frustration, fear, resentment. Probably a little bit of each. It was overwhelming and I decided I needed a break, so I watched an episode of Queer Eye.
This is the first time I really felt highly triggered in a session in a way that was not intentional. Dr. Osborne has already called to check in and see how I am doing (he’s a keeper, as far as therapists go) and it’s got me thinking about what I can do prevent this from setting me back and instead turn it into something that takes me forward in treatment.