Exhausted

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.

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Extreme OCD Camp

So, I knew about this BBC special called Extreme OCD Camp a while ago and looked for it once but couldn’t find it. I finally found it yesterday and watched it. It’s particularly intriguing to me for a handful of reasons.

  1. OCD. It gives a real visceral sense of the OCD experience, and gives you a sense of what exposure therapy is really like. This is similar to what I am going through (minus the ropes course and camping).
  2. British people!! I have British connections… or rather American connections living in Britain (both my partner and brother live in London).
  3. Bainbridge Island. I was surprised to learn upon finally watching that the camp starts and ends at IslandWood, a camp on Bainbridge Island. My hometown. The camp is literally within five miles of the house in which I grew up. Oh, the irony!
  4. The time period. This was filmed right about the same time as some traumatic experiences that were formative in the development of my OCD.
  5. My therapist. Dr. Osborne is featured in the special. He’s the shorter one with glasses.

Part 1 (the quality of this video is so-so for the most part, and there appears to be a couple gaps where some of the original is omitted. The audio cuts out for a bit in the middle at one of the most interesting parts)

https://m.youtube.com/watch?v=zAXjq28Wpyk&t=1192s

Part 2

https://m.youtube.com/watch?v=ywMsMjGF_nw&t=353s

I can relate to each person in this documentary, but mostly to Jack. His fear of spreading contamination, needing to wash his hands, and using plastic utensils to eat his food. I can relate to Imogen and the very first teeny step she takes in her first exposure session and how difficult that was. I can relate to Josh feeling an overwhelming urge to step on the line with his right foot.

My favorite exchange, though, is between Pete, the leader of the camp, and Ben, a member of the kitchen staff.

Pete: “What’s something that you’re terrified of?”

Ben: “…bears…”

Pete: “If you were to walk into a cage with a bear…”

Ben: “I wouldn’t walk into a cage with a bear.”

Pete: “Okay, that’s exactly the same mental process that Jack is about to take when he takes a drink out of this thing.”

This is the therapy we’re going through to treat our OCD. We climb into the cage with the bear and then we sit there and engage with the possibility that the bear may eat us. I hope that non-OCD sufferers can appreciate that.

IOP – jumping out of an airplane

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.

Productive sucking… because, screw you OCD!

Ok, today’s IOP went really well. Dr. Coco and Ashley were fantastic. We were able to openly talk and learn from the last session, make additional progress, and hit some milestones, and I have some very specific takeaways from the session.

The first thing that really helped to put me at ease (aside from the friendly and gentle demeanor of my visitors) was a little get-to-know-you conversation. After all, this was not only the first time having them in my house, but also the first time I had actually met both of them. Both Dr. Coco and Ashley gave me a bit of personal history, which I really appreciated. It helped me to see them as real people rather than just clinicians here to run me through exercises. Ashley and I bonded over experiences traveling to India. Then I was able to tell them a bit of my story.

They then summarized their understanding of how my OCD operates, which was on point, and the work that I have done so far. They summarized their understanding of what happened in the last session and then we planned together what to do today to move forward. We decided it was a good idea to repeat some of the exercises from last session to reinforce the safety learning.

One of the exercises involved simply walking by and being in a space in my apartment that OCD had made off limits. As I did this we listened to uncertainty scripts. Almost immediately there were two small-to-medium triggers. The first was that Ashley set my phone down on my table in a spot that was “contaminated” and I asked her if she could not put the phone there. Dr. Coco did an excellent job of seizing that opportunity to dig a little deeper and we were able to, in that moment, change course and do immediate exposure to that trigger. We were able to take address it rather quickly and it diverted us for less than five minutes. When I went back to the other exercise, there was another trigger where I stepped on a crumb on the carpet unexpectedly. I think Dr. Coco’s response to the first trigger gave me permission to talk about the second one and work through it in real time. I was able to verbalize my fears in the moment and analyze and talk through my choices for responding to the trigger and the reasons for responding in different ways. I noticed that when I have an OCD response to a trigger that pushing through and taking the next step is often the most difficult part. Stepping on the crumb set off my OCD alarms, and literally taking that next step without doing anything about it was the hardest part. As I slowly began to take baby steps it really did get progressively easier and OCD slowly relinquished. It was slow and it still hasn’t totally gone away. But it happened. So that’s takeaway number one: the first step is often the most difficult.

Takeaway number two was that social interaction and laughter really help to ease the tension. Throughout the session we were chatting and laughing and it helped me to tolerate the discomfort of the exposure. I think the ultimate goal of exposure is to experience the discomfort that comes with uncertainty, but laughter in this case helped to sweeten and ease the experience (thinking of Hannah Gadsby’s Nanette special right now). It’s also helpful as a tool to help break through into new territory.

Takeaway number three was to harness the emotions that will empower me to fight back against OCD. Dr. Coco again did an excellent job of coaching me through this. In the moments of exposure where my impulse was to ritualize, she would ask me what reasons there were for not ritualizing. The main reasons of course are because OCD has taken over my life and to fight back against OCD and reclaim what OCD has taken away. “What reason do you have not to engage in ritual?” Dr. Coco would ask. “Because, screw you OCD.” Dr. Coco mentioned another client who says that both OCD and exposure therapy suck, but that you might as well do the kind of sucking that is productive. So, I will try to do the productive kind of sucking.

Dr. Coco had to leave, but Ashley was able to stick around for an extra 90 minutes. We used that time to achieve another milestone: cooking a meal in my kitchen. We cooked ravioli with marinara, a meal that didn’t actually require me to touch the food with my hands (that will be future exposure). Then we ate the raviolis out of my bowls using real utensils, and then cleaned all the dishes and loaded them into the dishwasher. It’s been five or six months since I cooked a meal and used my dishes. So… win!

So, I wrapped up today with a boost in confidence and feeling like we accomplished a lot.

Processing my latest IOP

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.

First day of IOP

I started IOP!!!

Yesterday was my first day. It was a 2.5 hour session at the clinic. The first 30 minutes was just filling out paperwork. Then I spent about 45 minutes with both Dr. Osborne and the director of the IOP program, Dr. Tininenko, talking about goals for the week. It looks like every Monday will be an in-office session like this to review progress and establish goals for the following week.

My goals for this week?

  • Get my kitchen functional again.
  • Use my regular dishes and silverware again.
  • Cook a meal in my kitchen and clean up afterward.
  • Develop and work on exposure scripts for contamination obsessions.
  • Various other exposure exercises.

Then I had just over an hour to do some exposure work with Dr. Osborne. This was interrupted by a brief visit by one of the other clinicians I’ll be working with, Dr. Ravid, who came by to introduce himself and observe one of our exposure exercises. Dr. Osborne and I were then able to bang out exposure to a bunch of new words.

The rest of the week will be sessions in my apartment. Today Dr. Osborne will be spending 2.5 hours with me. Tomorrow I will have 2 hours with Dr. Ravid. Thursday will be 2 hours with Dr. Tininenko. Then Friday will be 2.5 hours with the final clinician on my team, Dr. Coco, and Ashley who is an intern from the University of Washington. Ashley will be sticking around another 1.5 hours to do additional exposure work.

One last note on the IOP… my insurance company has only agreed to pay for two weeks of treatment. At the end of the two weeks they want to re-evaluate to determine progress. This will likely be the pattern until I am either done with the treatment or the insurance company decides to stop paying for treatment. So, we’re really trying to figure out how to get the most out of these next two weeks in case they decide they won’t pay for any more. Worst case, I get two free weeks of covered treatment. Best case, they cover the whole program.

Milestone – somebody else in my apartment

Today I had somebody besides myself in my apartment for the first time in six months. Dr. Osborne came and did an in-home assessment and session.

This is a big deal for me.

I stopped having people in my apartment mostly because other people don’t know the rules of my OCD. I’ve been fearful that inviting other people into my home would stir the OCD waters and make what is already a difficult environment to navigate even worse. I know how to keep the “contamination” contained for the most part (or at least I know what is contaminated and what is not), but other people don’t.

Luckily, with Dr. Osborne, he understands how OCD works and I was able to get assurance from him before his visit that he would be careful and follow my instructions on where he could stand, where he could sit, and what he could touch. Before he arrived I placed sticky notes all around marking areas that have been contaminated so he would know how to maneuver through my apartment.

Another reason I stopped having people in my apartment is because I’ve been embarrassed about how messy it is. I like a clean and clutter free home, and OCD isn’t allowing that at the moment.

The mess was not an issue for Dr. Osborne. He also works with hoarders and he assured me ahead of time that whatever the state of my apartment, he had seen worse.

The visit went well. Having him in my home did exactly what I hoped it would do: it gave me a chance to show him all the OCD stuff that we’re not getting to in our in-office sessions, it gave him an opportunity to model how to do exposure work in my apartment, and it gave me permission to push the boundaries on some things in my apartment that have been “off limits.” On the third point, I’ve noticed that in my sessions with Dr. Osborne that when we discuss and do exposure to things that have been “off limits,” it’s almost as if discussing them with Dr. Osborne gives me permission to stop avoiding them. It’s like the OCD switch gets significantly dimmed, and while I still have an OCD reaction to the thing, it’s much less severe than it was before. This was the case with some of the exposure work we did today. Before, if I had tried to do this exposure work on my own, my SUDs would probably have been around a 6, but with Dr. Osborne there it dropped into the 2 to 3 range.

I’m looking forward to more in-home sessions. Luckily I’ll be getting much more of them once I start IOP.