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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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.

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.

More IOP processing

Alright, another day and more emotions to process from yesterday’s IOP. Here’s what I’ve been feeling.

  • First of all, I have felt physically drained and mentally weak since the session. Consequently, I haven’t done much exposure work on my own.
  • My OCD is saying “I told you so! I knew this would happen if you let other people into your apartment! You can’t trust any more people to be in your apartment.”
  • Speaking of trust… if I’m being totally honest about how I’m feeling, I think I lost a little bit of trust in my IOP team. Maybe this is just my OCD or some other part of me trying to place blame. But there are voices telling me that Dr. Tininenko should have been more sensitive and known not to use the triggering word. After all, it is a word I’ve made clear is highly anxiety inducing. There’s also a voice telling me that the IOP team should have communicated more clearly with each other about my current tolerance level for the word.
  • But there is also a voice that is berating myself and saying that I should have been more clear about my tolerance levels. I’m responsible for the way I responded and I should have had more control.

This is what my feeling brain has been telling me.

My thinking brain, on the other hand, is telling me that this was not intentional and that my IOP team has my best interests in mind. They are doing what they can to help me. They’re imperfect people who make mistakes, but they are kind and compassionate. What happened is in the past and can’t be changed. All we can do is learn from it and move forward.

(Sometimes I wish my feeling and thinking brains would just get on the same page already!)

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.