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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Treatment progress… in pictures

The following are “before” and “after” photos showing what life has been like for the last eight months under the control of OCD (before), and how life has changed since I entered the intensive treatment program (after).

To fully appreciate these pictures you have to realize a few things:

  1. The “before” photos literally show what my apartment was like for approximately eight months. Most of the clutter you see did not move during that time. The pillows on the couch, the bags on the floor, etc. all stayed in roughly the same spot.
  2. All the clutter you see in the “before” photos represents OCD land mines. OCD had marked each item as off limits. It was all contaminated and OCD told me I wasn’t allowed to move it, touch it, or sometimes even look at it. Imagine trying to live in a space like this where you have to dance around everything just to achieve basic functionality.
  3. The “after” conditions were only fully achieved in the last two weeks, and I’ve been able to maintain this condition since.

Before (shoes blocking my entry)…

After (clear entry)…

Before (chapped hands from excessive hand washing)…

After (healthy supple hands!)…

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After…

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After…

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After…

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After…

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.

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.