Exposures for the Week

I'm thinking about two scary exposures this week, and I thought putting them in writing might help. Both on Wednesday, both involving shoes.

One, I'm attending a training in a Federal building, where they make you remove your shoes to talk through the metal detector. And the same day, I have a bowling social event, with rented bowling shoes. It looks silly even to me, but they're both making me nervous even two days ahead of time.

A good practice for the mindfulness as well.

Sitting With the Anxiety

While I've been doing well with exposure, I know part of the reason is that many of my exposures, while they're scary in theory, don't actually cause me much anxiety once I've done them. Like going to the pharmacy, or letting my towel touch the floor. And those that are truly anxiety producing, well I often seem to find some reason to put those off.

My therapist has been pointing out for this process to really work, I have to be willing to accept uncertainty, and to sit with anxiety.

Ooh, it's hard! While I probably should have visited my aunt this weekend, and didn't, I did see my mom, which I hadn't planned to do. Usually I take a shower before I see my family, so I don't "contaminate" them. Today I didn't. And after I saw her, I felt really uncomfortable for a couple of hours, feeling like I'd sent her back home with some germs that she would share with my aunt.

I still feel a little anxious (it's been about 4 hours now), but it's definitely going down.

So I guess I get to remember, if I'm not really scared, I'm not doing it right.

A Goal for the Future

Today my boss reminded me that she wants me to attend a training in Atlanta in June of next year. I was hoping she'd forget (and slightly resentful that she didn't approve my request to go to this year's training in Seattle, a mere car ride away). I haven't flown since 2006. I'm not great with change, or leaving my house for a week, or flying, or hotels, or airport bathrooms. So that's going to be fun! But at least I have a while to get used to the idea, and to get better at dealing with exposures.

A Happy Week

Photo credit:

http://www.flickr.com/photos/carbonnyc/ / CC BY 2.0

I have been in an almost weirdly good mood this week (not that good, just unexpected). I'm not completely sure where it's come from, but I think it's related to making some really good progress on decluttering my house, and keeping the parts that I got clean for my guests spic and span for almost three weeks now. That's not like me.

I've found a really interesting support group online (note to self: must consider the growing percentage of my social life that's online) that's helping motivate me. I may write more on that later. It's all been part of consideration of whether I'm a "hoarder," so it does have OCD links.

Whatever the cause, it's a welcome change; I wish I could remember this when my mood swings the other direction.

On the exposure front, I've had a great couple of days. Didn't take a shower last night after a lot of grubby cleaning, and have been feeling pretty mellow at work, even as everyone around me sneezes the days away.

The Internet- Friend or Foe?

Most of the time, I love the internet, and it's been helpful for my OCD in a number of ways.

I post occasionally at both the yahoo-groups OCD support site and stuckinadoorway.org. On both sites, people are pretty good at providing support and advice, but not reassurance.

I found my therapist at the OCF website.

And of course there's this blog.

But I think most people with OCD also know that the internet can enable "reassurance seeking." I often look up dreadful diseases that I'm just sure I've been exposed to. But just reading one website is never enough, and the reassurance never reassures for long.

This week, one of my main "response preventions" is to avoid searching on the internet when I'm feeling anxious about something. Right now, while I'm not worried about anything in particular, it sounds really doable. We shall see.

More Faulty Thinking

Last week, my therapist pointed out that when I'm talking about an OCD fear, I often misrepresent the facts. The other day she asked me why I felt the shoes I was wearing were contaminated, and I said, "well, there was the whole walking in the vomit incident." She had to point out that I hadn't actually walked in vomit, but rather next to vomit, before I even noticed that I'd misspoken. It's not a case of lying, and I know objectively that I didn't step in vomit (sorry for repeating that vile phrase so many times!), but my brain still completes that connection as though I did.

I did a similar thing today. I was thinking that my headline today would be "Swine Flu in my Workplace" until I remembered that it isn't. I unfortunately sit next to the three health and safety staffers at work. People are always coming by with some horrible hazard or speculative scenario to share, as though I need to be provided with any more. Today it was to report that the wife of one of my coworkers is a doctor who recently treated a known swine flu patient. She has now developed symptoms herself and they were trying to decide if our coworker should stay home preemptively (which even paranoid me thought was a little much).

Chances are pretty good that swine flu will hit my office in the next several months. Maybe it already has. In my head, though, Joel was already sick and ready to sneeze on me at any moment. I'm happy to report that while I did a fair amount of freaking out today over this concept, I did not resort to a flurry of handwashing. So at least there's that.

Steps in the Right Direction?

Lately I've been on a very "one step forward, two steps back" system with my exposure. I've been making myself visit my aunt, despite fears that I'll mess up her cancer treatment, but I've been practically dipping my whole body in disinfectant before I go.

Her chemo is just about over, so I'll have no excuse at all to avoid a whole bunch of exposures. So that's good, and of course it will be awesome for her, too.

The rest of my family has been trying to help me out. We're not really a hugging family, but every time I visit my parents (which is most weekends), they give me huge exaggerated hugs, so that all our germs get all mixed together (by my theory anyway). Sometimes it's terrible that the rest of my family is so non-OCD, but often it's great, because they can help me see the humor in some of this.

I guess this post doesn't really have a point, mostly just marking a line in the sand to start up the next phase of exposure, post chemo worry.

Making the Right Choice

Today I came thisclose to calling in sick because I couldn't decide what pair of shoes to wear to work. It was a convoluted issue, involving feeling like the bottom of my shoes are contaminated, the car, and a trip to my aunt's house this weekend.

In the end, I made the right choice, picked a pair of shoes, and headed out to work. In the middle of the day, I realized that my shoes really looked horrible with my outfit. Oh, well, at least I was wearing them.

Hmm, I think my plate is too full

So I've been working on regular old ERP, plus CBT, plus ACT. That is too many acronyms, for sure.

Today I went for a walk, and I was going to do the mindfulness practice of really noticing everything around me. But then I was feeling really anxious, so I thought instead I should re-run through the CBT approach that looks at alternatives to my assumed worst case scenarios.

Then my brain got overwhelmed by the choice, and I did neither. So that was really productive. I think this weekend I need to spend some time thinking about how to focus some of these ideas.

On the plus side, one of the harder exposures for me at work is the darned communal birthday card. There are about 30 people in my department, and for every birthday, we pass around a card. Even without OCD I would hate the card, because almost everyone writes something totally generic. But on the OCD side, I'm in the corner and almost always one of the last to sign, after everyone else has touched it. So I've been working hard to not immediately wash my hands after I sign a work birthday card. Today I literally walked toward the sink (thinking of the guy who's been sneezing all week), stopped, walked back to my desk, and repeated this two or three times. But I didn't wash. Stupid birthday cards.

Rethinking Being Sick

A few days ago, I realized that while I'm moving at a decent clip down my OCD hierarchy, there's one thing I haven't worked on changing yet: the underlying feeling that being sick with a cold or flu would be REALLY bad, and would cause something terrible to happen to me or, more likely, someone else.

So while I'm doing a lot of exposures, and sort of resigning myself to getting sick (although I haven't yet, interestingly enough), I still feel like when I do finally get sick, it'll be awful and lead to a catastrophe of some kind. Which frankly, makes it all the weirder that I'm doing some of these exposures. But it's also keeping me from doing some of the harder ones.

I guess I need to work on a parallel track of non-exposure CBT, retraining my brain to acknowledge that people get sick without it leading to a doomsday scenario. It's a tricky balance, because the goal is NOT to reassure myself that "it will be okay, nothing bad will happen," but instead to take a more realistic view of the risk, all the while knowing that nothing much is certain in this world.

My plate is full!

Mindfulness Practice

Today's mindfulness homework involved taking a walk where I focused only on what I was walking by, and how my body was feeling, rather than thinking about what I would do tomorrow at work, or after I got back home, or what happened yesterday, or ...

After a successful 4 minutes, I thought, "Wow, I'm awesome at this, I'll bet I become a Zen master." Then I promptly thought about what I should make for dinner. It was a great 4 minutes, though.

Another Weapon in the Arsenal

Okay, I usually hate war-related metaphors, but I think OCD might deserve one, thus my title today.

I've been doing much better on exposures this week. But I haven't yet figured out how to deal with some of the underlying anxiety I continue to experience. I pretty much always have something I'm worried about running through the back of my head, usually completely unrelated to my contamination fears. My sister's having a house built, and this week I've been worrying about all the things that could go wrong.

About 6 months ago, I signed up to be part of this study of a self-help workbook that utilizes "Acceptance and Commitment Therapy" or "ACT" to treat anxiety. (The study is now closed, but they are recruiting for a new one.) As the workbook title notes, it stresses mindfulness and acceptance of anxiety.

I've read the book, but I haven't been all that successful at implementing it to date, because I haven't been able (willing?) to focus on completing the exercises in the book. But mindfulness and acceptance seems like a perfect approach to the type of worry I've been dealing with. And recently a friend has been telling me about the success she's been having with lowering her anxiety using meditation, which is closely related. So I'm going to really focus on this approach in the coming weeks and see what happens.

Another OCD Memoir Review

Well, I've read another OCD memoir. I swear it's not a compulsion, I just like them! The latest book was called Washing My Life Away, by a British woman, Ruth Deane. As you might have guessed, she struggled with contamination OCD, as well as checking. She washed her hands 80-100 times a day, and became so scared that she'd be made sick by her food that she basically didn't eat.

She eventually seeks treatment which is mostly unsuccessful, until she checks herself into a psychiatric hospital. While the hospital staff don't seem to know much about OCD, she has a great therapist who does (making it not completely clear if she needed the hospital). In any case, she begins to take Prozac, which she finds makes it possible for her to complete exposure therapy. The timeline of her treatment in the book is not completely clear, but it was written in 2005.

The author is now mostly free of her OCD and works as a counselor. This book was very easy to read at 100 pages, and quite relatable and inspirational. It has a lot less of the "I'm okay now, except when I'm not" that most OCD memoirs have. As always, I would have liked more detail about her therapeutic process, but I still found it an interesting read.

A good OCD day (finally!)

I've been putting off all kinds of exposures lately. I can totally wrap my brain up in knots thinking about doing an exposure and all the reasons I don't want to do them. Today I finally forged on through several. One of my tires has had a slow leak for months. But I didn't want to take it in to be repaired, because I hate having someone else in my car (as they move it into the repair bay).

But today was otherwise a perfect day to do it, so I did. There was a screw in the tire, so it's a good thing I brought it in.

I also picked up a prescription (I tend to avoid all the germy people at the pharmacy) and interacted with some sneezing people at work.

And finally, I stopped at the grocery store and the person in front of me was talking about carpet cleaner and bleach. My brain had a field day with the possibilities on that one, but I didn't freak out. My instinct after a day like that is to come home and take a shower and change my clothes, and I've done neither. I'm feeling anxious, but not ridiculously so, and I'm sure I'll feel less so as the night goes on.

I wish my progress felt steadier, but I guess if it were that easy, I'd have done it long ago.

Do You Think I Could Afford This?

Today I was thinking that it would be awesome if I could take my therapist with me everywhere.

She does an amazing job of encouraging me to complete my exposures. Things I would swear I'd never do, well, I do them.

Yesterday my sister and I went out for my sister's birthday. I had planned on taking a shower beforehand, and changing out of a pair of shoes that I considered "contaminated" after an unfortunate recent encounter (at a distance) with vomit. But right before this, I had my weekly therapy appointment.

Ultimately I went over to my sister's without taking a shower, and I wore my "dirty" shoes. I was a little uncomfortable inside my sister's house in my shoes, but I did okay. I also didn't wash my hands at all during an evening that included dinner out.

So, if I had my therapist around to say, "Do it, do it!" I think I'd progress faster. I guess I'd also be broke! I'll just have to remember her voice in my head.

My House is Clean!

A fabulous "side effect" of my dinner guests exposure was that I cleaned my house. It looks better than it has in about a year. Hopefully I can keep it that way- it doesn't come naturally.

I've been watching A&E's Obsessed show over the last few months. They've featured a lot of hoarders. I've sometimes wondered if I had slight hoarding tendencies. But I don't seem to have much of the emotional attachment that the hoarders on Obsessed have to their stuff; I think I'm just messy.

Still in something of a holding pattern on moving my exposures forward.

Made It Through the Weekend

My Saturday dinner got postponed till Sunday (not by me), but that was good as it gave me extra time to prepare. Everything went okay, but I always overanalyze. That's probably not a surprise. I'm terrible at making big meals. It always takes longer than I think, and I'm never quite ready when my guests arrive and it stresses me out. You'd think I would adjust for it, but I never do.

So I wasn't able to serve the raw carrots as part of an appetizer as planned, because I ran out of time. I should have prepared them way ahead, but of course I didn't. But it wasn't avoidance, it was just lack of organization, so I don't feel too bad about it.

Anyway, while everything was basically okay, and I'm glad I did it, I also don't have any "woo-hoo, that was awesome" feeling going on either. Oh, well. One step at a time.

I'm Not Responsible

Like most people with OCD, I have an extremely heightened sense of responsibility. I worry that other people will be sad or disappointed, or I worry that they'll be harmed by something I perceive to be my fault. It could be as simple as inviting someone out to a movie. What if they have an accident on the way? They wouldn't have been there if I hadn't invited them. This has been complicated by having an aunt undergoing chemotherapy, as she actually is more susceptible to illness.

Twice recently, in situations when I would normally spend a lot of time ruminating about leading someone into harm's way, I've been able to take and actually believe a more rational view: my friends and (most of) my family are adults, and they can make their own decisions, and are responsible for their own actions. It's quite liberating, saves a lot of time, and I hope I can do more of it.

It's so easy to cheat

I'd been doing great on exposures lately until this week. Because I'm so focused on my upcoming eventful weekend, with some really big exposures, I've been giving myself permission to avoid things that I feel might make me sick before the weekend (for instance driving to work instead of riding the bus full of people). So I'm trying to spend the next few days NOT doing that.

I'd been having trouble touching the bathroom floor after my initial attempt. My therapist suggested scheduling it into my day so I won't "forget," so I've done that and it seems to be working. The funny/stupid thing about the bathroom floor is that my cats go in there all the time. And my cats also sit on my lap all the time. So I suppose I'm already exposed every day. But it's "different," you know. OCD brain.

I also promised my therapist that I'd serve my dinner guests at least one uncooked food, all the more likely to food-poison them. That seemed impossible when we first talked about it, but now I think I can do it.

Happiness?

I have a good friend with bipolar disorder, and we talk "mental health" a lot. Yesterday we had a conversation about happiness. As in, neither one of us feels a lot of it. So much of our energy goes into making it through the day, and it's exhausting. But of course, we can never really gauge how much happiness other people experience as a comparison. I know in my pre-OCD days, in high school, I had a lot more fun in my life. But again, I had almost no responsibilities in high school, and a lot more time for fun.

In any case, while I have some small moments of pleasure in the course of any given day, mostly I feel like I'm just surviving. Sometimes it makes me think this is a sign that I should be reconsidering medication, but I'm not quite ready to go there. But I feel like a good measure of how well ERP is working in the long run, is whether it can shift me from surviving to living a more fulfilling life.

What Have I Done?

Well, I've got those friends coming to dinner on Saturday. And now somehow that same day, I'm lined up to go eat at an Indian buffet for lunch. Best day ever! (that was sarcasm). Sometimes my desire for exposure gets a little ahead of itself. This is one of those days. Goal for the week: not spend every free moment imagining the horrible things that could befall me after eating at an Indian buffet.

Today's exposure

This week I'm supposed to 1) just rinse my hands (if that) before preparing food and 2) stick my fingers in foods that will then go back in the fridge or cupboard, rather than only feeling comfortable touching foods that will be completely consumed at the current meal. Boy am I finding it difficult. I did touch the tortillas that were left in the package today. When I can stick my finger in the sour cream, I'll know I've really made it.

I realized a few weeks ago that it's been months since I invited anyone over to my house (other than the briefest of stops), so I invited some friends for dinner Saturday. This also means preparing food for others, which is also extremely hard for me. It's going to be an interesting week!

OCD Book Review

(Sorry this is so long!) When I was first diagnosed with OCD, I read a bunch of books about OCD- mostly self help books. There are a lot of goods ones out there, and one of these days I'll do a run down of my favorites. More recently, I'm really drawn to memoirs and accounts of people with OCD. I'm mostly looking for success stories, as inspiration. Generally I've been disappointed by most memoirs I've read. One, because few people are as recovered as I'd hope, and two, because it's hard to convey how frightening the process of fighting OCD can be, and so the books never completely resonate with my own experience of OCD.

Earlier this year, the book Life in Rewind was released to a decent amount of fanfare in the OCD community. I understood it to be the story of an amazing therapeutic relationship between Ed Zine, a man completely and utterly disabled by his OCD, and Michael Jenike, a well-known psychiatrist who specializes in OCD. And it sort of is. In the late 1990s, Ed basically didn't leave his basement for a year, and didn't bathe once during that time. By the end of the book, he's out of the basement and is married with two children. So his transformation is pretty amazing.

But in truth, Ed was not that interested in Cognitive Behaviorial Therapy. Ultimately he sort of does his own Exposure and Response Prevention, but in the end, he still has some pretty elaborate rituals, which those around him continue to enable. Here's a quote from near the end: "Ed struggles not to let his guard down, as he tries to capture every one of his rewinding routines, while still engaging in the real world... If he gets behind, he will get overwhelmed trying to catch up and then get locked down." Another: "At the same time, there is more punishment, and Ed must still repeat sentences backward, countless number of times... But Ed cannot physically speak to tell the person that he is actually in the moment doing his reversing protocol in his head." I'm left with the impression that he still spends every waking hour trying to be sure he's done everything "right" and performing hours of rituals in his head if he hasn't. It sounds exhausting, and it sounds like pretty severe OCD.

Thus, I was somewhat frustrated by the book for a couple of reasons. As a biography, it's quite interesting, but I don't think it will all that helpful in convincing others to seek out treatment, since Ed never really does. And I would imagine that only a very very few people with OCD would be able to do as much as he does on his own. Of course, books on OCD shouldn't only exist to convince people to seek treatment, but I still think it's a great side effect. Also, Ed's attitude even at the end of the book left me feeling like he didn't think he really had control over his actions when "OCD" tried to make him do something. And I think for most people, the realization that you can take control of your thoughts is pretty important. It's a quick and interesting read, but I have yet to find a truly inspirational OCD memoir. Have you?