Ashley Posted February 18, 2016 Author Share Posted February 18, 2016 In the past, Flooding was the worst thing I could have done and I got the idea and incentive to do it from an American OCD forum I used to practically live on. That forum held flooding and extreme exposure as the only way forward for recovery. Everything else was considered 'reassurance' or 'avoidance'. Which is guess is a great example of why I started the forum topic, too much focus on ERP rather than CBT. To be fair that's the belief that we had here too for many years in the early days of behavioural therapy (older members will remember the painful elastic band on your wrist to snap when a thought popped in). Thankfully therapy continues to evolve, we continue to learn which is why we now focus on CBT not just BT. I dare say there may be a time when CBT evolves even more and we have another form of therapy that is even more effective, but for now CBT is the best we have and can be helpful. It took me ages to realise that the cognitive side was just as important if not more important than the behavioural side. Only really when I joined OCDUK did I begin to realise than the majority of people who weren't suffering as such had trained themselves to not respond to their intrusive thoughts in the moment or reframed them when not anxious. And I'm still learning about emotions and their relationship with OCD and how to deal with them in a therapeutic way whereas in 'flooding' and exposure mode, I did not listen to my feelings at all and psychologically damaged myself. Good advice can go a long way to helping and bad advice can set you back so much. I'm glad I found this forum. Exactly right, emotions are an often overlooked factor of how we allow our thoughts to become OCD thoughts. And partly on the theme of evolving why the OCD circle image on our website and copies by most other OCD websites is perhaps technically wrong and will be removed from the new website. The diagram below (draft) whilst being a little more complicated is closer to being accurate of an 'OCD circle' and which references the part emotions play on interpretation of the thought. OCD Illustration - Version 3.pdf For those who don't understand what we mean by how our emotions play a part in how we think and feel, I love this great simple analogy I first heard a version of from Dr Victoria Bream a few years ago. ... You live alone in the middle of the countryside. You have had a bad day, problems at work, dumped by boyfriend/partner so already a bit sad and maybe even weepy, and to top that off you have gone to bed after watching a gruesome film on TV. You hear a noise downstairs and you might think 'oh my goodness, someone is breaking in, they are going to come and attack me, there is nobody to protect me and wake upright feeling anxious and on edge'. .... Now lets fast forward a few months, it's summer you are in a great new relationship and feel happy and smiley after a great evening out. You go to bed and hear the same noise midway through the night. But this time you respond differently, you simply roll over and think 'damn cat' or 'it's the wind tapping a tree on the cottage' and fall straight back to happy contented sleep. The point here is the exact same situation can have two completely different interpretations because of the person's mood and emotions at the time. Which of course partly explains why OCD is such a more intense bitch when we are going through stressful times in our life with work/relationships. Link to comment
Ashley Posted February 18, 2016 Author Share Posted February 18, 2016 I think for ERP to be done effectively it needs to be done in a graded way. To use a simple example - for someone with a fear of water/ drowning, the thing not to do is throw them into the sea and say to them 'well it's sink or swim mate'. A first step may me paddling into the sea from the beach until they are visibly anxious and then getting them to stay there and face that initial anxiety. Another great example, one I have used is you use the graded approach by teaching someone to swim by slowly walking them from a swimming pool shallow end towards the deep end, eventually they do have to give the swimming a go. One thing I do have disagreement with is not looking at the cause of OCD and just the current problem. For some people traumatic early childhood experiences or traumas at other stages of life can contribute to the development of OCD (as well as other disorders). Sometimes those affected have never been able to open up to anyone about these experiences because it's been too painful to do so. Just the process of talking through these difficult life events can be cathartic and can give a person an insight into why they've arrived at the point in their lives where they are at, and what has been fuelling their intrusive thoughts and behaviour. This may then help the sufferer engage more effectively with CBT. Generally over the years experience shows us this not to be overly helpful in terms of recovery from OCD. It might be interesting to know where the OCD developed, but for the vast majority of people it is never really known, and when it is it rarely helps a person move forward with tackling the OCD. Obviously past traumatic experiences may need exploring but unless linked to how the OCD is today it should be done separately from OCD treatment. I think it is ok for therapy to delve a little into past experiences (mainly so the therapist understands where the patient is coming from) but it should not usually go beyond part of session one. It should not form part of every session. I remember a story the amazingly lovely Dr Adam Radomsky told at an event last year I think it was. He is Canadian so no NHS over there and he works in a private setting. Somebody in the conference made the point you did Runner and so he went on to tell a little story of how many patients that come to him for treatment do ask a similar question. He always does the same thing he told us, he makes a promise to the patient that for now let him focus on treating the OCD and at the end of therapy we will come back to this question. So off he goes with the therapy which takes however many weeks and when he gets to the point of discharging the patient he makes a point of coming back to the question of cause. What he told us that he has never had anyone take him up on going back to that question, the majority of his patients answer with words along the lines of 'I am better now, I don't care where is came from'. Talking of Adam, good therapy tip... another practice he actions is after around the 8/10 session mark he asks his patients if they want to sack him has their therapist. This gives the patient a way out of therapy if he is not helping them. So if you are paying for therapy and not seeking any progress around the same mark, don't be afraid to tell your therapist and ask them to adjust the way of working or sack them and find another therapist. Link to comment
Running Lover Posted February 18, 2016 Share Posted February 18, 2016 Yes caramoole precisely. You know me. So they say I have ocd use erp as a way to get over it...... That being the case ( ocd" ers) don't act etc etc you know where this is going..... Hold the baby you'll be fine!!! So I hold the baby. Had an intrusive thought = acted on it. Erp doesn't work for me. Link to comment
Ashley Posted February 18, 2016 Author Share Posted February 18, 2016 OK. So, how would ERP work for me? I've just transferred from my non-BABCP qualified REBT practitioner to an OCD specialist CBT psychologist at Mindworks, by the way, who I am hoping can help me. Ah, are you the person I engaged in Twitter/email help with this week? I hope the Mindworks team can help, they are very knowledgeable when it comes to OCD and anxiety so that in itself bodes well. My main worries are: 1. Pretty much every time I have a memory from the past (anything - and I mean a real memory, no matter how trivial) my brain goes 'are you SURE that happened?' and it drives me bonkers and makes me doubt myself. So I feel like I can't really talk to people about the past in case I've 'got it wrong'. Or if someone remembers something I don't, it really freaks me out. 2. Did I do something wrong anyway and not remember? So even if I babysat a child on my own, e.g. how would I know I had not molested it and forgotten? So how would the ERP work anyway? Well the first thing to say is I am not a therapist and so my suggestion may be wrong and is merely a suggestion and example of how therapy might approach this problem. Obviously initially it's important to focus some time on exploring why you feel these thoughts matter, the feelings and emotions around the thoughts. Again to be clear any ERP exercise done with this form of OCD must not be done without preceding cognitive work. It depends what your compulsions are and how you respond to the thoughts with how an ERP exercise might be shaped, but at a guess many people with such thoughts of being a paedophile try and fight the thought, avoid the thought, avoid being near children. If you are focussing on past memories the OCD is seeking certainty, so we tend to fight the worse case scenario, so at a guess in such a scenario an example of some of the behavioural work (further down the therapy) might include giving the OCD nowhere to go by accepting the worst case by saying or writing down 'I did molest a child' to get used to the thought being in your head. By saying such a thing does not mean you did, or wanted to, or will. It does not mean you have to like the thought it5 just means you have to learn to accept the thought being there sometimes. By neutralising the fear associated with the thought, eventually the frequency will disperse. If you are avoiding being around children then the therapist might encourage you to spend time with family members with children. I know Prof Salkovskis used to ask his patients to babysit his children on some rare occasions. Like I say I am not a therapist myself and I may be wrong with the above suggestion because I am partly guessing what your OCD rituals are, it is merely an example of what a therapist may look to do. But here is the key point, a good therapist will only set exercises once they fully know and understand the patient and what the fears are and the compulsions are. Link to comment
Guest Cerisa123 Posted February 18, 2016 Share Posted February 18, 2016 Ah, are you the person I engaged in Twitter/email help with this week? I hope the Mindworks team can help, they are very knowledgeable when it comes to OCD and anxiety so that in itself bodes well. Well the first thing to say is I am not a therapist and so my suggestion may be wrong and is merely a suggestion and example of how therapy might approach this problem. Obviously initially it's important to focus some time on exploring why you feel these thoughts matter, the feelings and emotions around the thoughts. Again to be clear any ERP exercise done with this form of OCD must not be done without preceding cognitive work. It depends what your compulsions are and how you respond to the thoughts with how an ERP exercise might be shaped, but at a guess many people with such thoughts of being a paedophile try and fight the thought, avoid the thought, avoid being near children. If you are focussing on past memories the OCD is seeking certainty, so we tend to fight the worse case scenario, so at a guess in such a scenario an example of some of the behavioural work (further down the therapy) might include giving the OCD nowhere to go by accepting the worst case by saying or writing down 'I did molest a child' to get used to the thought being in your head. By saying such a thing does not mean you did, or wanted to, or will. It does not mean you have to like the thought it5 just means you have to learn to accept the thought being there sometimes. By neutralising the fear associated with the thought, eventually the frequency will disperse. If you are avoiding being around children then the therapist might encourage you to spend time with family members with children. I know Prof Salkovskis used to ask his patients to babysit his children on some rare occasions. Like I say I am not a therapist myself and I may be wrong with the above suggestion because I am partly guessing what your OCD rituals are, it is merely an example of what a therapist may look to do. But here is the key point, a good therapist will only set exercises once they fully know and understand the patient and what the fears are and the compulsions are. Yes, Ashley, that's me. Thank you for all your help. I'll be seeing one of the specialist OCD psychologists there, via Skype initially (due to returning to family nest as am so distressed), who has assured me that all the symptoms I have are hallmark OCD. Yes, I see about the 'Did I do that' thing, but the real memories thing is really upsetting me more. I guess it might be a case of going 'Oh well, maybe I'm not correct' and move on. After all, why does it matter? Why does it bother me so much that I might not be able to remember just exactly what happened? And I guess that's what you mean by working on the cognitive side of things first? Link to comment
Ashley Posted February 18, 2016 Author Share Posted February 18, 2016 Yes caramoole precisely. You know me. So they say I have ocd use erp as a way to get over it...... That being the case ( ocd" ers) don't act etc etc you know where this is going..... Hold the baby you'll be fine!!! So I hold the baby. Had an intrusive thought = acted on it. Erp doesn't work for me. I am afraid I don't really understand what you are saying with your example so I can't really answer your question scenario. You say ERP doesn't work for you, I prefer to say ERP doesn't work for me at this time... after good CBT (C part) there is no reason it can't work next time. What I will say though is OCD is a disorder it is something we suffer with and have, not something we are (ref your OCD'er term which I hate) but maybe that is a point you need to understand. OCD is not you or who you are Liberty, you are not OCD you simply have OCD and that is something you can choose not to have with therapy. I hope you don't think of yourself as being OCD Liberty, because honestly, you are not Link to comment
Ashley Posted February 18, 2016 Author Share Posted February 18, 2016 Why does it bother me so much that I might not be able to remember just exactly what happened? Ah, but if it did not bother you, you would not have OCD! But that's where we need to get you to. At a guess, you are placing far too much significance on the thought of not knowing, but that is something Annemarie will explore in therapy I assume. And I guess that's what you mean by working on the cognitive side of things first? Exactly right Link to comment
Guest Cerisa123 Posted February 18, 2016 Share Posted February 18, 2016 Ah, but if it did not bother you, you would not have OCD! But that's where we need to get you to. At a guess, you are placing far too much significance on the thought of not knowing, but that is something Annemarie will explore in therapy I assume. Exactly right I can't see Annemarie, waiting list is too long. I will be seeing Emma. Link to comment
Guest Cerisa123 Posted February 18, 2016 Share Posted February 18, 2016 I can't see Annemarie, waiting list is too long. I will be seeing Emma. And already, I can see how amazing she is from one phonecall/email. Link to comment
Ashley Posted February 18, 2016 Author Share Posted February 18, 2016 I can't see Annemarie, waiting list is too long. I will be seeing Emma. I don't know Emma, but I know Lauren who is the director and she only works with good psychologists (most of whom spent time at the specialist CADAT service). Link to comment
Ashley Posted February 18, 2016 Author Share Posted February 18, 2016 And already, I can see how amazing she is from one phonecall/email. It's amazing what difference a good therapist can make compared to shall we say an 'average' therapist. Link to comment
Guest Cerisa123 Posted February 18, 2016 Share Posted February 18, 2016 It's amazing what difference a good therapist can make compared to shall we say an 'average' therapist. You can see the difference between the person I was seeing, and a trained OCD specialist psychologist can't you? So glad I contacted you Ashley, I could have been going down the wrong path for years. And all because I tweeted Prof Salkovskis, who is a very generous man with his time & help. Link to comment
Guest Cerisa123 Posted February 18, 2016 Share Posted February 18, 2016 How does one simply accept uncertainty, though? Just say 'to hell with it' every time you get a thought? Link to comment
Caramoole Posted February 18, 2016 Share Posted February 18, 2016 Liberty, on 18 Feb 2016 - 12:32 PM, said: Yes caramoole precisely. You know me. So they say I have ocd use erp as a way to get over it...... That being the case ( ocd" ers) don't act etc etc you know where this is going..... Hold the baby you'll be fine!!! So I hold the baby. Had an intrusive thought = acted on it. Erp doesn't work for me. I am afraid I don't really understand what you are saying with your example so I can't really answer your question scenario What she's saying in essence (Like Cerisa above) is how can she be certain that whilst carrying out ERP the thing that she fears won't come true.......i.e If she's asked to hold a baby as an exposure, how can she be sure she won't harm it as she fears.....or how, if she's asked to hold a pan of boiling water whilst in the same room as the cat, can she be sure she won't throw it over him/her. What she's saying is how can I be certain the things I'm asked to do are safe, how can I be certain I won't act on the thoughts.......just as someone asked to put their hand down the toilet might be afraid that they actually WILL catch a deadly disease. Liberty wants absolute certainty and this is why at the moment, CBT is failing because she's afraid to move forward at all without certainty. In essence Liberty, nothing will go wrong by doing CBT, not in the sense you fear.....BUT we're back to the crux of the problem that we raise in every thread, you CANNOT have that certainty you crave. You have to move forward and face these exposures with an element of doubt. Link to comment
Guest Cerisa123 Posted February 18, 2016 Share Posted February 18, 2016 Liberty, on 18 Feb 2016 - 12:32 PM, said: What she's saying in essence (Like Cerisa above) is how can she be certain that whilst carrying out ERP the thing that she fears won't come true.......i.e If she's asked to hold a baby as an exposure, how can she be sure she won't harm it as she fears.....or how, if she's asked to hold a pan of boiling water whilst in the same room as the cat, can she be sure she won't throw it over him/her. What she's saying is how can I be certain the things I'm asked to do are safe, how can I be certain I won't act on the thoughts.......just as someone asked to put their hand down the toilet might be afraid that they actually WILL catch a deadly disease. Liberty wants absolute certainty and this is why at the moment, CBT is failing because she's afraid to move forward at all without certainty. In essence Liberty, nothing will go wrong by doing CBT, not in the sense you fear.....BUT we're back to the crux of the problem that we raise in every thread, you CANNOT have that certainty you crave. You have to move forward and face these exposures with an element of doubt. How did you accept uncertainty? With CBT? Link to comment
Caramoole Posted February 18, 2016 Share Posted February 18, 2016 It's the million dollar question and one that every sufferer asks at some time. Yes, with CBT which helps you to look at the risk and more importantly how your thoughts escalate the problem, the fear and anxiety. It is our response, our thinking, our internal dialogue and our avoidance behaviours that maintain the problems we have Link to comment
taurean Posted February 18, 2016 Share Posted February 18, 2016 You can see the difference between the person I was seeing, and a trained OCD specialist psychologist can't you? So glad I contacted you Ashley, I could have been going down the wrong path for years. And all because I tweeted Prof Salkovskis, who is a very generous man with his time & help. I got great help from another one of Lauren's experienced team at Mindwoks,London - Hardeep. She gave me some great new insight on my OCD. And the forum faithful subsequently showed me how I was engaging in unhelpful "hidden" compulsions, which can be just as damaging as obvious ones. Link to comment
Guest Cerisa123 Posted February 18, 2016 Share Posted February 18, 2016 I got great help from another one of Lauren's experienced team at Mindwoks,London - Hardeep. She gave me some great new insight on my OCD. And the forum faithful subsequently showed me how I was engaging in unhelpful "hidden" compulsions, which can be just as damaging as obvious ones. 'Hidden' compulsions? I thik I have several. Email/text messages provide me with instant relief, as do the forums. Link to comment
Guest Cerisa123 Posted February 18, 2016 Share Posted February 18, 2016 I got great help from another one of Lauren's experienced team at Mindwoks,London - Hardeep. She gave me some great new insight on my OCD. And the forum faithful subsequently showed me how I was engaging in unhelpful "hidden" compulsions, which can be just as damaging as obvious ones. How long did you see her for, Taurean? Emma seems so clued up, I'm really keen to work with her but also exploring other options. Link to comment
pureosufferer Posted October 24, 2016 Share Posted October 24, 2016 So, from my understanding of the above explanation, the cognitive side seems to just be explaining how and why you're doing ERP. Now for me, my therapist has done all of this but the focus has still been on ERP more than anything else, then speaking with him about it and talking about how it went, what I could have done better, what I did well etc. I have been doing this (with the exception of a six-week gap in the summer) for almost 8 months and I don't feel like I'm improving much, if at all. The only difference has been that I feel less overtly panicky but the thoughts still come, they still cause me a great deal of internal distress and I still feel the strong urge to perform compulsions. Link to comment
PolarBear Posted October 24, 2016 Share Posted October 24, 2016 The cognitive side of the equation is more than setting you up to do ERP. It's about getting Uou to think differently, getting you to see the way you think about the intrusive thoughts is just as much a problem as compulsions. You should be looking for Cognitive distortions like all or nothing thinking. That is where you think because you have a bad thought, you are a bad person. That is dealt with in Cognitive therapy. After eight months of therapy you shouldn't be freaking out about the thoughts much anymore. You should have come to the realization that the thoughts are just a bunch of junk that you can ignore. Link to comment
mummyoftwogirls Posted October 25, 2016 Share Posted October 25, 2016 The title suggests Erp is not recommended at all ? Can we change it to not recommended alone ? Xx Link to comment
Ashley Posted October 25, 2016 Author Share Posted October 25, 2016 9 hours ago, mummyoftwogirls said: The title suggests Erp is not recommended at all ? Can we change it to not recommended alone ? Xx I did that deliberately. If someone asked me would I recommend ERP to treat OCD I would answer no (sort of), If they asked me would I recommend CBT I would answer yes. Link to comment
PolarBear Posted October 25, 2016 Share Posted October 25, 2016 We have two people on the forum right now who have been told by their therapists to CONSTANTLY do ERP throughout the day. That's crazy. That's the equivalent of taking a person with a fear of heights and putting them on the edge of a roof of a forty storey building all day long and expecting that to make them better. ERP is a wonderful tool in the toolbox but there's other tools in there that need to be used too. Link to comment
mummyoftwogirls Posted October 26, 2016 Share Posted October 26, 2016 Personally I don't do erp intentionally as a task as such. BUT I wont avoid something and I come across a trigger accidently nearly every day. To me this is still Erp but not in a set way . Link to comment
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