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EXPOSURE THERAPY THE DIFFERENCE FROM THE REAL THING


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Hello

I have completed 15 of 16 sessions of CBT under the NHS. Primarily its been exposure therapy focusing on my inappropriate intrusive thoughts. It has not been successful and the thoughts are as intense as before and the anxiety.

The therapy has not had time to focus on two other situations which cause me anxiety.

1) The thought what if I jump out of a moving car.I suffer great anxiety in a car.

2)The general anxiety of being in public places even before I get an inappropriate thought.

Recently I am tackling these two issues by my wife driving me to places where we visit and then drive home. We doing this on a staged basis. It is causing me great anxiety but I doing it and I would Would consider this to be exposure therapy. Am I right?

But I am confused what is the difference now to when I was doing these things before and suffering great anxiety???

I accept I now know its OCD which I did not know before. Is the difference that I am now better prepared for the anxiety??

By the way I do not consciously have any reassurance or compulsions for these two situations.

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The thing is, with exposure therapy, you are prepared for the exposure. They are planned out in advance. You know what's going to happen. You expect to get anxious. You're willing to deal with that. It is also crucially important that you do not perform compulsions while doing an exposure. That's the whole point -- teaching yourself that you can get through troubling times without having to do compulsions. It's practice and it can take a lot of practice for you to see a positive benefit.

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After the initial thought pops up about you jumping out of the car, don't you sit there and think about it? Don't you think about the thought and jumping out of the car and whether you really would or not and what could happen and the implications of jumping out of the car? Don't you do that?

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Yes I do and is that a compulsion is it.Sorry If I am being slow but what am I meant to do sit with the anxiety and the thought and try not to react to the thought or analyse it?

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Yes I have avoided travelling by car and train recently.

In October 2014 I had a terrible time on a long weekend away with friends which involved a two and half hour car journey each way. Since then I have avoided any car journey apart very short ones.

That is until this week and the staged car journeys with my wife.

I have also avoided any train journey. We plan two staged train journeys this week. A scary and anxious prospect for me.

I have completed three staged car journeys this week. They have been agonising and before hand I do agonise at the prospect.

During the journey I mainly grin and bear it and long for it to be over

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Well it's important to know your compulsion so you can work on it which it sounds like you are. I have avoided many things in the past and have always increased my anxiety massively because of it. So try to face car and train journeys whenever you can to show yourself that the obsession and therefore the ocd is just a thought and to be ignored.

Gemma x

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Yes I do and is that a compulsion is it.Sorry If I am being slow but what am I meant to do sit with the anxiety and the thought and try not to react to the thought or analyse it?

You bet it's a compulsion. It's called ruminating -- probably the biggest, most common compulsion there is. It's like any other compulsion. You do it automatically and you go round and round in your head, never really coming to a final conclusion, and all it does is makes the situation worse. Compulsions strengthen the obsessions, making sure they come back often and more severe.

So with you, when you're sitting in the car and you get one of the thoughts about jumping out of the car, you need to practice not ruminating. Don't analyze the thought. Don't think about the thought. Don't try to figure out if you would or wouldn't. Just let the thought be there. If your anxiety goes up, that's fine.

We've had whole threads on ruminating and how to stop it. For the most part people recognize they are ruminating, forcefully stop themselves, then try to focus onto something else. You're driving in a car so it would be very easy to refocus onto the scenery, seeing what you can see.

Ruminating is one of the, if not the, most common compulsions. It's sneaky. It all happens in your head. But you need to practice not ruminating if you're going to get anywhere with your OCD.

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Try and notice what sort of conversations are going on in your head, what sorts of things you're thinking or going over. There can be neutralising/self-reassuring thoughts like "I'm going to be alright....I won't throw myself out.....I've got me seat belt on...it's okay, the door's locked, only 10 more minutes to go" There can be anxiety provoking thoughts like "OMG what if I jump.....I can't stand this....I'm terrified"

You can bet your bottom dollar you're not sitting there serenely admiring the view, there'll be a lot of "chat" going on and as you say, probably gritting your teeth and simply enduring it. So, yep....there is an exposure angle going on which will get you used to it and you're facing rather than avoiding.....but try to identify just what sorts of self-talk is going on in your head.

Well Done though anyway :)

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So is it okay to think neutralising/self reassuring thoughts. Which I try and do .Or try vainly most of the time to think of something else?

I certainly dont think I can just sit and look at the passing scenery.

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If what you are thinking brings the anxiety down for instance I have my seat belt on or the door is locked then that is not good. These are just checks that give the anxiety meaning. You can distract yourself with music or games or conversation.

If you think this is just ocd then personally I think that is ok. Your aim should be to have a 'normal' as possible car journey. No checks no neutralising. If you don't compulse at all the anxiety absolutely will drop in time but if you hold something back it won't.

Gemma x

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So is it okay to think neutralising/self reassuring thoughts. Which I try and do .Or try vainly most of the time to think of something else?

I certainly dont think I can just sit and look at the passing scenery.

No, it's not okay. neutralizing/self reassuring thoughts are compulsions -- something you do not want to do.

The goal is to let the thoughts about jumping out of the car pop into your head and do nothing about them. You don't try to neutralize them with a good thought. You don't reassurance yourself that you won't do it. In fact, you can take the attitude, "Yup, I might jump out of the car." Then leave the thought alone and try to focus onto something else.

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Well I certainly failed today.

This week my wife has driven me each day on staged trips. Monday just local roads but Tuesday to Thursday on longer trips to National Trust properties for a walk round and lunch. This was following the good advise given by Caramoole.

I have been very anxious on each trip and whist at the property but got through it by grin and bear it mainly. To be honest I have been deep breathing checking the seat belt ( I cannot lock the door) and talking to myself reassurances and trying to think nicer thoughts. Which I understand I should not have been doing.

However yesterday although anxious in the car about the visit to the property and other thoughts I did not have the jump out of the car thought. I thought I had turned the corner and talked about it with my wife last night.

Today the jump out of the car thought as intense as ever and the trip both ways been agonising. I feel very down after what was a false dawn.

I am meant to be going on a 50 mile trip with my wife to her mothers on Saturday. It includes busy dual carriageways and motorways which I am worse on . Last night I was more confident about it but not now.

I assume the forum is going to say do it Saturday and dont seek reassurance or do checks or change thought just sit and live with the thought. I am not sure sitting in the car I will be strong enough to do this

Edited by mackem1
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You did not fail. You exposed yourself. Okay, so you did some compulsions. That's okay. This is a learning process. You learn, you start doing the new things and off you go. It takes practice to stop compulsions. You don't just up and stop cold turkey right away. It takes time. You've been doing tremendous so far. Give yourself a pat on the back.

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I agree with polarbear. Don't feel down you are doing exposures and they are hard. All you can do is learn from them and try to do better next time. I am trying to expose myself too and it can be very hard pinning down the behaviours that are making the ocd worse. Its all trial and error.

Well done for what you are doing.

Gemma x

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Polar Bear is right.....and don't worry, you aren't going to get this right in a matter of days, it takes time, effort, courage and repetition.

So is it okay to think neutralising/self reassuring thoughts.

:no: As mentioned above, these are compulsions designed to self-reassure and reduce the anxiety. It's all terribly complicated, I know :(

You have to try and sit with the anxiety without using these coping methods, gently bringing your attention into the present

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I will try harder its complicated but also will be very difficult to do/

I assume doing the exposure ( being driven in a car ) and failing and having to resort to coping methods is better than doing nothing at all?

I find it much worse on open country dual carriageways and motorways. I assume its because I feel more vulnerable with he open space?

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I assume doing the exposure ( being driven in a car ) and failing and having to resort to coping methods is better than doing nothing at all?

You haven't failed, you're practising :)

Now you build on it. As I said yesterday, you have to work out what you're doing wrong to put it right and becoming aware of the dialogue and then working towards changing it is the way forward....it all takes time.

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You're already doing well because you're putting yourself out there and really trying, that's a step lots get stuck on because of fear. Give yourself a lot of credit....I know it's been a tough week but you've really tried....that's a recipe for success.....but don't get disheartened, it takes time :)

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I always try to simplify the complicated so, as I - with Caramoole and Bear - am doing my best to help you - here goes;

In exposure you feel those thoughts converge upon you and you need to listen to the meaning being given to the thoughts by the OCD. Then as you feel and experience those thoughts feelings and urges, the aim is not to engage with them or carry out compulsions - so not to "neutralise" them or deploy your usual coping mechanisms - they just strengthen the thoughts - give them power.

Simply remind yourself that the thoughts are false messages from an OCD'd misfiring brain where OCD turns our real desires and feelings on their heads and suggests an opposing unwanted thought should be carried out.

You need to believe in this with very high probability - you have to take on the OCD demand for certainty I have been helping you with and overcome it.

Then after you have sat a while - a few minutes certainly - with the unwanted intrusions and experienced the uplift in anxiety but reminded yourself the messages are false, that is the time to move your thoughts away.Talk to your wife, plan TV watching, count lambs in fields work out what type of of clouds are in the sky. And each time your OCD tries to claw you back to its intrusion, just calmly note that but refocus away again.

As my learned friends have told you, with practice - and a few failures along the way - we can get quite good at this and the intrusions will lose power and occur less frequently and the anxiety will fade too as you form a new mental view of the intrusion as in fact now benign, just mental flotsam.

Remember Patience and Perseverance must be your additional steadfast friends on this journey.

Edited by taurean
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I need to work harder when in exposure and I will try to develop the techniques you have outlined.

I do appreciate the support provided by the forum.

To be honest today I caved into the anxiety.

Edited by mackem1
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Ok so it wasn't a good day today but you are starting on a new tack, a new way of thinking and behaving, now and it will take time and there will be difficulties and failures as well as gradual successes on the way.

Don't be upset tonight. Be so pleased you have your new friends here to offer guidance.

There is no failure here ; rather more a taste of success, because by engaging honestly and openly with us we may have discovered what has been holding you back.

Edited by taurean
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