Cornerstone of cognitive therapy.

[Caramoole]

i suppose you are right - working more on accepting uncertainty maybe?

I'm not even sure about that. I think it has more to do with the emotion, rather than the instigating contaminant(s)

[Caramoole]

Tricia.....When your Mum was ill and in hospital you had to face many of these things and wear clothes and in very challenging and stressful circumstances. You did it.

What happened? What measures did you take to handle it? How long did it take to deal with the anxiety on return home?

[taurean]

Yes, great shame re hypnosis. Been there done that too. Even EMDR to sort out underlying triggers but no hope (I dissociated too much). I read a study about OCD and citalopram and the reviewers have 12 weeks as the test period ( http://www.scielo.br/pdf/rbp/v29n4/a03v29n4.pdf ). It would be wise to say to the doctor, if you still have no improvement after 12 weeks, that it might be a good idea to try something else, but by then you will know one way or another pity tablets take time! It's insult to injury really but what can ya do.

I tried the eye movement desensitisation but that didn't break the cycle.

What does help shift a loop is to rationalise it - but only used sparingly or can become a compulsion.

The idea is from my thera;ist. You write down the thought or image, then the meaning OCD is applying to it, you note if any other distortion is also present eg minimising the positive, black and white thinking, and you then determine and write down a more practial and rational way of interpreting the thought..

I usually at first get enormous distress from seeing this written down, then great relief when I review that its OCD ;plus the distortion and what the rational view is.

Often this disrupts the cycle so then is another opportunity to plant something nice or neutral or reframe..

Edited February 7, 2015 by taurean

[taurean]

Re the climical tests on citalopram becfuse of my age I am not keen to go above 20mg, certainly not unless I have stabilised my phycsical state.

Edited February 7, 2015 by taurean

[Guest Tricia]

I'm not even sure about that. I think it has more to do with the emotion, rather than the instigating contaminant(s)

I agree, Caramoole (as have therapists in the past, including one at the Maudsley).

Tricia.....When your Mum was ill and in hospital you had to face many of these things and wear clothes and in very challenging and stressful circumstances. You did it.

What happened? What measures did you take to handle it? How long did it take to deal with the anxiety on return home?

Yes, I faced it all, but it was terribly hard and I truly don't know how I would have survived had my mum been ill during the winter.

I returned home each day and removed my outer clothes in the garden and washed down with the hose. I had to wash the 'contaminated' clothes outside and then, very slowly, I side-stepped through the hall heading up the stairs to the bathroom where I scrubbed every inch of my body for nearly two hours. I could not have endured that, or the stress, much longer.

Facing Mum's home was also incredibly hard for me and I did that daily to wash her clothes.

I am ashamed to say I have as many flashbacks to the contamination incidents as I do over her condition. On one occasion a helicopter landed just as I walked out of the hospital. I had never experienced anything quite like it, as every bit of rubbish, dust, leaves etc. swirled around me and I felt utterly contaminated - almost didn't manage to return home that day, I felt suicidal.

My mum had a fear of hospitals and being mistreated (which, as you know, is a real possibility). My son had gone away and no one else was visiting, so I had to go to her. I couldn't have lived with myself if I hadn't.

P.S. You mentioned the anxiety, Caramoole. I can't say how I'd have coped if I hadn't decontaminated (probably as I did during therapy) but because I felt reasonably clean after the long shower, I was coping - just.

Edited February 8, 2015 by Tricia

[Guest Tricia]

Re the climical tests on citalopram becfuse of my age I am not keen to go above 20mg, certainly not unless I have stabilised my phycsical state.

Has your doctor suggested L-tryptophan, Roy? It used to be prescribed, with a drug like clomipramine or an SSRI, for those who couldn't tolerate a high dose of those drugs.

Edited February 8, 2015 by Tricia

[taurean]

We are due a catch-up consultation in the next few days. Can discuss it then.

As I understand it tryptophan is a base source for serotonin.Sounds like a product from the health food store?

Re your story on contamination I have digested the information. I just feel so sad that this is such a problem and maybe CBT could focus on getting to the bottom of the revulsion and fear through the downward arrow technique. Are you familiar with how that works?

[taurean]

Has your doctor suggested L-tryptophan, Roy? It used to be prescribed, with a drug like clomipramine or an SRI, for those who couldn't tolerate a high dose of those drugs.

Well the looping thoughts continue. I have been floored by one today after a reasonable morning so have retired to read.

A number of people have reported great benefit from anti-psychotics regarding intrusions but they seem like powerful drugs directly targeting brain chemicals but can be used with an SSRI.

Edited February 8, 2015 by taurean

[Caramoole]

I was coping - just.

Albeit only "Just" and that it was extremely stressful.....Could it be that you did cope because internally there was the slightest mind-shift because you absolutely had to do this, it was something you couldn't avoid?

[Guest Orwell1984]

Tricia, I wonder if the strength of the emotion could possibly be lessened by EMDR? That was one of the benefits when I did it.

[Guest Tricia]

Tricia, I wonder if the strength of the emotion could possibly be lessened by EMDR? That was one of the benefits when I did it.

Thank you, Orwell, I'll look into it.

We are due a catch-up consultation in the next few days. Can discuss it then.

As I understand it tryptophan is a base source for serotonin.Sounds like a product from the health food store?

Re your story on contamination I have digested the information. I just feel so sad that this is such a problem and maybe CBT could focus on getting to the bottom of the revulsion and fear through the downward arrow technique. Are you familiar with how that works?

Yes, Roy, I believe L-tryptophan is available in health food stores, but because it works on serotonin, I wouldn't take it with an SSRI without discussing it with your doctor. (It is also high in certain foods)

I didn't answer your question about the twin approach. I've read about this but because I don't fear harm it doesn't seem to help.

Yes, I'm familiar with the downward arrow technique you mentioned.

I was reading in one book on OCD that there's a theory that we latch on to something to mask a more painful thought. I'm not sure if that is true, but I certainly cope more easily with this obsession than I did intrusive thoughts that preceded it. Of course I am terribly cold and my life is far more abnormal now, but the mental pain is less.

Edited February 9, 2015 by Tricia

[taurean]

Hi Tricia,

Re the tryptophan I agree because of serotonin syndrome the count of serotonin has to be within tolerance.

Re your contamination problems has anything suggested given any food for thought re tackling them? Did you try the downward arrow technique and did it give any clue as to why the disgust and resultant fear occur - anything that could be worked on?

For the benefits of those reading who don't know what it is, the idea is that you start off with your base scenario, then keep asking the question what would be so bad about that? Then after the answer, you put a downward arrow then ask the same question of the preceding answer until you reach allegedly the root issue and can go no further.

I've been looking at OCD Guy's story from his blog.. I am not exactly sure what the substances are that he considers contaminants. But he has two rooms in the house he lives in and to get out of them he needs help. Then when he is out certain areas are considered clean and others contaminated. OCD triggers occur while he is out and there are of course problems when he crosses over from clean to contaminated places.

[Guest Tricia]

Roy, the problem is there is nothing bad about any of it. I can find no answer as to why I am so revolted and afraid. The only 'bad' thing is that I'd rather die than live with the feeling being in contact with it creates.

I am actually wondering if this is even an OCD symptom, as I have read yet another OCD book that focuses on harm.

David Veale and Rob Willson's book is one I read years ago and they state, "OCD is a problem of misinterpreting normal thoughts and ideas and believing that you're able to prevent harm from occurring."

[taurean]

Ummmm

There is obsession with it, there is fear and there are compulsions - avoidance, washing, researching - so it looks like OCD to me.

I have the book and I know that.

Here is another perception - maybe there may not be physical harm, but there is psychological harm - who says the harm has to be physical?. If you would rather die than come in contact with it, that's harm surely or at the very least fear of harm , so another form of it?

[gingerbreadgirl]

To me this seems like fear of the feeling of disgust rather than fear of the actual contamination. If that makes sense? You are not afraid of any physical harm coming to you but you are afraid of experiencing the feeling of disgust x

[gingerbreadgirl]

So In a way it is fear of harm - fear of emotional harm x

Edited February 9, 2015 by gingerbreadgirl

[taurean]

So In a way it is fear of harm - fear of emotional harm x

I agree - I think there is emotional harm.

Like in post traumatic stress disorder, the emotions are harmed causing mental and physical ill-health and phobic response. with avoidance.

[Guest Tricia]

The problem is, with every symptom I have had involving harm, exposure proved the harm never occurred. With disgust, the 'harm' happens every time, which reinforces the fear. The opposite to what I experienced when there was a consequence, like illness or death.

[taurean]

The problem is, with every symptom I have had involving harm, exposure proved the harm never occurred. With disgust, the 'harm' happens every time, which reinforces the fear. The opposite to what I experienced when there was a consequence, like illness or death.

I think this explains why the previous exposure did not work.

Lets take another viewpoint. Why the disgust - what is contributing to the very strong emotion of disgust? What is fuelling it? Not knowing whether there is faeces in it or not, but assuming there probably is?

[gingerbreadgirl]

Ok I see what you mean.

So your most feared consequence isn't some distant possibility but an assured event- ie that you will experience this extreme, intolerable disgust.

So every time you try ERP your anxiety doesn't fade because you experience your most feared consequence every time. If your plane crashed every time you attempted ERP for a fear of flying, your anxiety wouldn't exactly go down!

So I guess the solution is perhaps looking at ways of reducing your disgust so that this feared consequence doesn't constantly happen.

My thinking would be that you would need to find a therapist who is prepared to work creatively with you on this and think outside the typical paradigm. Maybe look at other types of therapy alongside CBT that may address the disgust response.

Just my twopenny worth. Xx

[gingerbreadgirl]

In fact if I'm really honest Tricia this doesn't really sound like OCD to me because you don't experience any doubt. To me it sounds more like an extreme phobia of the feeling of revulsion. You have developed compulsions which allow you to avoid the object of your phobia.

[taurean]

And I'll add:

When I stick a bit with my problems I use reframing which can be a powerful tool.

I know Caramoole was quick to dsmiss this, but let's fpor the moment keep the brains trust options open .

If the issue is that the we don't know if there is animal faeces, and if so what form there is, in the dirt or soil could the therapist not go down the route of reframing the thinking to assume that there was going to be various forms of common animal faeces within the muck? In other words, since the uncertainty is behind the disgust, why not seek to take away the uncertainty, addressing the disgust and the fear.

For example, I know that round where I live - on the very edge of the forest, the animal faeces in the dirt will be bird, rat and mice, dog, cat, squirrel, fox maybe rabbit. I know this area extremely well.

If I was living 10 miles to the north, there are farms so there could be farm animals and contamination elements would be possible in some way , and obviously if the farms had been visited - lone of them is a kids open farm.

In various books on CBT I have read, therapists have used uses these reframes on patients to change their perceptions and get them over seemingly impossible difficulties.

[taurean]

In fact if I'm really honest Tricia this doesn't really sound like OCD to me because you don't experience any doubt. To me it sounds more like an extreme phobia of the feeling of revulsion. You have developed compulsions which allow you to avoid the object of your phobia.

There is doubt though - the doubt is over the potential type of faeces in the muck.

But point taken does it really matter if it's OCD or a phobia, since CBT treats both?

[Guest Orwell1984]

Individuals with greater levels of disgust sensitivity exhibit heightened resistance to extinction (from http://www.sciencedirect.com/science/article/pii/S0887618509001807)

"Disgust domains in the prediction of contamination fear":

http://www.researchgate.net/profile/Peter_Jong/publication/8901208_Disgust_domains_in_the_prediction_of_contamination_fear/links/0912f5074831f60f46000000.pdf

Hi Tricia, hope these are useful. Sorry for bombarding you with papers! But I did think these ones were useful. Still trying to find a tried and tested method that has resolved the disgust OCD variant. Papers by Berle talk about disgust in OCD if you want to look into it more.

Edited February 9, 2015 by Orwell1984

[Guest Orwell1984]

Last one:

"Do All Threats Work the Same Way? Divergent Effects of Fear and Disgust on Sensory Perception and Attention"

http://m.jneurosci.org/content/31/9/3429.full.pdf