Debate - When Anxiety doesn't come down

[taurean]

I think this has some "legs" to it arrow.

As I said previously on the thread, until I got a - very high - level of anxiety down, there was no chance of me working ERP successfully.

(Nor in fact did my Citalopram start to work).

For me, understanding - I call it "mapping" - our anxiety-inducing OCD and other distortions and experiences is a necessary start process - for if we don't understand what things contribute to our anxiety, then we can't reslistically expect to get to the next stage - looking at the options to treat it, can we?

And - as is especially clear with Tricia and Daisy's experiences - one size definitely does not fit all - best to seek to have different tools to try.

So, I think ERP is unlikely to work until high anxiety levels are down.

Edited September 7, 2015 by taurean

[snowbear]

First, thank you for your responses, Taurean. :original: Everything you say is in agreement with the text books and will therefore resonate with the majority of people on here. I'm very conscious of what I say in response to people seeking help and advice on these forums because I don't want to give anybody the idea the text book advice is wrong. I fully support the standard advice when it works. And it does work for the majority of people with OCD.

But it doesn't work for me. Sometimes I get fed up with the implication that's because I'm not committed to therapy or resisting therapy because it puts me out of my comfort zone. So I couldn't resist the opportunity to speak up on behalf of those for whom the text book advice simply doesn't work despite their best efforts to comply. After all, it is a discussion thread! If I can't discuss my views when invited to do so, where should I express them?

Snowbear, resentment and anger are destructive emotions and will make things worse - a large dose of acceptance, then refocusing prior to anger and resentment taking hold will help.
.

Well, Taurean, all I can say is your thought reflexes must be a darn sight faster than mine to be able to refocus in the 0.0000001 millisecond before the anger hits! :lol:

Emotional reactions are much much faster than thought. Part of the problem is the feeling is there long before you have time to think at all, let alone refocus on a calmer feeling.

Our resolution therefore is to look to reframe that emotion so it doesn't hit the alarm button but a benign reaction occurs - the sufferer has come to terms with something that cannot be conrolled - and the false message of disgust is rendered ineffective.

A mental "rudder" that accepts it is a false message, leaves it be and refocuses is the path I think.

I agree with you that we need to learn how to reframe the emotions we feel. But I respectfully disagree with routinely giving people the message the disgust (or anxiety, or anger) is 'false'. The emotion may not be false at all, it may be entirely appropriate. What we need to recognise is that with OCD it is disproportionate to the stimulus.

Sadly, coming to terms with the fact something cannot be controlled doesn't typically 'render the disgust ineffective' - it's often the unfortunate fact that something cannot be controlled which generates such disproportionate emotion as much as feeling disgust 'of' something.

This is why I think it's so important to find a therapist who's aware of the language they use and not one who trots out routine phrases. I'd rip you to shreds for suggesting I should 'accept' anything. To 'accept' is asking me to acknowledge I have no control and must take the world as it is. This triggers a hot-wire straight back to the abuse of my childhood. I'd sooner be dead than 'accept' anything I don't like ever again. As a child I had no choice, as an adult is it any wonder I fight tooth and nail when yet another person tells me to 'accept', or suggests what I'm genuinely feeling inside is 'false'?

This is perhaps why some of us go round in circles with therapy, because we are being asked to accept we have a false belief and told our emotions are wrong, and that we must (must indeed! :furious: ) change them. Is it any wonder all but the very bravest find therapy difficult?

Of course, not everybody's OCD stems from abuse and not everybody's reactions are as extreme and entrenched as mine. For many people 'accept' and 'false' are appropriate and useful terms. I'm just trying to explain why they can be counterproductive for a few people.

Prof Salkovskis said on the JOGLE blog:

I have been thinking a lot about how the people I try to help can get the best from treatment for their OCD, and I have, I think, been able to clarify at least in my head something which I have known for sure for a long time, and which I have found difficult to articulate. It’s to do with choice, something I have highlighted in my teaching of professionals; I commonly title my clinical skills workshops “Helping people with OCD to choose to change”.

I totally agree with him. It's all about choice and wanting to change. But I'd go much further. When it comes to making the change, being given the choice should extend to therapy, not stop at the therapist's door to be substituted by 'accept'. I think for a considerable number of people with OCD, the language used in standard therapy is a stumbling block in itself.

Where I finally made progress was when all ideas of right and wrong, good and bad were thrown out the window.

Instead, I have a choice - every time. So faced with something I believe is contaminated, nobody needs to try to convince me it isn't contaminated, that my beliefs are false.

I am free to believe whatever I want, but must recognise beliefs come with obligations.

Similarly, I'm free to respond however I choose, but actions come with consequences.

Now, I'm totally in control.

I can go on believing things are contaminated and shoulder the burden of obligation (to feel the appropriate but unpleasant fear or disgust), and I can - if I choose - respond with cleaning, avoiding, or neutralising rituals. The consequence of which is my OCD will continue and the world will remain a fearful contaminated place.

Point is I don't have to accept anything. No outsider is coming along saying they are right and I am wrong. Nobody is suggesting my beliefs or my feelings are false (and by implication that normal people are on a better path in life or better than me,)

So, given the choice: some days I choose to believe in the contamination and I clean up and suffer as a result. Some days I can let it go, because it's my choice. It wasn't imposed upon me by the 'normal' world standing in judgement of what is good/bad, right/wrong, or what is acceptable!

This 'choice' approach won't suit everybody any more than the 'accept' approach. It scares the beegeebees out of some folk to be given total responsibility for their actions. And that's fine. We're all individuals. This is about finding an approach that works, especially when the text book advice hasn't helped.

(Sorry for the long post folks, and Roy, I'm not singling you out, you simply gave me some useful things to quote when I came to add my thoughts to the discussion.)

Edited September 7, 2015 by snowbear

[Gemma7]

I agree taurean. You can't start off with ERP and really high anxiety and then hope the anxiety will come down, you have to start with the cognitive side. Understand why you are where you are, why you react like you do and why you might choose to act differently.

Also, as you say work on recognising cognitive distortions that increase anxiety. You need to really understand why you are doing an exposure and what exactly the exposure shows you.

When doing an exposure the hardest thing is not relying on all the safety seeking behaviors we do with regard to ocd. These behaviors are what maintain anxiety but pinpointing them can be incredibly tough.

[Gemma7]

Snowbear, I agree with you in that choice is key. We the sufferer have decisions to make and we choose whether to compulse or not.

Sometimes we choose to compulse, it doesn't help and makes life hard or we choose not to and see the benefits of that.

Whether we choose to compulse or not though is up to us and if we make the wrong choice there is always another opportunity to make the right one. It is a simple thing 'choice' but really hard to do.

[snowbear]

Tried to edit my last post, but got to it too late.

I forgot to mention that deep down I'm fully aware the world isn't actually ''contaminated''. It's my emotional self that believes it is unclean and unsafe, not my rational, thinking self. Very important to state that because many people with OCD believe things are contaminated in their heads yet know in their hearts it's not as unclean as they believe.

Guess that's the difference between thought OCD and emotional OCD.

Make sense? I hope so! :biggrin:

[taurean]

Ok instead of just false, add exaggeration of minimal threat, or revulsion.

I know all abount millisecond responses. As Caramoole and Daisy know, such negative neural connections plagued me earlier this year.

At least for the moment I am doing much better on this. K believe it is because I have been choosing to actively find and then connect into positive and beneficial things, leaving the negative neural pathways unused, the new ones "burned" into my mental lobes.

It is what my therapist suggested could happen, so (cautiously) I am for the moment pleased (I have had too many episodic relapses to assume anything - time will tell if this approach is effective in the long term for me).

[daisy]

I really hope it is effective long term for you Roy,i just wish i could find something that works for me,i will have a read through this thread when i am not in such a panic,as at the moment i am reading the words but they are not going in properly! x

[snowbear]

I have been choosing to actively find and then connect into positive and beneficial things, leaving the negative neural pathways unused, the new ones "burned" into my mental lobes.

It is what my therapist suggested could happen, so (cautiously) I am for the moment pleased (I have had too many episodic relapses to assume anything - time will tell if this approach is effective in the long term for me).

That sounds the same as the basis of cognitive re-processing. Establish new connection pathways between brain cells so the old ones fall into disuse. Learning to think about things differently (such as adopting a positive approach rather than a negative one) physically changes the brain. New pathways are created between the areas of the brain responsible for emotions and areas dealing with thoughts and inhibitory responses. What's come to light with the latest PET scans and research is how specific areas of the brain can grow or shrink over time depending on how you use them. The brain is no longer seen as having fixed anatomy; it's a living thing, constantly in a state of change, adapting to the ongoing, every day challenge of living. So it really is possible to think yourself a 'new' brain!

I'm afraid I've been immersed in brain anatomy and physiology studies for months and I'm not very good at explaining my understanding of the theory in terms of practical adaptations. But positive thinking is always a good way to go, erasing those learned negative pathways.

[Ashley]

Prompted by one of Daisy's posts

Psychologists state that anxiety will always fall. In the text-book version we expose ourselves, sit with the anxiety and it will naturally recede, we will learn no harm is to come and abracadabra, problem solved!!!!

My experience, and clearly hundreds more here find the opposite and excruciating levels of anxiety can maintain for days, weeks or months.

So what are we doing wrong? What can we learn? What can we change?

Personally, I think it's the resulting, internal self-talk that maintains the anxiety.

It's something worth thrashing out and trying to identify "what we do" and how that can be changed more effectively.

Funnily enough I raised this very point at the Truro event (or may have been Wales). Therapists who have not experienced (worked much) with OCD think the anxiety simply fades on it's own and I pointed out (in my own way) that was ****. Actually, once you have done therapy, and the cognitive work is all making sense then you can do an exposure and the anxiety will generally fade quickly (these days for me in minutes), so they are right there.

However, pre-treatment and until you are on top of the OCD if the cognitive aspect has not been worked on chances are as you say the anxiety will increase and last, it did for me.

My own advice is during that time refocus if you can. Try and refocus your mind on something else, it won't get rid of the anxiety but it may help it subside quicker.

[taurean]

Anyone got any ideas to help those where background anxiety kicks in, but there is no definable reason?

And when a person, say, wakes up feeling anxious, then the mis-firing mind starts scanning for things to latch it onto, to worsen/ continue distress?

This is an issue for a number of people here.

[taurean]

Got spooked by that millisecond response by my brain to a trigger on the radio whilst in bed this morning. Instantly kicked in anxiety and cramping muscles

Did what my therapist told me; noted it as OCD turning a core value on its head, defused it by thinking of it as "just my silly obsession", and got up made breakfast and we got focused on a busy day clearing things for a man to lay two new carpets here in my mum-in-law's flat.

Technique worked beautifilly and we had a good day - all three of us got on famously

:original:

[Guest Tricia]

Tricia mentions hers as disgust.

I do find it difficult to describe exactly what I do feel. I certainly no longer have any fear of harm to myself. My dad once asked how I'd react if dog/cat faeces was 100 percent safe. I knew without giving it any thought that my fear would be as great. My daughter once said I experience disgust not fear, but I assured her it's both. (Which recently she witnessed as I was white as a sheet and shaking from head to toe).

I also know that when I am facing what I fear (and am disgusted by) that I honestly would rather die than remain in contact with it. I don't know if that's an unusual reaction or not, but many people I've spoken to with contamination fears seem surprised when I say that.

[Guest Tricia]

My own advice is during that time refocus if you can. Try and refocus your mind on something else, it won't get rid of the anxiety but it may help it subside quicker.

I used to attempt this (it didn't seem to help) but at the Maudsley I was told it's the worst thing to do. Professor Salkovskis has also said to remain with the fear and not distract ourselves.

---

I certainly find books that claim anxiety has to come down very frustrating to read.

In the recent Horizon documentary, Isaac Marks was talking about resisting a compulsion to wash (for half an hour or preferably an hour) and how the anxiety subsides and the desire to wash diminishes. I do not experience this any more (I did in the past). In fact, the longer I resist a compulsion the greater my fear/disgust becomes.

[Guest Tricia]

"I have been thinking a lot about how the people I try to help can get the best from treatment for their OCD, and I have, I think, been able to clarify at least in my head something which I have known for sure for a long time, and which I have found difficult to articulate. It’s to do with choice, something I have highlighted in my teaching of professionals; I commonly title my clinical skills workshops “Helping people with OCD to choose to change”.

----------------

Snowbear, you quoted Paul Salkovskis, above, but what choice do we have if stopping compulsions leads to more terror and misery? I have a choice as to whether or not to wear clothes, whether to sit in comfort or stand all day. I choose the physical discomfort because choosing the normal approaches resulted in perpetual mental agony! We cannot make a choice over whether our fear remains, that's the issue here.

​Thank you so much for your support on my thread about my grandchildren. I haven't responded there as I didn't want to push the thread back up, but I am so grateful to you and everyone who wrote to me.

[Handy]

ocd is internal, so my opinion is if you can't think you can't have ocd, but you can have anxiety if you can't think sometimes because there is anxiety based on external things.

[snowbear]

I do find it difficult to describe exactly what I do feel. I certainly no longer have any fear of harm to myself. My dad once asked how I'd react if dog/cat faeces was 100 percent safe. I knew without giving it any thought that my fear would be as great. My daughter once said I experience disgust not fear, but I assured her it's both. (Which recently she witnessed as I was white as a sheet and shaking from head to toe).

I also know that when I am facing what I fear (and am disgusted by) that I honestly would rather die than remain in contact with it. I don't know if that's an unusual reaction or not, but many people I've spoken to with contamination fears seem surprised when I say that.

Tricia, this is 100% as it is for me too. And I agree it's very hard to describe the exact emotion because it's a mixture of several emotions all at the same time (for me it's fear, anger, and disgust.) Sometimes one predominates, sometimes they are inseparable.

In the recent Horizon documentary, Isaac Marks was talking about resisting a compulsion to wash (for half an hour or preferably an hour) and how the anxiety subsides and the desire to wash diminishes. I do not experience this any more (I did in the past). In fact, the longer I resist a compulsion the greater my fear/disgust becomes.

I agree. Typically, the longer I leave it the stronger and more entrenched my emotional response becomes. If it's an area on my body that becomes contaminated and I resist (or am unable to) clean it immediately, the contamination slowly spreads. What begins as fingertip contamination I could wash off fairly easily becomes a need to scrub my skin to my elbow after a few hours. After a day of not cleaning, it morphs into a desire to amputate my whole arm. In the end I'd have to clean my whole arm with copious amounts of (potentially damaging) cleaning agents and for up to a day afterwards I'd hold the arm away from my body, unable to use it and mentally disowning it, even though it is now cleaned. I've come to understand this extreme response of mine is about punishment and retribution, but whether I'm punishing myself for not cleaning up sooner, or imagining it punishes somebody/something else in a form of 'making a silent protest' is hard to say. A combination of the two, I think.

People say, 'But you can't just not move your arm. You must move it when you dress or go to sleep.' But there's the rub - for the duration the mental discomfort (the aftermath of resistance) lasts, I won't sleep, or change my clothes, or even sit down. I have in the past stood for up to 60 hours at a stretch, occasionally dozing where I stand, swaying on my feet. That's how I got my leg ulcers - from the tissue swelling and damage to my leg veins caused by such prolonged bouts of standing.

Snowbear, you quoted Paul Salkovskis, above, but what choice do we have if stopping compulsions leads to more terror and misery? I have a choice as to whether or not to wear clothes, whether to sit in comfort or stand all day. I choose the physical discomfort because choosing the normal approaches resulted in perpetual mental agony! We cannot make a choice over whether our fear remains, that's the issue here.

I hear you, Tricia! I think your OCD and mine may be quite similar. But I've been working on cognitive reprocessing for a while now and I'm finally making really good progress (though you might not think it if you judged only on the basis of external factors like current lifestyle.)

I've learned I genuinely DO have a choice over whether the fear remains or not. It starts and ends with the inner dialogue I have with myself 24/7. That is more than just the voice you hear in your head when you have conscious thoughts, it also comes from the primitive regions of the brain in the form of emotional responses. However, those thoughts and reactions are largely learned responses. Anything that has been learned can be unlearned. Learning is just a matter of brain cells (or brain regions) becoming connected to other brain cells These connections aren't fixed - they are created, dissolved and changed on a daily basis throughout our lifetime. If they weren't this flexible we'd all be incapable of memory, or of learning anything new.

In short, unlikely as it sounds, we can (and do, all the time) teach ourselves what to feel. You've probably heard of 'positive thinking' and how you can make yourself happier just by thinking happy thoughts. Well, in the same way we can think away our fears and reduce the automatic negative emotional responses we get by changing the input you feed your brain 24/7. I could fill up the whole forum explaining this in detail, but in essence you need to look at your core belief system (what your emotional brain has adopted as reality based on your life experiences to date) and begin to challenge those beliefs.

Discover the inner dialogue where your core beliefs originate (''It's an unsafe world'', ''I'm a bad person'', ''I'm unlovable'', ''I'm unclean''....etc ) and decide whether (or not) what was valid at the time the emotional responses were learned is still valid. You then choose which ideas to keep and get rid of the invalid ones by changing what you tell yourself.

It's a quirk of nature that the brain is wired to actively look for things which support what we already believe about the world (seek reassurance things are as we think they are) and to reject or overlook what doesn't support our current understanding. So when the voice in your head screams 'DANGER! This is a threat. I'm unsafe'' it confirms and reinforces its own belief system that the threat is real. But you can break this cycle by programming the voice in your head to repeat back to you what you want your new belief to be. ''This is ok. I'm safe.'' You won't believe it at first - because your brain hasn't heard it often enough to adopt it as a core belief yet. But over time you break the brain cell connections you made when you learned 'This is a threat' and instead make brain cell connections that reinforce the new belief 'I'm safe.'

Then, when the things that once triggered fear arise again, your newly taught emotional centre scans it's belief system, comes up with ''I'm safe'' and instead of screaming 'DANGER, FEAR!' it shrugs it off and leaves you to get on with your life.

That's cognitive reprocessing in a nutshell. Maybe I should start a blog to explain the anatomy and physiology bits so I don't bore those who don't want to know the science behind why it works. :nerd:

Edited September 10, 2015 by snowbear

[Caramoole]

. I could fill up the whole forum explaining this in detail, but in essence you need to look at your core belief system (what your emotional brain has adopted as reality based on your life experiences to date) and begin to challenge those beliefs.

That's cognitive reprocessing in a nutshell. Maybe I should start a blog to explain the anatomy and physiology bits so I don't bore those who don't want to know the science behind why it works. :nerd:

An interesting post Snowbear

I think you should copy it across and start a thread of it's own. It would be interesting for people to be able to work together on many of the negative aspects of thinking....not only OCD but anxiety, depression, apathy, social anxiety.....everything.

Off you pop and get a thread started. I'd like to read the anatomy & physiology as well.....anyone who doesn't can flick past that bit

[daisy]

I agree with you Caramoole,i think it would be very helpful ,so yes please Snowbear x

[PolarBear]

Ditto here. Start a new thread. We don't talk enough here about the cognitive side of recovery.

[Lost_in_a_Dark_Maze]

I think it is a mixture of emotions for me too (fear, anger, disgust).

I can also relate to your excellent description of the spreading contamination, Snowbear.

[Caramoole]

Let's have that new thread/discussion Snowbear. I think it would be very helpful to many and a new angle that will be worthwhile to many

[Guest Tricia]

Snowbear, your comments are very interesting and I will go over them again and try to digest them more thoroughly.

I just want to say, though, that my reaction to faeces (only from carnivorous animals, for some odd reason, I could easily touch horse manure or cow dung!) happened in an instant. I was a veterinary nurse for years and owned two large dogs. One day I was fine (had other obsessions, but not contamination) and happy to clean up after my dogs, the next day I experienced blind terror. So, it doesn't seem like learned behaviour. I used to try rationalizing the fear, and sudden change in my response, but these days I am not consciously aware of any dialogue - positive or negative.

P.S Your mention of amputation (when contamination feels that extreme) really struck a chord...And, like you, I stand for hours. I haven't sat down in my house for many years now.

[Jack Russell]

I can relate entirely Tricia, I had OCD for many years, counting and touching things with a good thought.

No problem I can live with those.

Was only social anxiety that was my biggest disorder.

Then one night a fly was on my bed, I swiped it away and went to sleep.

Woke up the next morning a very different person, I was utterly obsessed with contamination, thinking that fly was dirty.

My life has never been the same since, 6 years later.

All my younger life I was a tearaway, always scruffy and filthy. Grew up in a house with dogs and cats, never once having a bad experience.

That was the behavior I learnt in life. My brain just seems to forget it.

[Guest Tricia]

A fly was a big trigger for me, too, but only after the contamination fear had set in. But I fully appreciate how it could start anyone's fear.

I was still able to hang washing on the line, until I saw a fly leave a pile of dog poo next door and land on one of my clean sheets on the line. Never again have I been able to hang washing on the line...

[Sodovka]

I'm so very sorry to hear how you've been suffering, Tricia. No one deserves this disorder but it seems utterly cruel and random for some people, yourself included. I hope you can find some peace of mind at least at times.