How do you maintain CBT strategies when you go it alone?

[Guest Clarity35]

I have just joined the forum today. I have been diagnosed with OCD for 3 years now but it was always there just not in its present debilitating form. I battle with the idea of contamination..esp blood related. My first devastating trigger was walking in Edinburgh at night and coming across blood on the pavement that I was upon before I realised which was the start of a hellish 3 years.  I have been for CBT and my therapist was great but the treatment only lasted for 10 weeks as he was a PHD student and his placement came to an end before I felt ready. I have been trying to implement what I learned but it requires such motivation and strength...which are the first things to leave you when you are in a heightened state of anxiety and your mind and stomach are churning! I have had a major set back last week ( blood on the toilet floor at motorway services and having to negotiate my way through it and don't know if I stepped in it) and I feel stuck...I had to bin my shoes...but of course that has made everything else feel more dangerous...I am  trying to resist the temptation to clean everything and remind myself of the strategies I should use...It is so very difficult and exhausting. I would like to hear is others have managed to overcome such feelings and carried out stategies, resist cleaning even though you feel at risk if you don't...how do you fight it?

[Gemma7]

Hi Clarity welcome to the forum

Sorry to hear you are having such a hard time at the moment. Was your last therapist via the NHS and have you been referred by your doctor for CBT? 

Self-help is hard and you definitely would benefit from a therapist but if that isn't an option, 'Break free from OCD' is probably the best cbt self-help book. There is also an OCD UK Edinburgh support group if that is where you are based

[Guest Clarity35]

Thanks so much for your reply and letting me know about the Edinburgh support group. Yes, I was referred by my GP for CBT. The thing is I really feel like I understand the 'academic' side of OCD...I know the cycle I'm trapped in...I know what I need to do to break it, although sometimes those lines are blurred by panic...I just need to be strong enough to carry out my strategies and let myself feel the anxiety but not follow up with compulsive behaviour...it's just so hard.

[Ashley]

Hiya Clarity,

Do you still have the shoes in a bin somewhere or are they gone now?

It's good that you felt ready to go it alone, often people feel a little lost when they suddenly leave their therapist. Have  you been proactively doing any therapy exposure exercises since you finished therapy?

When the anxiety starts after an obsession trigger it can be hard how to deal, I would refocus by calling a friend (and chatting about anything but OCD) and sometimes at the end of the call my anxiety had come down enough not to resort in a cleaning compulsion.

Like you I know 'what' to do, but sometimes knowing and doing are two different things and on my last exposure it took me a few months to build up to do that.

I suppose the best advice I can think of when the panic of an obsessive thought starts to perhaps if possible try and take a step back, focus on breathing and just take a moment to focus on your surroundings and calm yourself down to see if you can move forward without a physical or mental compulsion.

If not, then later re-stock and think about what you could try and do next time.

 

[Guest Clarity35]

Hi Ashley, 

Thank you for your reply. Having just found this forum today and am already feeling the benefit of knowing I am not alone.

Yes, the shoes are outside in the blue bin. I took a step inside my house and froze to the spot, had to take them off and my husband put them in the bin. We both know it wasn't the correct action but he has never seen me i n such a state and think he got a fright. Last time this happened was 3 years ago and I was trapped inside my house not knowing where I was 'safe' to stand, was having to jump over my last 3 stairs...it was awful and I was panicking that it was happening all over again.  

Thank you for your words of advice.

[paradoxer]

Clarity, firstly I'd say don't beat yourself up for yielding  (sometimes when that giant rubber band swoops down and yanks at you it's not always easy to not respond with a ritual. I'd say try and see this as a chance to 'regroup' - as a way to prepare for next time. Focus on all the successes you've had in combating the disorder. And keep trying to resist the urge to clean everything, the 'comfort' will only be fleeting, and will only get you into deeper trouble. As for how others avoid ritualizing? The answer - I think you know is a simple and tough one. Willpower (and a cognitive knowledge that avoiding a compulsion is for the greater good). But then offering advice is the easy part! All the best. 

    

[onepunch]

14 hours ago, Clarity35 said:

I have just joined the forum today. I have been diagnosed with OCD for 3 years now but it was always there just not in its present debilitating form. I battle with the idea of contamination..esp blood related. My first devastating trigger was walking in Edinburgh at night and coming across blood on the pavement that I was upon before I realised which was the start of a hellish 3 years.  I have been for CBT and my therapist was great but the treatment only lasted for 10 weeks as he was a PHD student and his placement came to an end before I felt ready. I have been trying to implement what I learned but it requires such motivation and strength...which are the first things to leave you when you are in a heightened state of anxiety and your mind and stomach are churning! I have had a major set back last week ( blood on the toilet floor at motorway services and having to negotiate my way through it and don't know if I stepped in it) and I feel stuck...I had to bin my shoes...but of course that has made everything else feel more dangerous...I am  trying to resist the temptation to clean everything and remind myself of the strategies I should use...It is so very difficult and exhausting. I would like to hear is others have managed to overcome such feelings and carried out stategies, resist cleaning even though you feel at risk if you don't...how do you fight it?

I also have contamination OCD. I know it can be really hard at times, especially when you already know the tools but the anxiety is just too overwhelming. The strategy that I use which usually works well for me is whenever I have an obsessive thought that is just too strong and I feel a strong urge to wash my hands or clean things, I do my best to delay performing the compulsion for at least 20 minutes. That means I give myself 20 minutes of free time to focus on other things besides the thought. Once the 20 minutes is up,  I delay it for another 30 minutes. Once that 30 min mark is up, I delay doing the compulsion for another hour. After the hour is up, I usually wait to see how I feel. If I feel the anxiety has gone down, I am able to delay doing the compulsion for a longer time. And then when I feel like I am ready, that is when I start doing exposure and repeat the delay strategy since doing exposure therapy will trigger anxiety again. The important concept here is to delay doing the compulsion in increments. That way you ease into it until you have enough courage to start doing exposure exercises. 

 

EDIT: I forgot to mention one thing; the better you are at focusing on other things besides the obsession during the delay, then the anxiety will usually go away quicker. During the delay if you continue to focus on the obsessive thought and over-analyze or think deeply about it (which is still considered an compulsion) then this technique won't work. The trick is to let the thought stay in your head in the background but focus on other things. If you allow the obsessive thought to be your main focus during the delay, then the anxiety won't go away. Hope this helps

Edited July 9, 2016 by onepunch

[lilyflower]

Hi Clarity!  I just recently found this forum and am so grateful I did.  I had blood related ocd for a long time and it was so severe I couldn't go grocery shopping, I would

have to send my kids for me.  I thought I saw blood everywhere and then there was always the thought, well, what IF there is blood, its red so maybe.    So yes, I totally understand you and

at what point you are at.  I threw out many, many things.  What helped me is speaking to a therapist and doing thought records.  You have to discuss what exactly about the

blood it is you fear and then learn why your thoughts are distorted.   I had to do this for a long time.  Then finally the fear started to subside.  

Please find a good therapist who specializes in ocd.  This will help you in your recovery. 

The hardest part of  ocd is challenging the thought to perform a compulsion when the anxiety strikes. With ocd, an obsession, which is blood contamination in this case, is followed by feelings of extreme fear/anxiety and then ultimately the need to perform the compulsion.  So the challenge for us is to feel the fear and not go thru with the compulsion.   The feeling anxiety provokes (panic, fear, sweating, mind racing etc.) sends signals that there is real danger in the obsessional thought.  This is the hard part of challenging the obession.  So what was helpful for me was to learn about distorted thinking and then labelling the thought as ocd.

Clarity, I always joke with my therapists saying I could teach classes on ocd.  So yes, knowledge of ocd is a must, but that is not enough.  You need to find what type of therapy is most helpful for you and start your journey.   

  

Edited July 9, 2016 by lilyflower

[Guest Clarity35]

Thank you Paradoxer, Onepunch and Lilyflower for your understanding and advice. I have started a little journal for myself and have written down your tips for powering on through the anxiety. The main messages I have taken are to try to refocus, delay behaviours, try not to get caught up in the obsessive thought - which I do often and never realised that in itself was a compulsion, thank you for making me aware of this, Onepunch. 

Exposure is something I haven't really been doing..but I do recall when I have my therapy I had to sit and hold the things I perceived to be contaminated and not wash my hands...is this what you mean?

So for example, after coming into the house with my 'contaminated' shoes and worrying about what door handles I touched, instead of cleaning I should be forcing myself to touch them and then try to carry on with my day without hand washing or cleaning? ....even if I want to iron my clothes and bed sheets...cause that does panic me..

[onepunch]

12 hours ago, Clarity35 said:

Thank you Paradoxer, Onepunch and Lilyflower for your understanding and advice. I have started a little journal for myself and have written down your tips for powering on through the anxiety. The main messages I have taken are to try to refocus, delay behaviours, try not to get caught up in the obsessive thought - which I do often and never realised that in itself was a compulsion, thank you for making me aware of this, Onepunch. 

Exposure is something I haven't really been doing..but I do recall when I have my therapy I had to sit and hold the things I perceived to be contaminated and not wash my hands...is this what you mean?

So for example, after coming into the house with my 'contaminated' shoes and worrying about what door handles I touched, instead of cleaning I should be forcing myself to touch them and then try to carry on with my day without hand washing or cleaning? ....even if I want to iron my clothes and bed sheets...cause that does panic me..

Yes. That is exactly what I mean. Exposure is exposing yourself to the feared objects/stimuli repeatedly, while at the same time resisting all compulsive urges until the anxiety fades away on its own. I am glad that you're aware that getting caught up in the obsessive thought will only give power to it. That's a big step!