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ERP! need some help


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Today was session 5 of CBT my therapist wants to start doing graded ERP as of next week. Its been difficult establishing whether it was OCD or GAD that ive been struggling with. we have now completed a formulation which shows my avoidence of certain emotions or feelings because of my interpretation of them and then this leading to intrusions, i dont get visuals anymore just more What if questioning all the time. She wants me to get these intrusions / fears on paper so that we can work out some ERP excercises. Ive been experiencing suicidal ocd on an off for 6 months now, ive worked through almost all of the physical compulsions so its a bit difficult to get it down on paper. 

 

Anyone have any helpful suggestions or advise i dont wanna go to my session next week not having anything on paper it takes 4 buses and almost full day of travel so dont want to waste it

Edited by beckyboo
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Hi BB, 

I'm also doing ERP which is by far the hardest thing I've ever endured. I do not want to second guess your therapist because my homework is of course different. Is there no way you can contact her to get clarification? I am sure she wouldn't mind if you did.

 

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16 hours ago, beckyboo said:

Today was session 5 of CBT my therapist wants to start doing graded ERP as of next week. Its been difficult establishing whether it was OCD or GAD that ive been struggling with. we have now completed a formulation which shows my avoidence of certain emotions or feelings because of my interpretation of them and then this leading to intrusions, i dont get visuals anymore just more What if questioning all the time. She wants me to get these intrusions / fears on paper so that we can work out some ERP excercises. Ive been experiencing suicidal ocd on an off for 6 months now, ive worked through almost all of the physical compulsions so its a bit difficult to get it down on paper. 

Hi Becky, congrats on progressing with your therapy!

With ERP there are two things to consider, the reasons you feel anxiety (obsessions) the actions you take to cope with that anxiety (compulsions).  What I would recommend you do is consider these as pairs and do what you can to list them.

For example, you mention "What if" questions, a very common type of intrusive thought pattern for OCD sufferers (thats how my obsessions typically manifest as well).  So to start you could list out the most common "What if" questions you have faced recently.  Perhaps you can identify a theme to them, maybe they are health related - "what if I get AIDS", or relationship related -"What if I don't love my boyfriend", or work related - "What if i blurt out something rude in front of my boss".  Once you identify some of those, try and think about what you do in response to those actions.  Some things might be obvious, and you've talked about working through physical compulsions, but maybe there are some subtle ones you don't notice, like avoiding certain places, or certain types of objects, or certain situations.  Maybe its mental compulsions, such as rumination or reassurance seeking.  Think of what you can identify that you use as coping mechanisms for anxiety.

One more thing I want to mention, I encourage you to be open and honest with your therapist.  I dealt with a bit of suicide related OCD a while back (fear I would lose control and hurt/kill myself) and I was very very anxious about opening up to any medical professional about it for fear they would misunderstand or what not.  In the end my anxiety was so great that I went in and was honest with them.  They treated me with understanding, kindness and compassion, not judgement or fear.  While not all situations work out like that, in my experience, people in the mental health field are for the most part very dedicated individuals who genuinely want to help you.Turns out they hear scary sounding stuff like that all the time so to them it wasn't nearly as shocking as I took it.  

Anyway hope some of that helps.

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On 08/11/2018 at 05:49, dksea said:

Hi Becky, congrats on progressing with your therapy!

With ERP there are two things to consider, the reasons you feel anxiety (obsessions) the actions you take to cope with that anxiety (compulsions).  What I would recommend you do is consider these as pairs and do what you can to list them.

For example, you mention "What if" questions, a very common type of intrusive thought pattern for OCD sufferers (thats how my obsessions typically manifest as well).  So to start you could list out the most common "What if" questions you have faced recently.  Perhaps you can identify a theme to them, maybe they are health related - "what if I get AIDS", or relationship related -"What if I don't love my boyfriend", or work related - "What if i blurt out something rude in front of my boss".  Once you identify some of those, try and think about what you do in response to those actions.  Some things might be obvious, and you've talked about working through physical compulsions, but maybe there are some subtle ones you don't notice, like avoiding certain places, or certain types of objects, or certain situations.  Maybe its mental compulsions, such as rumination or reassurance seeking.  Think of what you can identify that you use as coping mechanisms for anxiety.

One more thing I want to mention, I encourage you to be open and honest with your therapist.  I dealt with a bit of suicide related OCD a while back (fear I would lose control and hurt/kill myself) and I was very very anxious about opening up to any medical professional about it for fear they would misunderstand or what not.  In the end my anxiety was so great that I went in and was honest with them.  They treated me with understanding, kindness and compassion, not judgement or fear.  While not all situations work out like that, in my experience, people in the mental health field are for the most part very dedicated individuals who genuinely want to help you.Turns out they hear scary sounding stuff like that all the time so to them it wasn't nearly as shocking as I took it.  

Anyway hope some of that helps.

This is very helpful thank you! Ive been very open and honest, always am because if i want to recover then theres no point in holding nack. I think it took a couple of weeks to acrually be comfortable with saying the word suicide out loud the very word had become quite triggering. my difficulty has been constantly trying to figure out if i was or i wasnt and all the reassurence seeking habits that come with that but also alot of doubt is it ocd or am i just in denial which is sooooooo classic of OCD. i do have mainly mental compulsions with elements of a few physical too. I just struggle to get thoughts on paper because they are very fast. 

 

Im coming to the conclusion that certain emotions or feelings trigger off the intrusions of 'im not going to be able to cope, maybe i should just have done with it or maybe me feeling like XYZ is going to lead to it. 

 

Even though i have no plan no intent and actually positivley think about the future and have goals. my therapist has said if she was concerned that she would make the neccesary calls and stop CBT. 

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My Therapist rang me back. the home work was to note down ways that i could itentionally bring on these intrutions so that we can start doing some graded ERP excercises. 

Im.still struggling with noting down triggers except when im experiencing negative feelings or emotions which then trigger the what if questioning / ruminating 

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Hoping ive understood the therapist correctly. 

So she asked me to write down ways i think.i could bring on the what If intrusions. so far i have

Reading articles about people who have completed suicide (morbid i know) 

Talking about how they must have felt or the circumstances around it. 

Just actually sitting with the thought rather than asking questions and the whole am i sucidal or not. 

Stressful situations such as arguments with someone, critisism, being unorganised or in a situation i have zero control over, tension / arguments with my partner 

Looking at trees, rope, tablets for longer periods of time 

Stand on a building roof or balcony 

Watch programmes or films that has death or sucide features (again morbid!) 

Fail or messing something up. 

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On 10/11/2018 at 14:56, dksea said:

Sounds like a pretty good list of triggers for intrusive thoughts for suicide.  I think you're on the right track.  I hope your next meeting goes well for you!

Thank you :)

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