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How do you prevent relapses?

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Hi All,

I've had a really bad episode of OCD this week and it has really scared me because I thought that the days of my OCD being all-consuming were behind me! I had a breakdown when I was 15 and the past week has been very similar- I've struggled with showering, dressing, (both of which I have done multiple times a day but with compulsions and lots of anxiety/distress); making even minor decisions and I have been repeating every routine action. The thoughts have felt too overwhelming to ignore and even when I've resisted a compulsion I've struggled with intrusive thoughts and haven't been able to distract myself from the thoughts much of the time. 

I was just wondering whether anyone has written a relapse prevention plan and whether it has helped you during 'blips'?

Edited by BelAnna

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I've had a few relapses over the years and they are never fun of course.  Here are some things I've found helpful for me:
Practice your CBT!  It can be really easy to slip out of the habit when things are going well, but the more you practice the better you'll be and you can continue to apply the priniciples outside of OCD incidents.  

  1. If you start to feel worry/anxiety creeping in,  start applying CBT techniques early.  I've often found that these flareups don't happen suddenly, its usually a slow build for one reason or another.
  2. If you are taking medication for OCD, take it regularly.  Missing a dose isn't the end of the world, but if you start to get sloppy, particularly when things are going well, it can lead to slipping under the critical threshold of what works for you.  I have a weekly pill case so I know at a glance whether or not i've taken my pills that day.  Also, take them as much on a routine as you can.  If its part of your regular pattern your less likely to forget.
  3. Be aware of situations that will make you more vulnerable such as stress and dramatic change.  It doesn't mean an OCD incident will happen, but its good to be prepared.  Make sure to give yourself the time for self care.  Even just taking a few minutes for some relaxation breathing or mindfulness meditation can help ease stress and anxiety.
  4. Diet and exercise!  You don't have to be a hard core health nut (I am definitely not) but maintaining good general health is good not just for your body but also for your mind.  Its amazing how eating even just a little bit healthier can make you feel better.
  5. Be realistic with your expectations.  Its possible after you get over a particular OCD incident you may never experience one again, and if so, thats fantastic!  But OCD is a chronic condition, so theres always a possibility of flareups.  You shouldn't spend your time fretting about the possibility of another one (that would be an obsession all on its own!) but you should be prepared to handle flareups if they do happen.  It sounds like you are taking good steps to do that and I hope my observations and experiences help.
  6. Remind yourself that you've beaten it before and you can do it again.  It can be really frustrating to end up back in the ring with OCD, but you know that its something you can overcome.  Sometimes crappy things happen to us in life, but that doesn't mean they are permanent.  Remember that OCD is very beatable and there are tons of great resources (like this site) to help you do that.  You are not alone!

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For the past few days I have been in crisis due to a collapsed ceiling mentioned in my recent thread. I am going to take on board the advice. My eating has become haphazard. Which tends to occur during crises.  I think that a relapse prevention plan tends to be an individual plan. I do not have one at the moment but I think it is a good idea. During therapy would be a good time to devise a plan. But if you have insight to your triggers then you can make a plan at any time.

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6 minutes ago, Angst said:

My eating has become haphazard. Which tends to occur during crises.

I find the same.  Given that stress can mess with your appetite I've worked on making sure I eat something, even if i'm not feeling particularly hungry.  Most of the time just eating a bit helps me to feel somewhat better.

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I'm sorry you're going through this Bel Anna. I think what dksea has outlined is really good advice. I would just say that for me, it's really helpful to make sure I don't let my daily life slip up. So you say it's difficult to shower, dress yourself etc. I think these are the things to start with - make sure you shower, dress normally, try to eat the things you normally would, make your bed, try to focus at work etc. When I feel really down, I always make sure that I have a good breakfast, shower and put on some make up. I think that if you let your physical self care slip, it'll make your mood even worse. Also, CBT - do your best to remember what you have learned and put it into practice. Don't worry, these things don't last forever and I think the first time you experience a crisis (like you did at 15) is usually the worst because you don't know what is happening and you don't have the skills to cope. Relapses feel awful, but in my experience, are never as bad as that first time. 

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If you have a copy of "Break Free From OCD" it tells you how to devise a plan, and there is a template in the appendix. 

It's copyright of course - but you might wish to buy the book anyway as it's really good CBT for OCD. 

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Thanks so much Dksea, that's really helpful. I have noticed that there might have been a few triggers for this episode so I'll try to keep those in check. 

I know that discussion of medications is generally discouraged on this forum because each individual experiences each medication differently but have you found SSRIs very helpful? I am not on medication and do wonder whether it would help me to recover. Thanks again!

Thanks so much Taurean, Malina and Angst too, for all of your help. I will take all the tips on board, I will definitely have a look at that thread too- thanks Taurean! 

I hope you get better from this crisis soon Angst, I'll see if I can find your thread too xx

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It's a contentious thing, meds - and they take a long time to build up in the system - and,ultimately, a long time withdrawal process to come off them.They are powerful drugs, often with short-term side effects which can be unpleasant and worse. They can also typically reduce libido, and one is not advised to drink alcohol when on them - though I do drink a small amount (8 units a week).

And for around 40% of OCD sufferers, they may not show any benefit. 

I was really struggling with relapses into episodes of OCD over a long period, and stuck out trying to find an SSRI that I could tolerate.

I couldn't tolerate fluoxetine - seemed to zombify me - but after a battle against the side effect of diarrhoea, eventually managed to settle on Citalopram. 

So here's the money question. Did it help re my OCD? 

It didn't resolve the constantly-repeating intrusions and the relapses. Adding mindfulness and love kindness thinking to my therapy were the gamechangers for me there. 

But it does balance out the peaks and troughs of my moods - and this seems to help my resilience. 

As I have been doing really well now for nearly two years, my doctor and I are planning a gradual withdrawal from the drug in the Spring. 

That's my warts and all view of the meds, and my own experience. 

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For me medication has been a big help, but I want to qualify that too. Because the medication was effective for me early on, with little/no side effects, I did very little on the CBT side of things. This lead to some real struggles later when I had relapses/flare ups. I wasn’t really well prepared how to handle it and they got worse than they should have. Fortunately I got the help I needed and a big part of that was learning the therapy side. Every OCD sufferer, whether they take medication or not, should embrace CBT and all it can do. 

Im still greatful for the difference medication has made in my life, it has definitely made battling my OCD easier. I don’t think there is anything wrong with considering it, but it’s good to go in to it with a clear understanding of what it can and can’t do. The results will vary from person to person and it might take awhile to see results. It’s not going to cure your OCD. It’s not magic. Make an informed decision and do what’s best for you, but don’t rely on medication alone, CBT should always be a part of your recovery. 

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