CBT question.

[phillev]

Hi everyone, after a massive spike this time last year I am finally under a therapist for CBT and yesterday on my third session let's just say we got down to the nitty gritty involving myself having to write down something awful regarding my harm OCD. I deliberated long and hard and basically didn't write down a thought but more like something I could never do involving killing a member of my family and it's now kicked my OCD into overdrive with guilt etc and I now have to look at this for several minutes a day as homework for next week, to say I'm anxious is an understatement and any advice would be happily received thank you.

[hazydaze]

What level are you letting your anxiety get to??

My psychologist has taught me that getting to a 10 out of 10 probably won't be helpful. But you want to make sure you are getting anxious, and then you sit with those feelings until the anxiety reduces. Get yourself to an 8 or so, and sit with the anxiety until it's tolerable. Eventually whatever event was making you so anxious, in this case writing down a violent scenario, wont make you anxious. And as this happens, you can move up to more difficult things. Write down an even more violent scenario, and then once again, sit with your anxiety until it dissipates down to a 3 out of 10 or so

Edited February 19, 2020 by hazydaze

[phillev]

1 minute ago, hazydaze said:

What level are you letting your anxiety get to??

My psychologist has taught me that getting to a 10 out of 10 probably won't be helpful. But you want to make sure you are getting anxious, and then you sit with those feelings until the anxiety reduces. Get yourself to an 8 or so, and sit with the anxiety until it's tolerable. Eventually whatever event was making you so anxious, in this case writing down a violent scenario, wont make you anxious. And as this happens, you can move up to more difficult things. Write down an even more violent scenario, and then once again, sit with your anxiety until it dissipates down to a 3 out of 10 or so

Hi, I think it's the fact that while these thoughts have been in my head for as long as i can remember actually writing down a scenario about hurting a family, member has increased the OCD's ability to make me feel guilty,  what I wrote was evil but as regards my recovery probably necessary, after all writing out something ineffective will have no impact on how I react to it. My therapist said as long as whatever I wrote disgusts me my moral compass is pointing in the right direction. Does it matter though that I just wrote down a scenario rather than an intrusive thought at the time?

[hazydaze]

3 minutes ago, phillev said:

Does it matter though that I just wrote down a scenario rather than an intrusive thought at the time?

I don't believe so, as long as you are working on something that will help your general OCD. I'm sure the scenario is related to the theme you are struggling with, it is probably ok that you didn't write down your exact intrusive thought at this point. But honestly I'm not qualified to totally make that call, talk with your therapist about it. If a certain specific intrusive thought is going to shoot you to the moon with anxiety, then it's probably too soon to be doing that yet anyway is what I would think

[phillev]

Ironic that I've been doing really well with the intrusive thought side of my OCD up until I did this exercise yesterday, now its brought all the guilt/anxiety back.

[PolarBear]

Which tells you you're not over it yet. Keep on doing what you are sipposed yo do. Every day, without fail.

[dksea]

3 hours ago, phillev said:

Ironic that I've been doing really well with the intrusive thought side of my OCD up until I did this exercise yesterday, now its brought all the guilt/anxiety back.

As PB says it just demonstrates that this is still something you have to deal with.  The goal of CBT is to get to the point where encountering things related to our intrusive thoughts doesn't cause us to panic/get extreme guilt/etc. 
For example, if you asked me to write down a thought involving harm to a family member I could do it and then move on, because thats not my particular intrusive thought area.  (though I might ask you why you are asking me to write down something about harming someone out of the blue like that  ).  It doesn't mean I LIKE the idea or I want to DO the thing or anything like that, its just a thought, just a moment, it doesn't MEAN anything will or must happen.  Your goal is to get to that point too, or at least close enough to it that you can go about your life without panicking when this sort of thing pops up.

[phillev]

I think the main issue was that it wasn't a thought in my head that I wrote down but more a statement related to thoughts I've had that kicked my OCD anxiety into overdrive and the fact I used " I want to kill" which of course I don't. I realise it's going to be very hard going doing CBT and I do want to get better, after all it's the first time I've ever written anything to do with my horrible thoughts down on paper, it seems to make it horrifically real if that makes sense.

Edited February 20, 2020 by phillev

[phillev]

Still stressing, my OCD has latched onto the fact that I've written it down therefore I want to do it, I wish I'd worded it differently but I know to have the desired effect it must be a ruthless sentence otherwise there's no point in the exercise. Does anyone have any experience on here with harm OCD and CBT and having to write these awful things down, I feel very anxious looking at it every day and it doesn't seem to be deminishing.

[PolarBear]

A little ERP lesson here. There are two parts. The exposure, which you are doing. Then there is the response prevention, which means not doing compulsions.

You need to know what your usual compulsions are when you get an intrusive thought. Those are what you practice not doing after you have done the exposure.

Just doing exposures is worthless. 

Edited February 21, 2020 by PolarBear

[paradoxer]

phillev, try also to remember that the content of OCD is absolutely irrelevant. I have a disagreement with your therapist making reference to your 'moral compass'. To do so, I suggest, plays OCD's game. See my first statement re irrelevance. 

 

[phillev]

I suppose I could have written out a phrase such as "When I get home from my therapy session I could kill whoever"  but I don't think it would have been powerful enough. I made a throwaway comment at work the other week about an awkward and nasty customer saying I hope his business goes under which of course I didn't mean but I told my therapist and he told me to write it down word for word and do the same, reading it every day until the anxiety passed and within two days I was over it. Writing down I want to kill a family member has knocked me for six and I don't see a fix!

Edited February 22, 2020 by phillev

[paradoxer]

Again, as has already been alluded to, others, including myself, could write down, 'I want to kill my mother, father ...', whatever, all day, and it would be an exercise in nothing but boredom and an aching wrist. Try to see that the content means **** all. OCD picks random rubbish for the sufferer to deem 'important'. 

[phillev]

It's the typical scenario of my OCD in that it's taking everything literally including what I wrote down in that session. I know deep down I was giving my therapist an example of a horrible thought I've had or may have yet OCD twists and manipulates it to the point where I believe what I've written is actually true however rubbish it may be.

[phillev]

After another session yesterday my therapist has told me to keep doing the exposure but instead of denying to myself that it's something I'd never do instead I have to admit that it's something I could possibly do! Wow I had a little idea of CBT before I started but this is another level. Basically something I have fought for forty odd years about killing/harming people and I'm now told to do the opposite... Another anxiety filled week ahead!

[Closed for repairs]

3 hours ago, phillev said:

After another session yesterday my therapist has told me to keep doing the exposure but instead of denying to myself that it's something I'd never do instead I have to admit that it's something I could possibly do! Wow I had a little idea of CBT before I started but this is another level. Basically something I have fought for forty odd years about killing/harming people and I'm now told to do the opposite... Another anxiety filled week ahead!

It's not really doing the opposite, it's just admitting to your self that you can never be 100per cent sure, and that degree of doubt is fine.

For example I can't be totally sure that I'm not going to put this phone down and go on a mad killing spree, I'm pretty sure that's not going to happen but it's not physically impossible., But I'm fine with that.

What upsets me is the chance that I've left something switched on and it's going to cause a fire, the guy I work with shrugs and says "so what"

But I need absolute proof, so I have a phone full of pictures of switches and keys and stuff.

It's all the same thing

 

[PolarBear]

14 hours ago, phillev said:

After another session yesterday my therapist has told me to keep doing the exposure but instead of denying to myself that it's something I'd never do instead I have to admit that it's something I could possibly do! Wow I had a little idea of CBT before I started but this is another level. Basically something I have fought for forty odd years about killing/harming people and I'm now told to do the opposite... Another anxiety filled week ahead!

Perfect.

Think about this: you spent 40 years doing things one way. How did that work for you? Did you get better? No? Then maybe you were doing the wrong thing for 40 years.

[dksea]

19 hours ago, phillev said:

After another session yesterday my therapist has told me to keep doing the exposure but instead of denying to myself that it's something I'd never do instead I have to admit that it's something I could possibly do! Wow I had a little idea of CBT before I started but this is another level. Basically something I have fought for forty odd years about killing/harming people and I'm now told to do the opposite..

Yup, part of overcoming OCD is accepting the inherent uncertainty that exists in the universe.  The idea that we can ever be 100% certain about something is an illusion, a helpful illusion, but an illusion none the less.  If you asked me whether or not I would ever murder my best friend of course I would say no, why would I do that? But we can't guarantee the future, who knows what would happen!  I can come up with an endless number of "what if" scenarios that involve me killing my best friend.  Are any of them likely?  Of course not, but they are technically possible.  OCD demands absolute certainty, an impossible goal.  Accepting uncertainty undermines OCD, its the right thing to do.

[phillev]

I sound like a stuck record but the OCD is picking up on the way I wrote down the thought " I WANT to kill my wife when I get home from therapy" I know full well in my head as I was writing it I was denying it.... Wrong again I know but it's so hard for me personally to break down that train of thought. OCD tells me I want to kill people but I know full well I don't. I feel like throwing it all in I'm totally drained!

[dksea]

1 hour ago, phillev said:

I sound like a stuck record but the OCD is picking up on the way I wrote down the thought " I WANT to kill my wife when I get home from therapy" I know full well in my head as I was writing it I was denying it.... Wrong again I know but it's so hard for me personally to break down that train of thought. OCD tells me I want to kill people but I know full well I don't. I feel like throwing it all in I'm totally drained!

I know its scary and hard, but its important to remind yourself that having a thought doesn't mean wanting to do a thing, and wanting to do a thing doesn't mean you have no choice but to do a thing.

I have had the thought (while driving!) of suddenly swerving on to the sidewalk and mowing over pedestrians.  That image has literally popped up in to my head.  Who knows why.  Maybe its from seeing it in a movie or video game.  Maybe its from a news report.  Maybe its because of the simple physics involved.  Regardless of the reason I didn't give it much thought because OCD didn't latch on (luckily) and the idea was treated as it should be, just a silly thought.  I can think it, I can think, imagine, visualize a bad thing, but it doesn't ACTUALLY make that thing happen or even mean I *WANT* to do it.

What about things I DO want to do?  There is a very attractive woman in my office (well many of them in fact, but lets focus).  I would love to make out with her, I would love to do more than make out with her.  Guess what?  I haven't done that.  Even though I know it would be enjoyable (for me at least) I don't do it.  Why?  For any number of reasons.  Work place sexual harassment policies, not wanting to be a bad person, shyness, etc.  Even though its something I would very much like to do, it doesn't mean I'm destined to do it.

All of the above is a reminder that a thought is just a thought.  You don't HAVE to treat it as important.  Its hard when OCD is at play, true, but you need to work on accepting that you can have these thoughts and it doesn't mean anything.  Right now I'm guessing you are still fighting very hard against even the idea of having the thought.  Its ok to have the thought, it doesn't mean you want to kill your wife.  It doesn't mean you will kill your wife. I can't prove it will never happen, but I'm gonna say the odds are slim.   You had this thought, thats ok, you aren't doing anything wrong.  Work on being ok having the thought, it doesn't mean anything about you as a person to have the thought.  

[paradoxer]

22 hours ago, phillev said:

I sound like a stuck record but the OCD is picking up on the way I wrote down the thought " I WANT to kill my wife when I get home from therapy" I know full well in my head as I was writing it I was denying it.... Wrong again I know but it's so hard for me personally to break down that train of thought. OCD tells me I want to kill people but I know full well I don't. I feel like throwing it all in I'm totally drained!

Every time you desperately try to reject or fight the thoughts, you give them importance. You send yourself a message that they matter. They don't. Accept the thoughts. or if you're feeling daring, up the ante, tell yourself yourself you 'want' to kill your wife, and throw in a few other people too. 

In my experience when OCD feels threatened e.g. the fact that you're doing therapy, it'll kick back with vengeance. Make that the disorder's desperation, not yours.  

[phillev]

Thanks for all the replies I really appreciate all the effort everyone puts out on this forum, but how do you cope with the guilt that CBT throws up? especially after your post telling me to do that paradoxa, that's scary. My therapist didn't seem to get that the OCD has taken a task he's given me and turned it into an obsession, I personally think he's underestimated it's hold over me.

Edited February 28, 2020 by phillev

[PolarBear]

It was already an obsession of yours. Rather than have it pop up unannounced, you are forcing it to appear at a time of your choosing.

It is ctitical, however, that once you expose yourself to the obsession, that you refrain from your usual compulsions. 

You expose yourself, by saying the words, over and over. Your anxiety rises. That's good. You sit with the words floating in your head. You don't analyze them. You don't try to figure out if they're true or not. You sit with them floating around for 5 or 10 minutes. Then you get up and get on with your day, whatever that may be.

You do this every day. Twice a day would be better. Be relentless.

It will take time for you to get it right. Once you do, you will begin to notice that your anxiety level does not go up so high when you do the exposure and it will return to normal quicker and quicker, without doing compulsions.