Remote CBT / ERP Experiment

[constantly2curious :)]

Does anyone have guidance on doing an exposure experiment when it is not possible to physically expose yourself to the trigger? Are there any resources people can recommend? I am doing CBT at the moment and some of the items on my fear hierarchy relate to the location where an assault took place, but I no longer live in that country and with COVID-19 travel restrictions in place, travelling back there is not a possibility now anyway.

I guess other people may face a similar challenge now for challenging their fears, for example if public transport was one and now we are advised not to use public transport unless you are an essential worker, etc. 

I did ask my therapist how we could tackle these items but they seemed to be drawing a blank. Hopefully they have had some ideas by our next session. Thanks!

[Ashley]

I am happy to ask this question of a therapist (specialist) friend to see what they would suggest if you would like me to?     But off top of my head, exposures could be:

• Use Google Street view to look at the place if possible
• If there are photographs, look at those to trigger thoughts multiple times a day (but not respond to them of course)
• Writing the name of the place or the assault (whichever is the biggest trigger) and looking at that bit of paper hourly.  Even say the name of the place out loud if you need to too.

On another note, if at the next session the therapist as not gone away and done some research to come up with their own list of therapy examples for you, I would sack the therapist if private, if NHS I would ask to be escalated (blame me for recommending it if you need to).

 

[constantly2curious :)]

1 hour ago, Ashley said:

I am happy to ask this question of a therapist (specialist) friend to see what they would suggest if you would like me to?     But off top of my head, exposures could be:

• Use Google Street view to look at the place if possible
• If there are photographs, look at those to trigger thoughts multiple times a day (but not respond to them of course)
• Writing the name of the place or the assault (whichever is the biggest trigger) and looking at that bit of paper hourly.  Even say the name of the place out loud if you need to too.

On another note, if at the next session the therapist as not gone away and done some research to come up with their own list of therapy examples for you, I would sack the therapist if private, if NHS I would ask to be escalated (blame me for recommending it if you need to).

 

Thanks Ashley. If you could ask your therapist friend that would be great. Unfortunately I can’t see the exact location of the assault using google street view or photographs - I’ve searched online and already tried. 

Do you know of (or your therapist friend) know of any therapists that work with/in relation to trauma and potential OCD as an outcome of that? Or know of any good resources they could recommend? If it makes any difference, I was indecently assaulted.

I have seen two people many years ago closer to the time of the assault and the first one thought I had PTSD OCD resulting from the assault. I definitely have had hyper-vigilance since. 

After the assault I was very anxious, but I didn’t have OCD symptoms initially. Then subsequently I saw the perpetrator again and “triggered” so to speak and I guess I didn’t feel safe because I could see them again at any time, which was out of my control. I wanted to get rid of everything related to the assault and there was a process of washing involved with that so everyone subsequently jumped on it as OCD and treating that and left behind treatment for the actual trauma that I feel was the cause of the problem.

For me everything has always had a link back to my assault and anything to do with the perpetrator and location of the assault. I’ve already challenged some of the remaining habits that became a part of life as an outcome of surviving 3.5 years of going back to the grounds where the assault happened (but not the specific location of the assault).

Now I feel the greatest fear is triggering and feeling as bad/anxious and out of control as I did at the time of seeing the perpetrator for a second time after the assault when things got crazy (self fulfilling prophecy there potentially ). I have seen the perpetrator in the distance multiple times since (unfortunately where I am from is not a large city like London) and get instantly anxious, but it hasn’t always caused compulsive behaviour subsequently.  Hence my dilemma.

I want to be free of this for good and so I know it is important to challenge the location of the assault ultimately so want to make sure I am working with someone who can do this remotely given the actual location is not an option right now.

Thanks for your help.

 

[constantly2curious :)]

On 15/05/2020 at 10:03, Ashley said:

If there are photographs, look at those to trigger thoughts multiple times a day (but not respond to them of course)

Thought about this suggestion a bit more and I’m getting some family to take some pictures of the area and send them to me so I can have this as one option for exposure. Thanks!

[constantly2curious :)]

On 15/05/2020 at 10:03, Ashley said:

I am happy to ask this question of a therapist (specialist) friend to see what they would suggest if you would like me to?     

Any luck speaking to your therapist friend Ashley? TIA

[dksea]

Hi @constantly2curious :), sorry for the trauma you went through and the resulting issues, it sounds very much like PTSD rather than OCD, though ERP and CBT can be used to treat both of course. Ashley gave some good ideas, I just wanted to add one more, and that's imaginal exposure.  In situations where its not possible/safe to do an in person exposure, coming up with a scenario and imagining it in your head can also work.  As long as you can generate anxiety related to the intrusive thought/memory you can use it for ERP.  Imaginal exposure can also be done gradually like other ERP, you can start with a more general/less intense scenario and work your way towards more specific/intense scenarios over time. Variations would include writing out and then reading and reading the scenario or recording yourself describing the scenario and listening to it repeatedly during your ERP session.  You can always run these ideas by your therapist of course to make sure everyone is on the same page.  Hope that helps and hope you feel better soon!

[constantly2curious :)]

Thanks dksea for your reply. I feel it is more PTSD but now everyone runs down the OCD route it’s hard to shift it. It feels like my therapist is a little stuck themselves in that they have a way they want to operate/process they feel compelled to do, so it isn’t flexing for the situation - I’m not talking about exposures specifically. Almost like they are also stuck having to do things a certain way themselves or they get an idea of what they think is my belief and don’t fully comprehend it. I don’t know how to explain it but the relationship doesn’t feel 100% right. I’ve seen other therapists for non-OCD things and it seems to flow and work a lot better. I asked in the follow up appointment about challenging things remotely and they were saying there wasn’t really a way to do it until I challenged about imaginable exposure and the images idea etc. so I’m a bit concerned that it would be a waste of time to continue down this path and may be better to push for a change in therapist. I know I tend to avoid conflict so looks like one difficult conversation ahead....