It’s a whiteknuckle ride

I came across an expression the other day which I absolutely loved. It was this: “white knuckling your way through an exposure” (found in this post by Angie)

It summed up something that I’d been thinking about in relation to exposures but I’d never heard mentioned in great detail. Having said that I think it could be the key to why a lot of treatment doesn’t work as adequately as it could.

So what is “whiteknuckling” your way through an exposure?

I became aware of it through a friend who is also undertaking ERP (Exposure Response Prevention) for her OCD. She was describing doing exposures but explaining that it all felt rather perfunctory. Whilst I heard her talk about the imagery scripting she was having to do it sounded as if she had very little anxiety from it. It was like she was doing it as a rather academic exercise but not really connecting with it. Once she described this I began to honestly reflect on some of my exposures and I remembered that I’d “whiteknuckled” my way through some of them too.

In my experience I didn’t always fully commit to the uncertainty and the exercise (sorry CBT therapist). In fairness to myself I did become aware of this but I never had a word to describe what I’d been doing.

Now I do. And it’s “whiteknuckling”. Whiteknuckling in my mind is doing your exposure but not really “being there” either. It’s doing an exposure but detaching yourself from what is going on. My friend spoke of not really believing it’s OCD so half heartedly doing the exercise fully expecting to have to “figure it all out” later. It’s gritting your teeth and kind of telling yourself that maybe you’ll believe that you’re contaminated/a paeodphile all the while telling yourself that you’ll keep checking later.

So now we’re aware that we all whiteknuckle our way through some of our exposures (we all do right?) what can we do to address this.

The first one is showing up wholeheartedly to whatever exposure it is. Really connect to whatever it is you’re doing; if it’s writing an imaginal script really embody the words that you’re writing. It’s no good writing it as if you were writing your times tables. You have to really step inside the script.
If you’re having to contaminate yourself with dirt then really smear it on and commit to the belief that you might be really truly dirty and so on.

Secondly, check your breathing. If you’re holding your breath then it might be a clue that you’re whiteknuckling through an exposure. When we hold our breath tightly then we’re often not really allowing ourselves to feel whatever sensations may arise (usually terrifying anxiety). I can remember having to look at pictures in magazines of children and kind of holding my breath and crossing my legs whilst I did it. I was doing my exposure right? Wrong, I was squinting at a picture but with one eye on the exposure whilst the other part of me looked in the other direction (metaphorically speaking).

Thirdly, be honest with your therapist if this is what you are doing. They may have some things they want to try to help you truly commit to the task at hand.

And remember it’s not about getting an exposure 100% right but it is about being honest with ourselves and getting down and dirty with exposure.

Any thoughts? Anyone else identify with whiteknuckling?

Emily x

 

Compulsive habits

When I was a teenager I had contamination fears. To deal with these I came up with some rituals which helped ease my mind. I was never an excessive hand washer particularly but I had other little routines to enable me to do things such as use a public toilet. Over the years my contamination obsession faded away, to be replaced with other more intense obsessions, but my toilet routines remained – except now they were just re-labelled as “quirky habits”. They weren’t extreme, they didn’t take up hours of my day and I wasn’t particularly distressed by it but I still needed to do them in order to be comfortable in certain hygiene scenarios.

I got thinking about these “habits” towards the end of my CBT and ERP. I think it could be an important part of CBT that when identifying your compulsions, that a good look is taken at “habits” that slip through because they’ve been given a more palatable name. Rightly so, in CBT I focused on my extreme compulsions related to my more current obsessions, that were taking up hours of my time. But now I am no longer having regular CBT I have decided that a useful next step is to challenge some of my other old ingrained beliefs and “habits”. This weekend, we have people to stay and I am doing some exposures around using the toilet when I know that strangers (I don’t know these people very well) have used it. How do I know it’s an exposure? Because not doing my usual “habits” leaves me feeling pretty uncomfortable. My anxiety isn’t through the roof but I’m left with a lingering feeling that something isn’t “right”. So those compulsions all those years ago (15 years ago!) that just became a habit? Turns out they’re just compulsions by another name. They’re ideas and beliefs that I never challenged. 15 years on it’s just a fact in my mind that I can’t touch the flush with my bare hand and so on. Yes, it’s very mild and yes a lot of people who don’t have OCD may have certain things they will and won’t do in a public toilet but why not challenge it? Why let OCD have the final say?

Emily x

“Something good comes with the bad, A song’s never just sad, There’s hope, There’s a silver lining…”

I’ve been thinking about silver linings a lot recently. It helps that I love this song by First Aid Kit quoted in the title. It was then suggested as a blog hop topic too by @FightAgainstOCD

It has always seemed a complete anathema to me that there could be anything positive about OCD. It felt a bit like saying that Hitler was just a bit misunderstood. OCD – you know the monster that convinces you that you’re some sexual deviant harbouring murderous tendancies that’s also likely to contract HIV, nope not much fun to be had in any of that. Let me be clear, having OCD is miserable, I would never try and argue otherwise, but since recovering I have grudgingly started to see some silver linings.

1) My blog – I have always thought that I like to write and would like to do more of it. It’s been the kind of thing that I’ve told myself throughout my life, a fact about me, as true as I’d like to do an open mic night and I’d like to dye my hair a brilliant red. All of which have never happened. If it wasn’t for OCD and anxiety I would never have set up a blog, I would never have started writing regularly and as much as it pains me to say it I am kind of thankful for that.

2) Support network  – Through having the blog I went on to set up a twitter account. I have connected with an amazing twitter community and have met some lovely people (some in person and some online).  I would never have known that lots of other people have the same thoughts as me and that there’s a whole little community if OCD hadn’t reared it’s head and pushed me in that direction. I can’t honestly say it’s been all awful when I’ve met such wonderful people who have really made a difference. Actually scrap that, I can say it’s been awful but it’s been made a whole lot better by the lovely people out there. I actually wouldn’t change that for the world.

3) I have learnt to say “No” – I’ve always been someone who thought that I ‘should’ be doing various things in my life. I’ve never been good at saying no to invitations or truth be told putting myself first. Last year that all changed. I was forced to re-consider my priorities, figure out what I did and didn’t like doing and what felt right for me. This came about through duress, anxiety made it impossible for me to do all the things I had done previously but actually I’m realizing that something good has come of this. I’m now able to say no with few qualms to things I don’t fancy doing and without feeling like I’m missing out. I put my health and well-being first so if something doesn’t feel right for me I am able to choose. Anxiety and OCD pushed me to the edges of myself but with that has come a greater understanding of who I want to be.

4) Mindfulness – I’d always had a fleeting interest in meditation (in the same way that I’ve decided I’m going to become an epic knitter only for it to be discarded after a few half-hearted attempts). When my anxiety and OCD reared it’s head I decided out of desperation to give it another go and so has begun what I really think will be a life long daily practice. It has taught me more about myself than I imagined it would and has given me a quiet confidence that I have the answers within. It has helped with tackling the cycles of rumination and compulsions beloved to an OCD sufferer. Not only that but it has given me a new career route – I have decided that I would like to train in facilitating Mindfulness-Based Cognitive Therapy groups and am currently going through the necessary steps to start this. This will complement the work that I already do but now I will be able to do something that is a passion. It got me out of the house when I couldn’t face doing anything as the only thing that didn’t seem too daunting was sitting in a group of people who smile serenely and don’t say anything to you! In the same way that I have learnt to say no, through mindfulness I have also learnt the simple pleasure of just ‘being’. I love sitting quietly these days and have shaken off the false ideas I had that to live a happy life I must always be constantly busy, always on the go. By going through the experience of having a mind that has been filled minute to minute with horror, like a record stuck on the worst bit of the song, I now have glorious minutes where there is just peace and quiet and whereas peace and quiet perhaps once struck me as a bit dull it is now music to my ears.

It is as if now I have known absolute misery I can know absolute happiness. Mindfulness helps me see those moments. I notice and observe things in more detail; objects, views, music – things that previously I may not have paid much attention to I now enjoy with the pleasure of a thirsty person coming across water. Rose Bretecher sums it up perfectly for me (and more eloquently than I could ever hope to) in her article for the Guardian when she says:
“If it wasn’t for the comparative cacophony of pure O, I wonder, would these moments feel so impossibly beautiful in their sheer, simple unthinkingness?”

Emily x

“The only thing we have to fear is fear itself” – Roosevelt

 

I have a fear of relapse.

There I’ve said it. Not all of recovering from OCD/anxiety is smooth sailing. It seems to be the case that the more I head towards recovery, the greater my fear of relapse is. I have more to lose now it seems than when I was only at the beginning – there is further for me to fall. I have a bad day and I become convinced and anxious that I am slip sliding my way back into the pile of mud at the bottom of the slide. It reminds me of the game ‘Snakes and Ladders’ that I used to play as a child – move forward a couple of spaces and before you knew it you’d landed on a snake fast on your way back to the bottom of the board.

It terrifies me that my brain could go back to where it was and not to really know what may set it off.  It scares me that my brain can do as it pleases without a heads-up (surely it would have just been common courtesy to warn me what it was planning?!). What really terrifies me is that I feel that I can’t trust my mind. I have spent quite a long time trying to work out what caused my OCD to escalate so badly. I analyse all that was going on in my life at the time and for a while I have made changes according to that. Perhaps it was the friends I was socialising with at the time. Simple, I just won’t see them. Stress at work? I’ll just do the bare minimum to keep stress levels low. Flat situation getting me down? I moved out and in somewhere else. I have fortunately reached a point where I have realised that this perhaps isn’t the healthiest of mechanisms. Of course it’s useful to look at where you can make positive changes in your life and I actually think moving out of a slightly toxic flat situation probably did help. But what I’ve really realised is that this fear of relapse is all part of my OCD thinking. I want 100% certainty that I won’t relapse. I want an absolute answer as to what caused my OCD and really what I know (I should know) after months and months of CBT is that maybe I have to be able to tolerate the uncertainty. Maybe I will have another OCD struggle on my hands in the future. Maybe I will face more stress that might trigger another OCD outburst. Maybe just maybe I’ve done enough work (emotionally/psychologically) to stand me in good stead. So what I keep trying to remind myself is that if I can’t ever really know for sure then maybe there’s just no point in worrying about it at all. 

Emily x

 

What’s in your tool kit?

As I’ve been winding down my CBT therapy my therapist keeps saying to me “you have all the tools you need” and you’ve got a number of “tools at your fingertips”. I quite like imagining that I’ve got an actual tool bag that I can carry around at all times and so it got me thinking about what’s in it to help me overcome my Generalised Anxiety Disorder (GAD) and Obsessive Compulsive Disorder (OCD).

I have found that thinking about this has actually helped me feel more confident about facing the future without having regular therapy (which after all can be a daunting prospect and may be an entirely separate blog post!).

So here are the tools that I will be turning to again and again as I navigate my way forward.

Professional help: Knowing when to access professional help is really key. I know that it can be difficult to accept that things have gotten to a point where outside help is needed but to be honest I think if the insight is there that this is a problem that isn’t going away then you’re half way there. Helping yourself through accessing professional help is a really powerful tool (It’s the equivalent of a power saw in my kit!). We all deserve to feel better and that first step in reaching out for professional help will tell yourself that you matter. I also know that if in the future things become difficult that that resource is always there and that is what it is there for. It is not ‘bothering people’ or ‘weak’, it is necessary and a large part of recovery. I will be using all my CBT lessons as time goes on including worry postponement, exposure techniques and more (this will also be a separate blog post!)

Walking: At the beginning of the year when things were starting to fall apart I started to walk. I walked through my lunch breaks at work and I walked in the evenings until I could walk no more. I only ever started to feel settled and soothed when I walked. I don’t know about you but when I am highly anxious I start to feel like my head is separating from my body and is drifting off up towards the clouds. Walking helps me to feel grounded. It also releases endorphins which is vital for mental health but was a good compromise at a time when I didn’t have the energy to run or do anything that required anything more than putting one foot in front of the other.

Exercise: This has only become relevant since I’ve started to feel better and have regained some strength. When I am highly anxious I cannot eat and I often vomit through panic. Please don’t exercise if you are in this state as it will make you feel worse. However, now that I have a full appetite exercise is a vital part of my week. Sometimes it’s a jog, sometime’s it’s a cheesy aerobics class, sometimes it’s yoga – it doesn’t really matter what it is –  it just helps to be out and about in the real world. I am distracted from my thoughts and my worries when I am doing exercise and doing a class of some kind often lifts the spirits. As long as it puts a smile on your face then do it.

Meditation: In all of my frantic researching about “cures” for anxiety and OCD I came to mindfulness meditation. A staple of recovering from OCD and anxiety is to realise that you are not your thoughts and your thoughts are not you and guess what mindfulness meditation says…. yep you’ve guessed it our thoughts are not facts. Through mindfulness meditation I have learnt how to better watch my thoughts rather than getting tangled up in them and then convincing myself that to untie the knot I need to “figure out” the solution. There is no solution and if you’ll let them thoughts will just pass on by like clouds in the sky. I also find that meditation helps me to sleep which can be an errant friend when anxiety strikes.

As I write I realise there are so many other things that I have learnt and picked up along the way. Plenty of sleep, good diet, natural remedies such as Rescue Remedy to settle the anxious feelings in the stomach, being outside in the natural world, writing, and sometimes the hardest one of all… feeling the fear and doing it anyway!

So what about you…. what’s in your tool bag?

solar tool bag

Image courtesy of Daniel on Flickr

OCD

I’ve been wanting to write a post about OCD for a while now. I always talk about anxiety but OCD deserves a post all of it’s own it’s such a nightmare.

OCD is so hard to explain to someone that doesn’t have it and to be honest I struggle to get my head around it too. I really want to emphasise that I can’t talk about other people’s experiences of OCD as even from looking at other people’s blogs I can see that it affects people in such different ways, although all just as horrendous the next.

The first thing I want to say is that OCD is a b**ch. There’s no other way to describe it except to say that it’s a clever, conniving trickster that plays with people’s minds.

OK now we have that introduction out of the way, here’s a little bit about my own experience with OCD.
I have had it since I was young (hindsight is a beautiful thing I obviously didn’t realise this is what it was at the time). I am lucky, (if I can use that word in relation to this) in that my OCD has come and gone over the years. It appears that in my case it’s related to stress so I fall headlong into it when other things in my life are stressing me out which is why since the beginning of the year it’s been particularly bad.
I have gone through a range of the classic OCD worries including worrying as a teenager about losing control of myself around knives. Then I moved onto a fear of contamination particularly in relation to dirty needles and HIV. Walks in the park were anxiety provoking as was walking barefoot on a beach, in fact what am I talking about? I didn’t do that for the longest time.
I remember going on a school trip abroad and someone asking me before we went if I was looking forward to it. My response? “No not really, I’m worried there will be needles there”. Not every child’s average answer in relation to a holiday.

For the most part, I have a type of OCD also known as ‘Pure O’, there are no obvious compulsions although I do actually have checking behaviours which I will talk about more in a minute but they can’t be seen so anyone looking at me would probably not really know anything was wrong (except maybe for a look of frozen panic on my face). Pure O tends to be having really awful, intrusive thoughts often driven by a fear of being a bad person or being responsible for something.
It’s described on the OCD UK website as: “Pure-O is a form of OCD in which sufferers are plagued by unwanted, troublesome thoughts that they despise beyond measure”.

I would like to be able to describe to you some of my own current ‘Pure O’ thoughts but unfortunately because the nature of them is so awful – so shame inducing my OCD tells me that it wouldn’t be a good idea to put it on the internet because other people might believe it of me and then what would happen (never mind that I write under a pseudonym, OCD doesn’t work with that kind of logic).
See people with OCD are often aware that the thinking is skewed –  that the things they worry about are highly improbable but it’s the element of doubt that it feeds on. OCD LOVES doubt and uncertainty, they’re best friends in it’s little game.

I’ll give you one example of a Pure-O thought, it’s not one of my own – I know this lets OCD have the power but I don’t feel able to just yet. However, this is one I can relate to and can imagine how it goes. I know that some people worry incessantly about whether or not they may have killed someone and just don’t remember doing it or didn’t realise they did it. This is exactly how OCD works –  it’s the “What if?” part of it.
I’m sure other people who don’t have OCD are wondering how you can worry about something that quite clearly isn’t true. Well believe me you can, I know that I can ruminate for hours just searching for that elusive certainty, to eradicate all doubt.
And that my friends is my compulsion. With a lot of my OCD fears I will sit and rake through my memory, sift through all happenings in my life. For others the compulsion might be physically checking something, so they might repeat the car journey a hundred times over just to be absolutely sure they didn’t hit anybody. Most of my compulsions are mind based although not all. I can be having a conversation with a friend but all the while mentally searching, searching for something, anything.
People might think that doesn’t sound so bad just searching through a few memories but I cannot emphasise how anxiety provoking and tiring it is. This is not just me having a tea break at work and thinking maybe I’ll just scan my memory now – this is all the time, all the hours of the day, sorting through all my memories even from when I was a small child –  and if I can’t remember things from when I was a small child well I’ll be damned if that will let that stop me. I have spent days at a time just focusing on one of my obsessive worries and trying to work out if it could be true.
OCD can also often lead to a lot of avoidant behaviours so for example someone might avoid their car or they might avoid being around knives. See how it escalates until it’s strangling your existence within an inch of it’s own life?

So here is my example of a Pure O obsession. I’m going to use the example of whether or not I killed somebody, just because it’s not a worry I’ve had so I feel more comfortable putting it out there but you can pretty much insert any awful, abhorrent thought into this dialogue.

OCD: Hey here’s a thought, what if you killed someone and you didn’t realise you’d done it.
Me: Well that’s crazy I would remember how could I not?
OCD: Well you know it’s possible that you just blanked it out and you’re in denial.
Me: Well that’s insane, I’m sure I would remember…… wouldn’t I? And anyway there would be evidence and there’s not (ha take that OCD!).
OCD: No, no you’re mistaken, it would be perfectly easy for you to kill someone and not even know about it.
Me: Weeeeellll I guess you have a point, but what can I do, if I don’t remember, I don’t remember (yeah OCD I’m hanging on).
OCD: Oh you sweet innocent thing, of course it’s not OK to just not be sure. You need to know ‘beyond all reasonable doubt’ that you didn’t do anything. Imagine if you did, you would have a responsibility to tell somebody.
Me: (Slightly shrilly) But who am I supposed to have killed? Wouldn’t I have heard about this by now?
OCD: Forget the details! You just haven’t heard the news yet or no one’s found the body, I really think you should try hard to remember what you did.
Me:  (By now feeling sick and panicky) God you’re right, this is terrible, thank you OCD I really should try to remember what I did, how shit would that make me if I didn’t try to remember and then I didn’t own up to my crime. But how can I remember if I don’t remember?
OCD: (with a sly smile) Well it’s just a suggestion but why don’t you have a look back through your memories, see if there’s anything there.
Me: Great idea! I’m going to sit and pore through all my memories, one by one and see if anything comes up.

Hours/days later….

Me: (Momentarily triumphant) Nope I definitely don’t have any memories so it can’t be true can it?
OCD: Are you sure? Did you really look back through all your memories? Maybe there’s something you missed? Are you sure you can account for every moment?
Me: (Feeling sicker and sweatier) Well there were some blanks and of course the times when I’m sleeping so I suppose I didn’t remember EVERYTHING.
OCD: (Now getting impatient) Well that’s no good, go back and try again, you need to be sure, absolutely sure, anything less isn’t good enough. Maybe as well as scanning your memories keep double checking too with family and friends (no I’m sure they won’t mind, why would they find it irritating?) Maybe also then whilst you’re at it just avoid things that you could use to kill somebody and as a last resort you could scan/check your body see if you have any signs of having killed anybody (such as blood on your hands).
Me: (Panic stricken) Sure thing OCD, anything you say, I’ll get on it now.
OCD: You’re making me so proud, just keep looking, remember you need to be absolutely sure.

And on and on and on and on it goes until you feel like you’re losing your mind (and then in my case that becomes another obsessive worry).

I hope this has given a bit of an insight into the nightmare that is OCD and hopefully challenged some of those thoughts that it’s just someone who “likes things a bit tidy or a bit clean”. Chances are if you like any aspect of it then it’s not OCD.

xx

PS. I’m receiving CBT for my OCD and I’m working on challenging my own Pure O thoughts.

Conflicting advice

So we’ve all been there. You’re doing some research and you read something that says take vitamin B tablets, then someone else has written about how great acupuncture is and then CBT and Reiki and on it goes until you’re head is spinning with all the possibilities of how to treat your anxiety.
This is the beauty and the downfall of the internet – knowledge is power but it’s also a giant red herring.

Unfortunately, I’m not here to add anything new to what will or won’t help, I’m in as much of a quandry as the rest of you probably. I think one of the things I’ve found hardest to decipher is that some people say acceptance is key and that actually fighting the anxiety makes it worse. So I try to be all zen and cool with the fact that my insides are tying themselves up in knot and I frequently feel like I may vomit. I can’t figure out though whether looking for things to treat your anxiety is the same as fighting it?? Can you have acceptance whilst also looking for things to improve the quality of your life or are they mutually exclusive?

I stumbled across this website the other day Anxiety No More which has been developed by a guy who had anxiety for 10 years. His big philosophy appears to be that fighting the anxiety and trying to drive it out of your life is just ultimately going to give it more power. So today I have tried that philosophy and every time I felt anxious or afraid I noticed it, said to myself “I’m feeling anxious but that doesn’t mean I can’t continue with what I was doing”. Funnily enough for a very simple philosophy I did actually find it helpful. I don’t think that means that I will stop doing other things, for instance I don’t think daily meditation is going to do me any great harm or have anxiety banging down my door with a giant axe. I’m also going to try CBT as I do think it may help in the long run with my obsessive thoughts. However, I think with the more immediate sensations of anxiety I may just try noticing it but not giving it any more power than that.

Other than that I think it’s just important to do things you feel comfortable with and most importantly that offer you some level of comfort.

So my thought for the day is:
*****Acceptance allows us to keep moving forward*****