It has been a while! Since starting my 14.0 credit hour load at Lakeland, nightly musical rehearsals, maintaining my Etsy business, volunteering, and attempting to have something of a social life, I haven't been keeping up with my blogging. However, I am back, and with some good stuff, too!
In this post, I will continue my series on OCD and this time I will discuss something a little more current: treatment. As I have explained in previous blog posts, I came home from Notre Dame on medical leave after a few weeks of experiencing terrible panic attacks, depression, and particularly poignant OCD thoughts. The main reason I came home was not to run from the problem, but to address it. Prior to college, I had received some therapy in addition to taking medication. The bulk of this therapy was focused on what is known as Cognitive Behavioral Therapy, or CBT. CBT is defined by Wikipedia as "a psychotherapeutic approach that addresses dysfunctional emotions, maladaptive behaviors, and cognitive processes and contents through a number of goal-oriented, explicit, systematic procedures." CBT is essentially the process of attempting to change one's thoughts and behaviors. The therapy I received prior to college was of little to no help, for a variety of reasons. I was not open enough about the specifics of the intrusive thoughts and anxiety I was experiencing. Instead of saying, "I have intrusive thoughts that I might be gay" or "I experience anxiety due to an obsessive thought about possibly being gay," I skated around the issue, saying something like, "I have intrusive thoughts that really bother me about stuff..." I essentially led my therapist to believe that I was dealing with very general forms of anxiety, when in reality I was being tormented by specific, phobic fears that occupied every waking thought to float through my mind.
After my first year at Notre Dame, I had made a great deal of progress. I began to engage in more research about my specific issues, learning I was most certainly Obsessive-Compulsive in addition to dealing with Generalized Anxiety Disorder. I began working with a therapist at Notre Dame to overcome the constant occupation with these thoughts. He introduced me to a book entitled "Getting Over OCD: A 10-Step Workbook for Taking Back Your Life."
This book was incredibly eye-opening. It introduced me to a very new form of therapy that is most used to treat Obsessive-Compulsive Disorder: Exposure and Response Prevention Therapy. Exposure Therapy is based on a very simple concept: facing one's fears. Exposure helps you to habituate to your fears. First, you build a hierarchy, or a list of events that trigger your fear. These are listed in order of least-anxiety-provoking to most-anxiety-provoking. You begin at the bottom of the list and exposure yourself to that fear. You simultaneously track your anxiety on an arbitrary scale known as "SUDS," or Subjective Units of Discomfort Scale. You will notice that as time passes, your SUDS will begin to decrease as your anxiety decreases. You begin to habituate to the feared subject. Each time you engage in exposure to the feared subject, the anxiety will not spike as high as the previous time. Eventually, the hierarchy item no longer provokes anxiety, and you can move up on your hierarchy. The photo below gives an example of a graph used to track SUDS during exposure.
An example of exposure: If I was terrified of spiders, I would initially sit in my room with a spider in a cage in the room next door. When this no longer caused me anxiety, I would sit in the same room as the spider in the cage. Then, I would move next to the spider in the cage. Finally, I would pick the spider up in my hands. Throughout this process, I will habituate to the anxiety caused by the spider and no longer respond with this anxiety.
The second part of exposure therapy is known as "response prevention." When dealing with OCD, the sufferer creates compulsions, or ways to lower the anxiety caused by the obsessions. In order to effectively engage in exposure therapy, the participant must refrain from engaging in any compulsions to lower the anxiety. The anxiety must be allowed to lower on its own, without any assistance from the sufferer and his or her mind. Response prevention is the process of breaking the compulsions or refraining from partaking in them during exposure therapy. The end result will be habituation to anxiety caused by the obsessions and the loss of subsequent compulsions.
Exposure is grueling work, but boy is the payoff amazing. I partook in some exposure at Notre Dame, but I found it was easy to push to the wayside in favor of homework and extracurricular activities. Exposure requires many hours of time, and as I was faced with the decision of healing, I realized this was something I would need to do at home, away from school, stress, and a lack of time. Upon arriving home, I began an intensive therapy program with my current doctor (who is absolutely PHENOMENAL!) and attended therapy three days a week for 90 minutes each, with one to two hours of homework each night. We set up a strict exposure program involving some pretty bizarre stuff, to an outsider. To combat my HOCD, or fear of being gay, I read literature about homosexuality, looked at pictures of attractive women, and made a recording of myself reading a script about the possibility of being gay, all in order to lower the anxiety caused by specific triggers. To combat my fear of harming myself, I even had to sit next to a sharp knife in my room and listen to a script I recorded in which I described the process of harming myself. This made for some amusing conversations in the family, as I finished dinner, picked up my knife, and proceeded to walk away, saying, "Time to expose!" You may ask, "Isn't that dangerous? Aren't you afraid you will hurt yourself?" The beauty of exposure therapy is that though some of the techniques seem like they could be dangerous, those with OCD do not intend to follow through with or partake in the obsessive thoughts that come their way.
In all, my exposure therapy sessions were successful, and my SUDS charts proved as much. My anxiety would increase and decrease, forming a perfect bell curve that became smaller and smaller with each exposure.
Exposure therapy is not the only form of therapy used to treat my OCD, panic attacks, and depression. An additional form of therapy my doctors introduced to me is known as Acceptance and Commitment Therapy, or ACT. ACT has, in my humble opinion, changed my life, and changed it for the better. Previously in this blog post, I discussed CBT, which is based on the concept of changing your thoughts and behaviors intentionally. ACT is quite the opposite. The basis of ACT is that by fighting your thoughts and attempting to change them, block them out, and get rid of them, one only perpetuates the intrusive thoughts, and thus the suffering involved. Instead of engaging in a constant battle with OCD, anxiety, depression, and other difficulties, one accepts the thoughts, fears, worries, and feelings experienced and commits to the things one values most in their life. I could write 20 blog posts about ACT, but I won't, so I encourage you to do some looking into this form of therapy if you or someone you know is currently struggling with a mental disorder or just a very tricky problem. When one finally gives up the battle, paradoxically, the battle is won.
I would like to share one last tidbit about my treatment, because I think it is hilarious! During the first week of treatment, my doctor asked me to describe what my OCD looked like and to draw a picture of it. I did my best (yes, it was a stick figure), and presented it to him. He then asked me to give a name to my OCD. I looked at him like he was crazy--ironic, I know, since I was the patient in the shrink's office. He ordered me to stop referring to my OCD as "My OCD" and give it a proper name. After many "Ums" and "Wells," I had a stroke of genius. I recalled a particularly scary animated character from my childhood: Heffalumps and Woozles, the creepy elephant-like creatures in Winnie the Pooh. From then on, my OCD became known as "Mr. Heffalump."
| Tell me these aren't terrifying! |
The idea behind this naming of Mr. Heffalump was to separate him from me. I had essentially made OCD a piece of me, Maggie Skoch, by constantly referring to it and visualizing it as "my OCD." Though it seemed incredibly ridiculous at the start, renaming my OCD to Mr. Heffalump did wonders to remove the association between this disorder and my self.
So there you have it folks: a peek into the treatment of an OCD-sufferer. I encourage you to ask me any questions you may have--this can be some pretty confusing stuff! Thank you for taking the time to read my blog!
Words Truly,
Maggie
