Friday, December 9, 2011

Decisions, decisions

I saw my psychiatrist today, and I left his office knowing I still have some decisions to make.
I wrote in my last post that I planned to ask him about possibly seeing a therapist for cognitive behavioral therapy, specifically exposure response and prevention therapy.
I did ask him, and he said there was a therapist in the practice who did the exposure therapy if I wanted to see him.
He said medication could take a person only so far, and such therapy could be very useful.
My hesitations stem from my concerns about the time it would take to do the therapy and whether or not I really need it. I had learned little tricks over the years for dealing with some of the OCD symptoms, I told him, and I recognized my OCD when I experienced it.
By that, I meant that I realize when it’s OCD that makes me obsess over possible dangers and compulsively try to mitigate the feelings of anxiety.
I wondered if I could do exposures on my own.
He said I would need the guidance of a therapist to benefit from it, and then he asked me to what extent my symptoms were under control.
That is always a difficult question to answer. I always think to myself, “In comparison to what?”
Compared to the extreme nature of my symptoms in my teens and later in my 20s, my current symptoms are negligible. Compared to my experiences in my 30s, my current symptoms are better. Compared to what they were five years ago, they are worse.
I was not seeing my current psychiatrist when I experienced the OCD at its worst, but I gave him an overview and said I thought about 75 percent of my symptoms were controlled now.
He thought that was pretty good.
We left the discussion with the understanding that I will let him know if I want to start other therapy.
I had also been experiencing higher levels of anxiety of late. In fact, I had a small but noticeable anxiety attack on the way to the doctor’s office. My arms felt numb, I felt lightheaded, and I felt like I was going to come out of my skin. What seemed like a million different worries consumed me.
He made an adjustment in one of my medications, which I was happy to do. It’s a change that won’t affect the OCD, he said, because it doesn’t affect serotonin, but it will hopefully lessen the hyper feelings I’ve been having.
He wants to see me again in four weeks, which is a good thing, because I can think more about therapy and consider further how controlled my OCD symptoms really are.
Because I’m worried about that 75 percent figure I gave the doctor. It’s really just a guess. I can’t truly quantify the percentage of symptoms I experience versus what I would be experiencing without medication.
I’m confused. How bad does it have to be to need ERP? How much “struggling on my own” is too much? Why is it so difficult for me to agree to just try the therapy?
It would probably be helpful if I took some notes or kept some type of log of my symptoms. That might help me identify how much my life is being adversely affected by OCD specifically.
Have any of you been in this kind of quandary? What do you think?


  1. Hi Tina! You ask some great (and most likely very common) questions concerning treatment. You are probably the best judge of whether you need treatment or not. Are you in turmoil all the time? Can you currently live a fulfilling and satisfying life? Are you avoiding things that matter to you and your family? I remember when I sought treatment - I told the psychologist I thought I had a mild case of OCD. Boy was that funny because come to find out I actually had a severe case. I was avoiding so much of life, and had been doing it for so long, that I didn't even realize it. Anyway, I think it's awesome you're asking yourself these questions. Good luck with your decision!

  2. Thank you, Sunny. You gave me more food for thought!

  3. I think keeping a journal is a very good way of keeping a note on how much you are being affected by OCD and, if you give it a time frame, say four weeks, then you will have a good reference to decide whether ERP therapy is worthwhile.

    Best wishes!

  4. I've done some exposure therapy with my therapist. Currently, I've been largely ignoring my OCD. It feels like it's not a big deal. I'm not sure if this is because it really isn't a big deal, or if I'm just so used to it (and I really don't like to do exposure therapy). Having said that, I am in favor of exposure-response prevention, and I do try it sometimes. Currently, I'm working on driving issues, but I'm doing it off and on, which probably isn't as helpful.

    I did try Exposure Response Prevention on my own. I tried too much too fast and was overwhelmed. But it did help me realize some of how out-of-control my symptoms were. I new how to do this therapy, but I wanted a therapist to give me encouragement and support to actually do it.

  5. I agree with OCD anonymous. I kept a journal of my symptoms for several months and that helped me get a clear picture. I get so used to it that sometimes I don't realize how bad off I am.

  6. Have you tried taking the Psych Central Sanity Score test? It might help you get a bit more insight into the severity of the symptoms rather than your interpretation of the severity. I know I have difficulty sometimes thinking things are worse than they are and other times thinking they're not as severe as they are. It really is sometimes tough to see it from the inside.

  7. OCD Anonymous and Elizabeth--I think I will use the journal, even if it's nothing fancy, just a record.
    Abigail, I think I would get overwhelmed too. You make a good point about have a therapist to give encouragement.
    Kat, thanks for the link. I will try it.

    Thanks to all!


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