Today I had my first real session of cognitive behavior therapy. It was my second appointment with the new therapist, a psychologist. The first appointment was taken up with giving him a history and overview of my OCD.
Today we talked a lot about how the brain works, how it works differently in people with OCD and how we can learn to override the obsessive thoughts.
Last night I made a list of my main obsessions and the compulsive actions and avoidances that I practice to try to rid myself of the anxiety caused by the obsessions.
I printed it out and took it with me to the doctor’s office. While I was in the waiting room, I added a few more compulsions that I hadn’t thought of last night.
My main obsessions revolve around my writing, contamination, checking, driving, harming others and talking.
The list I made up helped guide today’s session, but we won’t actually set up a hierarchy or decide what to work on first until our next session.
The therapist described how the brain stem, the amygdala and the prefrontal lobe work together. I won’t go into all the detail that he did, but basically there’s a disconnect between the amygdala and the prefrontal lobe, and the negative thoughts, or obsessions, get stuck in the amygdala.
About thoughts, he said many people believed that all thoughts were volitional, but it wasn’t true. He also said it was impossible to get rid of the negative thoughts, but I could learn to override them.
I’ll do this using three steps: I’ll reattribute the obsessions to OCD, to my brain. I’ll turn my attention elsewhere. And I’ll do some other behavior instead of acting on the compulsions.
There was no need to try to rationalize my way out of obsessions, he said, because it wouldn’t work.
I would learn to be mindfully aware of my thoughts so that I could observe a thought, acknowledge it, reattribute it and move on.
He demonstrated this in an interesting way. He held his hand like he was holding something (a negative thought) and looked at it in his hand. That reminded me of the Impartial Spectator that Dr. Jeffrey Schwartz writes about.
He said I would have to challenge myself with things that ramped up the anxiety. I would gradually update my brain. My brain would learn that even though I didn’t follow up on a compulsive urge to, for example, check the stove, the house didn’t burn down.
I would learn to tolerate the anxiety and, in what he called a paradox, I would eventually learn to accept it.
Our next appointment is in a month, but he said he’d like to see me on a weekly basis at first. So I’m on the cancellation list, and I’m to call the office Monday morning to see if there have been any cancellations.
In the meantime, I will start working on these steps and really consider which of the OCD categories I want to work on with him first.
I asked him about mindful awareness meditation, and he was all for it.
I’m excited. I feel like I’m on the road to real recovery. Not a cure, but recovery.
On a side note, I was off work today, so I went to the bookstore and the craft store after my early-morning appointment.
While I was in the craft store, I started feeling anxious, like something bad was going to happen. It’s like my heart was on high alert. Even after I got home, I still felt like that.
I wasn’t obsessing about anything, and I have no idea where the anxiety came from. Perhaps it was the generalized anxiety making itself known, and maybe I was more nervous about my appointment and the changes ahead than I thought I was.