CBT Session #6: Facing the anxiety

A bit of spring: dogwood blossoms.

How wily are the ways of obsessive-compulsive disorder.

I had another cognitive behavioral therapy session today, and I left my therapist’s office with a new understanding of how subtle avoidance can be.

I have compulsive rituals that I perform to try to lessen the anxiety caused by obsessive thoughts. I also avoid doing certain things because of the anxiety caused by whatever it is that I’m avoiding.

As I wrote about two weeks ago, my therapist and I decided that I would work on clearing my clutter of papers.

I did one 15-minute session of clearing clutter two weeks ago, and I haven’t done any more work on it since then.

Let’s change course

Today, I decided I would tell my therapist that I wanted to change course. Several things fed into my decision.

·        I have been feeling a lot of anxiety lately, even waking up with it.

·        I have had no interest in continuing to clear the clutter.

·        I have felt overwhelmed by the fact that I’m trying to work on several things at once—my issues with clutter, with writing, with checking, with rituals that slow me down.

It would be better if I just focused on one OCD manifestation, I told him. I would work on checking.

Not so fast

He sat back in his chair and smiled a little.

“OK,” he said. “You want to focus on one thing, the checking. So what happens when you come in here next time and want to work on something else?”

I was taken aback. I wasn’t sure what he meant. Or, rather, I was afraid that I knew what he meant.

What he meant was that he believed I wanted to change course because I didn’t want to face the clutter. I didn’t want to face the anxiety of cleaning it up because it was not going to be easy.

It’s all about the OCD, he said. It was about my scrupulosity, my fear of finding something in the clutter of mail and papers that showed I had missed paying a bill, missed doing something that I was supposed to have done.

I immediately knew he was right. Apparently, I’m pretty good at finding ways to put off OCD issues that I don’t want to face.

Face the anxiety

My therapist said the only way I was going to get over this anxiety was to face it. The 15-minute rule wouldn’t work after all, because though I got anxious during the clutter session two weeks ago, I moved away from the anxiety after 15 minutes.

What I had to do, he said, was to keep on working on the clutter, even with high anxiety, until it started to go down on my 1 to 10 scale.

Focus on what I could control now. I could deal with future problems when they happened, he said.

So, here I go. I have to face the anxiety. I don’t want to. But to get well, I have to.

What about you? Do you practice avoidance? How do you face the anxiety?

Learning: Meditation is a safe space

When my husband and I got married, it didn’t just change our lives. It changed the lives of our cats.

Waddles had lived with just me for three and a half years. My husband had two cats, Thunder Cat and Sam.

It was not love at first sight when Wa met TC and Sam. It usually isn’t with cats.

They hissed, growled and made other sounds I had never heard. Wa was normally very calm. She hissed more in those first few months in our new home than she had in the years we had lived together.

We did everything the experts say to do when introducing cats: allow them to see each other, but not get to each other. Give them treats when they are together without arguing, thereby rewarding calm behavior. Spray pheromones around the room.

What really worked was time. They had to learn to live with each other, and they had to do it on their timetable.

During the hard times, I put one of Wa’s beds underneath one of the windows in the master bedroom. That way we could keep a protective eye on her.

Eventually, I added a covered bed for her. She loved that space and spent a lot of time there even when peace finally settled on the household. She moved around the house, playing and lounging around. But her place in the bedroom seemed to be her home base.

TC and Sam never bothered Wa when she was there, and they never tried to take it over. It was Wa’s safe space.

Now the space is empty. After Wa died, we took up the beds. We picked up her special blanket and her favorite toys, which still sit on the dresser where we can see them.

When I decided that I wanted to commit to meditating on a regular basis, I wondered where I would do it. I wanted a space in the house where it would be quiet and where I knew I could always go to be still.

I decided to use Wa’s space. I sit on the floor looking out over the bedroom like Wa did. I stare at my candle (battery-powered, of course). Then I close my eyes and listen.

It’s difficult for me to use breathing as a way to center myself. I don’t know if it’s because I have asthma or if OCD makes me think too much about breathing. But I feel out of breath when I try.

Chanting or saying words out loud is also a problem. I feel out of breath or I get into a mindless mode instead of a mindful mode.

So I listen. I listen to the sounds around me: the tick of the clocks, the creaks of the house, the soft puff of the ceiling fan, a train passing through town a mile away. I imagine that my ears are stretching out and turning, like a cat’s.

I practice letting my thoughts go, and I picture them swirling into a globe and spinning around there. I try to watch myself. I try to be here right now.

And I share a safe space with my Wa in spirit.

I have written before about mandalas, and how coloring them, and then creating my own, comforted me during a hard time and continue to comfort me.

The mandala pictured with this post is one that I created to illustrate my meditation, my safe space.

Do you have a safe space? Is it an actual place, or is it a place you go to in your mind? What makes a space safe for you?

Spreading hope

This week, Becky Green Aaronson of the blog “The Art of an Improbable Life” nominated me for the HUG (Hope Unites Globally) Award.

I was very honored to be nominated for such an award, and also very honored to be nominated by such a wonderful writer who herself spreads hope and grace with her writing.

The HUG Award was created by Connie Wayne of “A Hope for Today.” A complete description of the award can be found here.

The main guiding principal behind my work on this blog is to encourage hope in others. I want others who suffer from obsessive-compulsive disorder, depression and anxiety to know that help is available and they are not alone, and, also, that things will get better.

I have been blessed to connect with so many other bloggers who have inspired hope in me.

On her blog, Becky Green Aaronson gives “a head spinning look at the improbable life my husband and I have shared in the world of art, photography, writing, and parenthood.”

Illustrated with beautiful photographs, Becky writes about art, being a parent, raising money for the fight against cancer, writing, running, stories of her husband’s experiences as an international photojournalist and a multitude of other things.

She is full of optimism and hope, and I read her blog because I know I’m going to learn a little more about the world and be inspired to do my part in making it better.

My nominees

One of the guidelines for nominees for the HUG Award is to pass it on to others.

Before I started blogging, and when I first began blogging back in November 2011, I started reading several blogs that gave me hope.

I learned that I had more work to do in my own battle with OCD and depression, but I knew that these bloggers would support me in my efforts and provide not only valuable information to me, but hope.

These were the first blogs I read by people who were writing about OCD, and I was amazed by their honesty and their triumphs over obstacles.

They are my nominees for the HUG Award:

Elizabeth of “On My Own.” Elizabeth’s blog is beautiful to look at and beautiful to read. She writes about her life with such warmth and hope, and she is generous in her comments to others.

Ann of “The Beat OCD Blog.” Ann has worked hard in her own battle with OCD, and her stories show others that they can achieve success too.

Sunny of “71 degrees & Sunny: One Christian’s Odyssey through Obsessive Compulsive Disorder.” Sunny writes with a heart turned towards helping others. We started blogging almost the same day.

Lolly of “Lolly’s Hope.” Lolly lives a life of hope and writes about it in a way that inspires others.

Janet of “ocdtalk.” Janet’s son has OCD, and she is working to educate others about the mental disorder.

Karin of “My Journey Thru (& hopefully out of) OCD.” Karin uses her wonderful sense of humor when she writes about her own experiences with OCD.

  “Pure O Canuck.” POC has a lot of insight into her own journey with OCD and shares that with her readers.

   One Anxious Gal of “Light One Candle.” One Anxious Gal writes with honesty and humor.

   Kat of “Keeping in the Sunlight.” Kat has wonderful insight and writes about the practical ways she deals with OCD.

   Please check out Becky’s blog and the blogs of my nominees so you can experience their hope.

Fighting OCD and depression: I make the decisions

Two things my therapist taught me have been on my mind this week.

“Willpower is not a feeling you have. It’s action you take,” he told me during last week’s cognitive behavioral therapy session, which I wrote about here.

And during a February session, he taught me that the only things we can control about our thoughts are which ones we attend to and how we respond to them: our attention and our behavior.

Willpower, attention and behavior. The common factor I began to see is that I make the decision about putting one foot in front of the other and acting. I make the decision of what to pay attention to. I make the decision of how to respond to my thoughts.

I make the decision.

I haven’t been making good decisions in regards to my obsessive-compulsive disorder and other anxiety. I also recognize that I haven’t been making the best decisions regarding my depression.

I avoid doing things that I know will help me. I’m trying to figure out how I can do better.

To be more specific, I’m trying to get out of bed at the same time every morning, at 6. I’m trying to be more diligent about setting a deadline for myself in getting my work writing done and not put it off until I have to do all of it in one day. I’m trying to be more consistent in things like working on my own writing and clearing my clutter.

When my alarm goes off at 6, my arm reaches automatically over my head so I can hit the snooze button. I hit the button every 15 minutes for the next hour or two.

Early this morning, I was awakened by Chase Bird, one of our cats. He was crying his distressed cry, which usually means he’s getting ready to throw up.

I got up and cleaned up the poor boy’s hairball. It was 5:40 when I came back to bed. I knew I could decide to just stay up. But I consciously made the decision to get back in bed. When the alarm went off, I knew I could decide to get up. I consciously made the decision to hit the snooze button.

Why can’t I make the right decision?

I am able to get up when someone else is depending on me to get up. When I have a work-related reason for getting up early, such as an interview or a trial to cover, I get up. When I have a doctor’s appointment or even a haircut appointment, I get up.

Basically, when I am responsible to someone else, I am able to put one foot in front of the other.

So why can’t I do that for myself? Why can’t I make decisions to do things such as cleaning up clutter, writing in spite of my anxieties and exercising, things that will help me?

I’m not sure.

My sleeping in is likely due to the fact that I dread having time on my hands. If I get up early, what will I do with my time until I leave for work? Well, I might have time to do something like write. But that causes anxiety. I might have time to exercise. But it will be difficult because I’m out of shape, and I won’t get in shape overnight.

It’s much easier to hit that snooze button.

I’m still avoiding. I’m still placing too much emphasis on how I feel. I’m still paying attention to the thoughts that tell me I can’t feel anxious.

This cognitive behavioral therapy is hard. Changing my life is hard.

I have to keep on trying. But I am looking for insight from you. How do you push through and do what needs to be done? How do you make the right decisions for yourself?

Learning: Nature does comfort

We had a hailstorm today. On the first day of spring, a battering of ice balls fell from the clouds, rain poured and thunder rumbled.

Afterwards, when I left work this evening, the air felt so comfortably cool. And it felt clean.

When I got home, before I went inside, movement high in one of our oak trees caught my attention. It was a squirrel.

A lot of squirrels hang out in our yard. I see a fluff of gray just about every day.



See the squirrel?



But this evening, this squirrel, high up in the tree, kept my attention. I don’t know how the small limb, a mere twig from my viewpoint, held the squirrel’s weight. But it did as he or she walked back and forth.

I still had my head back enjoying the play when my husband opened the door to greet me.

Periwinkle around rocks

After going inside and saying hello to my husband and cats, I grabbed my camera back up and went outside. I had to capture some of the beauty of this spring evening, our first spring evening this year.

Being among animals, trees, flowers—nature—calms me. I love the beauty I see. I love knowing that all this life goes on, even while I’m gritting my way through a long day at work.

Today was layout day. We went to press tonight, so all day I sat at the computer and created pages. I drew text boxes, formatted copy, input photos, wrote cutlines, made the stories fit.

My shoulders are telling me that I used poor posture most of the day. My jaw is tight, my stomach a bit unruly.

But I feel good, too, because of my little walk in nature, my little adventure.

That nature can calm and comfort is not my discovery, not a new idea. But I need to be reminded sometimes that there’s more to life than the four walls around me, my thoughts, my worries, my concerns, much more to life than I can even imagine.

It’s not that I had such a terrible day. Life is very good in many ways right now. But the darkness of depression and the anxiety of obsessive-compulsive disorder are there, in different degrees on different days. And I’m old enough to know that sorrows happen to everyone.

We all need comfort sometimes, different kinds and for different reasons. And nature is a form of comfort.

I have so much to learn about what is in nature. I grew up on a farm. I’m a country girl by birth. But I don’t know the names of all the trees around me, the birds, the flowers. I can enjoy nature without knowing such things, but I want to learn.

I love to read about nature. One of my favorite collection of essays is called “Wild Comfort: The Solace of Nature,” by Kathleen Dean Moore.

I turned to her writings last fall, when I was mourning losing my Waddles, when I couldn’t sleep because of the pain.

Moore, too, finds comfort in nature, as her title states. I highlighted the following passage from the introduction to her essays:

“I don’t know what despair is, if it’s something or nothing, a kind of filling up or an emptying out. I don’t know what sorrow does to the world, what it adds or takes away. What I think I do know now is that sorrow is part of Earth’s great cycles, flowing into the night like cool air sinking down a river course. To feel sorrow is to float on the pulse of the Earth, the surge from living to dying, from coming into being to ceasing to exist. Maybe this is why the Earth has the power over time to wash sorrow into a deeper pool, cold and shadowed. And maybe this is why, even though sorrow never disappears, it can make a deeper connection to the currents of life and so connect, somehow, to sources of wonder and solace. I don’t know.” (“Wild Comfort: The Solace of Nature.” By Kathleen Dean Moore. Page 10-11, e-edition.)

I am not a hot weather person. Spring in Virginia seems to so quickly lead into the hot, humid days of summer.

But I welcome the blooms, the green, the robins. I welcome this part of nature.

Do you find comfort in nature? What part of nature? How does it comfort you?

OCD: Perfectionism

A public safety agency in our town periodically puts up interesting sayings on a sign in front of its facility. Right now the sign says something like the following: “IF YOU DON’T M3SS UP SOMETIMES, IT MEANS YOU’RE NOT DOING ANYTHING.”

I laugh a bit when I drive by the facility and read the sign, but I also understand the truth in what it says.

Perfectionism is part of my obsessive-compulsive disorder. I believe that it sometimes keeps me from doing anything.

I avoid writing because it might not be perfect. I avoid doing more artwork because I won’t do a perfect job.

I also have a hard time letting tasks go. For example, I have a hard time letting go of assigned stories on the job.

I read and reread and revise and proof over and over before I finally turn in a story to my editor. This process takes a lot of time, more time than it should, and it leaves me dreading writing and even avoiding starting writing assignments until the last minute.

I really hate to mess up. I fear that others will think I’m incompetent or unintelligent. I am afraid that I’ll make a mistake with terrible consequences, especially in my writing for the newspaper.

Perfectionism is not always a bad thing, and not all perfectionists have OCD.

In a post called “Perfectionism in OCD: When the pursuit of success turns toxic,” on Dr. Steven Seay’s Psychology Blog, Seay wrote about adaptive and maladaptive perfectionism.

Seay described the adaptive perfectionist as “the prototypical workaholic student/employee who goes above and beyond expectations. This person is intelligent, hard-working, dependable, and passionate about meeting or beating deadlines. He or she sets high personal standards of performance and has an attention to detail that is appreciated by (and often draws accolades from) others.”

Seay wrote that the maladaptive perfectionist also believed in hard work and tended to be intelligent and have high standards. But he “often misses deadlines and fails to deliver an exceptional work product (or, in some cases, any work at all).”

This was because a person with maladaptive perfectionism “often gets stuck in repeating tasks and has difficulty finishing projects. He or she may repeatedly recheck or revise their work. However, despite these efforts, the product never quite feels ‘good enough,’” Seay wrote.

He said maladaptive perfectionists may also practice avoidance: “Alternatively, the person may suffer from intellectual paralysis due to an over-concern with living up to their own potential, fear of failure, or a fear of disappointing others (e.g., teachers, parents, loved ones). This intellectual paralysis may lead to complete avoidance, and this avoidance often becomes chronic and difficult to change.”

On Friday, my therapist and I discussed my tendency towards perfectionism and how it played a part in my avoidance of going through my piles of papers.

The cognitive behavioral therapy exercise I did Friday was one way of fighting through the avoidance caused in part by perfectionism.

OCD Chicago offers other ways of fighting perfectionism in an article called “The Search for Imperfection: Strategies for Coping with the Need to be Perfect,” by Andrew M. Jacobs, Psy.D. and Martin M. Antony, Ph.D., ABPP.

An example of a strategy was testing your beliefs about perfectionism. Make a typo in an email to your boss, the authors suggested, and see if your fears come true. If they come true, consider how you were able to deal with them.

Other strategies include putting your sense of perfection into perspective and think about areas of your life where imperfection is OK; attempting to define perfect; considering how you have different standards for others; and finding out the standards of people you admire.

The authors also encouraged exposure response prevention therapy. That is basically what I did Friday night: I worked on my piles of papers for 20 minutes, but I didn’t allow myself to get caught up in a never-ending session of trying to make everything perfect. I also didn’t allow myself to continue to avoid going through the papers.

Are you a perfectionist? Do you also have OCD? How has perfectionism affected you? What strategies do you use to fight against the negative effects of perfectionism?

Now I am going to stop rereading and revising this post and use it as an exposure exercise. I really want to read it again, but I’ve done my best, and it’s time to let it go.

CBT session #5: Willpower is not a feeling

I had another session of cognitive behavioral therapy with my therapist today, and I left his office with a concrete plan and determination.

After our last session, I felt frustrated about the course the therapy seemed to have taken. I didn’t feel like I was working on the obsessive-compulsive disorder. I wrote about my concerns here.

As some of you said in your comments, working on other anxiety concerns would benefit the work I was doing on the OCD.

During today’s session, we discussed the importance of staying open to working on my avoidance of conflict and my fear of anger, in addition to other sources of anxiety. But today, I wanted to work on OCD.

We focused on something that I’ve been avoiding: going through piles of papers and organizing the mess.

I have stacks of opened and unopened mail and other papers sitting on the dining table, on my desk and in boxes.

A number of anxieties keep me from going through the papers, including fear of what I might find. What if I found a bill I hadn’t paid? What if I discovered some legality that I hadn’t followed? What if I found something that would cause me to obsess over things like, did I really pay that bill? Did I check my bank statement carefully enough? Did I miss something vital when I read the insurance explanation?

In other words, what if it fired up my checking and scrupulosity rituals?

I was also overwhelmed at the thought of taking the time and making the effort of going through what seems like a mountain of stuff.

We made a plan for me to take 20 minutes this evening and sort through the papers on the table, putting them into piles to later go through more closely.

I can string together as many 20-30 minute periods as I want to, but for the purposes of therapy, we would focus on the first exercise.

My therapist and I talked about the steps I would take to do the exercise, including deciding on the categories I would sort the items into and then the actual sorting.

Then we discussed obstacles I might face.

There is the “I don’t want to do this” obstacle.

Willpower is the best way I can push through that obstacle. My therapist said something very helpful about willpower.

“Willpower is not a feeling you have. It’s action you take,” he said.

He told me a story about himself. Earlier this week, he took a walk. He decided to examine his own resistance to going for a walk and see how far he was into the walk before his attitude began to change.

He said I would just need to take one step at a time, and if I thought it would help, I could practice “watching” my own reactions and examine my own resistance.

Also, he reminded me that I was not my brain any more than I was my gut. The brain and gut were parts of me, but not all of me.

My thoughts might tell me that since I didn’t feel like doing the exercise or I felt anxious about it, I didn’t have to do it. But my brain wouldn’t learn anything from it, and I wouldn’t move forward.

He said the only thing my brain would listen to was real data. If I completed the task, my brain would make note that nothing terrible happened: I didn’t die, I didn’t get arrested and no one else was harmed.

Another obstacle I face is the fear of feeling even more overwhelmed by the task I have before me.

He assured me that no matter what, whether I was able to work for the 20 minutes or not, the exercise would be valuable because it would tell us something about my anxiety and what we needed to work on.

So, at 8:50 p.m. this evening, I started.

Anxiety levels

Anxiety level immediately pre-exercise: 5

Anxiety level during exercise: rose to 7 to 8

Anxiety level immediately post-exercise: 7 to 8

Anxiety level one hour post-exercise: 6

The process

I was able to quickly sort the items, even opening up envelopes and glancing at the contents to know where to place them in the stacks.

I had four piles: bills to pay; items to file, such as paycheck stubs, receipts, and bank statements; items to look at and do something with soon, such as an envelope with a return address I need to record, the county personal property statement and car insurance cards I need to place in my car and purse; and items to read/file at some point.

I finished up the sorting before 20 minutes had passed, so I looked at some items more closely and sorted through a box of decorative items that I need to take to the basement.

My experience

The time didn’t pass quickly enough. I kept looking at the clock to check the time and calculate how much longer I had to do this.

I didn’t find any late bills or other items that needed immediate attention.

But I did begin to feel very overwhelmed, because I knew how much more I needed to accomplish beyond the 20 minutes of sorting.

My anxiety level did not drop as quickly or as much as it does when I do the other cognitive behavioral exercise I’ve worked on, the one where I write for 30 minutes without editing.

But I felt good that I had done as much as I had. Nothing awful happened.

And I was able to follow the exercise with a shower and then a relaxing time watching the season premiere of “In Plain Sight.” My anxiety level has dropped down to about a four now.

One step at a time. Push through the resistance. Willpower is action.

Learning: The role of ritual

The word ritual can have terrifying connotations for people with obsessive-compulsive disorder.

The compulsive rituals we perform to try to alleviate the anxiety caused by obsessions result in even more anxiety. They become the source of much pain and much waste.

Religious rituals are especially difficult for me. I’ve written about my scrupulosity and my particular problems with praying.

Lately, however, I’ve been thinking about religious rituals in a more positive light.

In the years after I left religion behind in my 20s, I made brief forays back into spiritual practice, but I continued to eschew what I considered to be meaningless rituals.

During church services, I wondered what was accomplished by response readings, recited prayers and ceremony. What did those rituals have to do with finding God, with learning to live a good life?

I came back to formal religion over seven years ago, for various reasons. One was that I wanted to have a home for my spiritual questions.

I have been happy with my decision overall. I must admit, though, that the rituals in my United Methodist tradition at one time did not mean a lot to me. They were exercises to participate in until we reached my favorite part of the service, the sermon.

I think differently now.

What I have been learning is that rituals have a way of bringing me to a place where I am ready to seek God’s presence.

The book “The Case for God,” by Karen Armstrong, helped to launch my meditation on ritual.

In the book, Armstrong traces the ways that God has been perceived and practiced since man had the first inklings that there was perhaps more to the world and to life than what he could see or experience with his other senses.

Armstrong writes that before the matter of belief became so important, ritual was deemed the way to make myths come alive and become meaningful. She places a great deal of importance on the role of ritual:

“Religion is a practical discipline that teaches us to discover new capacities of mind and heart. . . . It is no use magisterially weighing up the teachings of religion to judge their truth or falsehood before embarking on a religious way of life. You will discover their truth—or lack of it—only if you translate these doctrines into ritual or ethical action.” (The Case for God, page 10, e-version)

She writes further about the role of ritual:

“Many thousands of people find that the symbolism of the modern God works well for them: backed up by inspiring rituals and the discipline of living in a vibrant community, it has given them a sense of transcendent meaning. All the world faiths insist that true spirituality must be expressed consistently in practical compassion, the ability to feel with the other.” (The Case for God, page 14, e-version)

I am learning that one way I can prepare myself to practice compassion is to attend my church’s services and participate in the rituals. Doing so helps to prepare me to listen more intently to the scriptures, to the sermon and to the quiet voice within.

During the service, we listen to the reading of the scriptures based on the lectionary. After the reading of each selection, the leader holds up the Bible and says, “The Word of God for the people of God.” The congregation responds, “Thanks be to God.”

We sing hymns. We sing the Gloria Patri.

We listen to the minister’s sermon, based on the scriptures that we have heard.

We read as a congregation an affirmation of faith, usually the Apostle’s Creed or the Nicene Creed.

All of this gives me much to ponder, including the unity of us all.

During communion, we first pray for forgiveness. We then greet each other in peace before taking part symbolically in Christ’s Last Supper.

There would normally be all kinds of red flags flying around me with any talk of forgiveness and prayer.

And to be honest, I have yet to begin a personal prayer practice.

But in a group setting, I can follow along with the words that were written long ago. I don’t have to make up the words and worry that I haven’t said the right ones.

Being with others also helps. It’s not a ritual that I’m doing alone. I don’t feel alone.

What do you think of rituals? Do you participate in any rituals that are comforting, that go beyond the rote to become meaningful? Or does the thought of participating in any rituals make you uncomfortable?

OCD: Slowness

   Turn the shower faucet on. Squirt face soap into my hand. Step into the shower. Pull door closed the second time to make sure it’s sealed.

   Wet my face with one hand. Rub face soap on my cheeks, nose, chin, forehead, cheek, nose. Rinse my hands until they’re free of soap. Splash water on my face. Splash water on my face and rub hands across my face. Splash water on my face. Splash water on my face. Splash water on my face.

Rub my eyes to the rhythm in my head. Open my eyes and pick up liquid bath wash.

Squeeze bath wash bottle with my right hand to put soap in palm of my left hand. Hold soap bottle under my left arm to use my right hand to wipe off any soap residue from top of bottle. Slowly close bottle cap to hear it click. Hold the bottle under the running water to wash off any soap residue before setting it back in its place.

Cover body with bath wash. Each part gets a number of swipes and scrubs according to the rhythm. Rinse bath wash off. Rub skin until it feels free of soap residue.

Wet my hair. Rub my eyes to the rhythm in my head. Pick up shampoo bottle.

Squeeze shampoo bottle with my right hand to put shampoo in palm of my left hand. Hold shampoo bottle under my left arm to use my right hand to wipe off any shampoo residue from top of bottle. Slowly close bottle cap to hear it click. Hold the bottle under the running water to wash off any shampoo residue before setting it back in its place.

Rub shampoo into my hair. Rinse hair. Rub eyes to the rhythm in my head. Squeeze water out of my hair.

Cup my hands to catch water and splash any soap off the shower walls. Squeeze water out of my hair again. Splash water again. Turn off water. Push the lever one more time.

That’s my shower routine. I don’t take 30 minute-plus showers anymore. I can finish up on good days in about seven minutes.

But I can’t seem to let go of a lot of the little rituals, little movements that are embedded in my shower routine.

I didn’t realize that I had so many rituals regarding showering until I started thinking about the things I do that take me significantly longer than it takes my husband.

Maybe a seven to 10 minute shower doesn’t seem like much, but that’s on a day when I’m focused. And the other grooming tasks that I have to do in the morning before leaving for work make the whole process take too much time.

And since the process is steeped in rituals, I dread it and avoid starting, which makes me take even longer.

My parents used to fuss at me for how slowly I performed tasks. Besides the long showers, I took a lot of time to wash dishes, to perform household chores and to get ready to go anywhere.

I researched OCD slowness and discovered that the term obsessive slowness and similar terms are controversial. I found one expert who seemed to write about what I experienced in a commonsense and helpful way.

Fred Penzel, Ph.D., wrote an article called “What the Heck is ‘Obsessive Slowness?’” for OCD Chicago.

He believes the term obsessive slowness is not useful: “There are a great many subtypes of OCD, and many of them cause sufferers to do things slowly or tediously. OCD usually makes sufferers inefficient because of all the extra steps and activities it adds to their lives.”

Penzel goes on to explain that it is important in treatment to determine “why some OCD sufferers do things in what appear to be painfully slow ways.”

He names doubtfulness, waiting for the “just right” feeling and perfectionism as reasons for slowness.

I think all three apply to my shower routine.

With my new awareness, and in my continuing quest to weed out the “hidden” aspects of OCD in my life, I am starting to try to combine and delete steps to become more efficient and to free myself from rituals that are only weighing me down, not just in my shower routine, but all my routines.

And I plan to discuss this with my therapist at my next appointment.

Do you have OCD rituals that slow you down? What success have you had in letting go of the rituals that were not useful and just time consuming?

Thinking about hope

“Hope begins in the dark, the stubborn hope that if you just show up and try to do the right thing, the dawn will come. You wait and watch and work: You don’t give up.”

-Anne Lamott

Lesson in empathy

The writer of the great blog ocdtalk recently wrote a post called “The Nicest People.” The post was thoughtful and raised an interesting question: do people with obsessive-compulsive disorder tend to be nice people?

She described her son who has OCD as “thoughtful, gentle, sensitive, and kind,” and said others she knew with the disorder were the same way.

She suggested that perhaps nice people who were predisposed to have OCD were more likely to develop the disorder than others with the predisposition, because they would give more credence to horrifying thoughts and fixate on them.

This post gave me pause. After thinking about it, I commented. Part of my comment was the following:

All people suffer, all people have burdens. But I think when people suffer so much inside, and many people can’t even tell that anything is “wrong,” they end up sensitive to and empathic with others because they know there’s more to people than what’s on the surface.

I’ve had plenty of experience with people telling me that they never knew I was depressed or had OCD. The pain inside does not always show on the outside.

I don’t think I’ve suffered more than most people. There are many people who have had much more difficult, traumatic and tragic lives than I have.

I do think that having suffered great despair and loneliness, I feel a kinship with others who are suffering. It hurts to know that other people are feeling as bad or worse than I have.

I try to empathize with others and give them the benefit of the doubt.

But, oh, how I can fail at that.

Yesterday, after I read the ocdtalk post, I was out with my husband in a customer service venue. We had a curious response from a person whom we thought worked for the establishment. She gave us what we considered to be poor customer service.

We didn’t say anything to her or anyone else. We just looked at each other and I leaned towards him and mouthed to him something like, “That was rude.”

A few minutes later, we found out she wasn’t an employee, just a customer who was helping out. She was married to an acquaintance of my husband.. After he arrived, she and I chatted a bit while the men talked.

It became obvious that she had some physical problems, similar to a person who has had a stroke.

It was also obvious that she had a hard time getting around, but she was still trying to help out the employees.

I felt horrible.

Out in the parking lot, I told my husband how badly I felt, and he, too, had a different perspective.

I thought about how I had just written about my empathy for others, and my understanding that what’s on the inside doesn’t necessarily reflect what’s on the inside. And then I thoughtlessly judged another person.

And what if she had just been rude? Did that give me the right to judge her? No, I don’t believe it did. People act certain ways for their own reasons. I don’t know what those reasons are. It wasn’t like she was aggressive towards us or mean in a way that called for being defensive. So what if she seemed rude?

This is another lesson for me that actions are more important than feelings. I may feel empathic, but acting with empathy is more important.

I can’t be perfect. I won’t always act with empathy. But I hope this lesson helps make me stronger in that respect.

Thanks to the writer of ocdtalk for starting the discussion and making me think more deeply about my own actions.

Do you think your capacity for empathy has increased because of your battle with OCD, other anxiety disorders or depression, or because of suffering caused by other things? Does it affect how you treat people?

OCD: Washer, dryer, lights

I don't like going down into the basement because that's where the washer and dryer are. But the only way I can do the laundry is to use the washer and dryer.

I turn the first light on at the top of the stairs and walk down and around to the laundry area. There’s another light to turn on.

I have no problem getting the water running with the detergent. Then I have to put in the clothes.

The whole time I’m doing that task, I think about the chances of dropping clothes between the washer and dryer or even behind the washer. If I do, the clothes could get hot and start a fire.

After I close the lid of the washer, I check between the two appliances. I stare until I can tell myself, with a “right” feeling, that there are no socks or other small items there.

I know that I didn’t fling the clothes into the washer. I know the open lid, leaning against the washer, would stop clothes from going over it.

But what if I threw them high enough to go over the lid?

I check behind the washer. I look until I feel “right” again.

Then it’s time to leave. I walk to the light switch, then look behind me until I’m satisfied that there are no clothes lying near the washer. Then I turn off the light. I stare at the bulb until I feel “right” about it being off.

Back at the top of the stairs, I look back down the stairs for any fallen clothes that might cause my husband to trip when he walks down. Then I turn off the light and close the basement door behind me.

Then I open the basement door to make sure the light is off. Then I close it again.

When the load has finished, I go back down. I open the dryer and see the worst thing I could see. The clothes from the last wash are still in the dryer.

I take them out. My laundry basket still has unwashed clothes in it, so I try to be careful to lay them on top of the dryer and not let them fall between the appliances or behind the dryer.

I take out the dryer filter. I clean the filter with my back turned to the dryer, because I don’t want any lint to fly into the dryer or down into the filter space.

I drag the lump of lint around and around the filter and its edges, trying to get every bit of lint. Lint can cause fires.

I finally put the filter back in and transfer the clothes from the washer to the dryer.

Then I check between the washer and dryer and behind the dryer. I have to make sure I didn’t fling any clothes back there. Clothes left behind the dryer are scarier than clothes behind the washer. I turn my head from side to side, to catch all angles, and stare until it feels “right.”

Then I pick up the dried clothes and return to the light switch and go through the routine of checking behind me, checking the light bulb, walking up the stairs, turning around, turning off the light and rechecking to make sure It’s off.

I went through this or a similar ritual every time I did laundry for several months.

But now I reattribute and refocus. I'm better at not allowing myself to give in to the compulsive urges to check, check and check.

The initial anxiety making me want to check ebbs away once I get away from the scene and start doing something else.

I have found that the more mindful I am of what I’m doing, the easier it is to refocus on something else and move on.

Do you have checking rituals like this? How do you deal with them? Do you have a success story you’d like to share?

CBT session #4: What does this have to do with OCD?

Let me preface this post by saying that I hope all of you in areas where tornadoes hit today are safe and well.

According to what I can glean from weather reports, I think all we’ll get in Central Virginia are thunderstorms.

Elizabeth, on her blog “Into My Own,” wrote an excellent post today about weather anxiety. If you haven’t read it, go here.

***

I had another cognitive behavioral therapy session today, and I left depressed and cried a good part of my drive home.

I have been experiencing a great deal of anxiety, the kind that causes my limbs to feel numb, makes me feel hyper and gives me a feeling of doom and fear.

I’ve tried to monitor myself enough to ask myself, when I felt this way, questions like, what am I thinking? What has happened? What am I doing?

The point was to find the triggers that promote the highest levels of obsessive-compulsive disorder symptoms and other anxiety. That was one of my assignments from last week’s therapy session.

Some of my worst anxiety occurs when I think about the clutter that I have around me. It’s mostly papers: paycheck stubs, paid bills, receipts and other records. I deem some of them too important to dispose of, but I don’t have enough space to store them, and the process of sorting through them is daunting.

Another time that provokes intense anxiety is when I’m writing for work. I have been working on limiting the time that I give myself to edit once I’ve written a piece, but I haven’t made a great deal of progress.

I have also had a lot of anxiety about workplace issues. I even woke up at 4 one morning this week thinking about work with anger and resentment. But I didn’t relate it to OCD.

The last couple of days, I’ve also been feeling depressed.

When my therapist asked me today how things had been going, I told him I have been feeling very anxious and depressed, and mentioned the work situation.

He jumped on that and asked questions about that specifically. Soon he was talking about the underlying anger that can make things like OCD and generalized anxiety disorder worse.

People with anxiety disorders tend to suffer from what he called “over niceness.” We don’t like conflict, so we tend to stuff our feelings, sweep our anger under the rug. But it bubbles up, he said, and, hence, aggravates OCD and GAD.

We spent the rest of the session talking about using empathy, assertiveness and respect to get our desired effect, not necessarily the desired outcome. We role-played. I cried, which I haven’t done in our other sessions.

At the end, I asked him if we could talk about OCD again. He said, of course, but he didn’t want me to avoid facing things like the conflicts we talked about today.



Sometimes, fire extinguishers are necessary.



He said he could give me tools that would work like a fire extinguisher on my OCD, but if gas (the stuffed anger and resentment) was poured on the fire, the fire extinguisher wouldn’t do any good.

So it was a session that didn’t help me with OCD. And I felt like, oh, here’s one more thing I’m doing wrong.

I’m sorry if this post sounds whiney. I went along with my therapist today and talked about the work conflicts. I’m sure I do need to work on facing conflict.

But I don’t want to deal with that right now. I want to deal with the OCD that plagues me and has plagued me for most of my life.

Yes, I cried during today’s session, which I admit could mean we were touching on a subject that is bothering me a lot. But I’ve also been depressed and hopeless. The tears could have been related to that too.

I don’t have another CBT session for two weeks, though I can call the office next week to see if the therapist has any cancellations. In the meantime, I am going to work on my OCD.

Any thoughts on this?