Friday, March 30, 2012

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?

19 comments:

  1. Sounds like he's a wonderful therapist because he challenges you (in a healthy way of course). I think facing anxiety, as with facing any fear/compulsion/phobia etc., is probably the most efficient remedy. Exposure over time is a time-tested therapy. I enjoyed reading this Tina!

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    1. Thank you, OE, for your comment. You're right, and I guess I knew it too, that facing the fear is best. But I avoided it pretty well.

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  2. Oh, avoidance! I have so many avoided behaviors. One of the biggest avoidance behaviors for me is things that feel "good." OCD tells me that if I enjoy something good, something bad is bound to follow. So I avoid doing things that I really like, or that feel too perfect or good.

    I'm sorry you're having to go through this challenging situation. Anxiety is so hard to face. Something that helps me when I'm doing CBT is to tell myself that I planned the anxiety. I'm not sure if that's a helpful thought to have, but I remind myself that I purposefully made myself anxious. It makes me feel in control, somehow.

    I hope everything goes well - keep up the good work!

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    1. Sarah, Thank you for the encouragement. That's a good suggestion, to remember that I planned the session with the accoompanying anxiety.

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  3. Well, I know it's a lot different for me, but I generally know that I feel better after I get something done, so it doesn't do me any good to put it off. I'm trying to clear some things out right now, and it feels so good when I actually get something accomplished, so this motivates me to continue.

    I'm sorry you have to deal w/ so much anxiety along the way!

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    1. Lisa, Once I start making some progress, I hope the results will motivate me to keep on. It will feel good not to look at the clutter and worry about it!

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  4. I suffer a lot from anxiety, and nothing seemed to help, not even therapy. what is helping me most besides medication are reading i am doing about it. If you would like to check the link i will share with you. It's from a Blog that helps me a lot, with articles and videos.
    http://www.healthyplace.com/blogs/anxiety-schmanxiety/2012/03/youtube-graduated-exposure-therapy-emetophobia/#more-137

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    1. Thank you, Nikky. I like reading others' takes on these subjects too. I've read that blog before, and it is helpful. Thanks for reminding me of it!

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  5. "How wily are the ways of obsessive-compulsive disorder." A.MEN. That is a great and witty and true statement! I love it!

    Do I practice avoidance? Yep ;-)

    My therapist always reminds me: "you can try to run, Elizabeth, but you can never hide."

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    1. I like what your therapist tells you: You can run, but you cannot hide. So true, because hiding is where the anxiety is.

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  6. Oh, yes! I avoid. I spent much of my working life avoiding doing basic aspects of my job because I was afraid I'd make a mistake. I'd get on the internet and sidetrack endlessly. It helps me to remember what my therapist says about OCD offering an illusion that we can avoid all anxiety if we just avoid long enough, but this isn't possible, since the more I avoided, the more anxious I got in the long run(I did get the hit of short term anxiety relief which my therapist said is like heroin.)

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    1. I avoid work-related tasks, too, until I can't anymore. Then I play catch-up, which causes its own anxiety.

      That's interesting what your therapist said about short-term anxiety relief. It's amazing how really destrutive our compulsions can be. That is a good word to use for it: "illusion."

      Thanks for stopping by! :-)

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  7. I am the avoidance Queen! In fact, for a long time whenever I took the Y-BOCS test, I always tested lower than I should have because I didn't realize that avoidance was a compulsion. It's easy to think you don't have compulsions when you avoid everything! I think avoidance is one of the hardest compulsions to overcome, because it's like you have to overcome two things. First you have to stop avoiding, then you have to face your obsession without doing any physical compulsion which you are likely to feel the need to do. But you can do it. You now have been made aware of the avoidance and for me that was always half the battle.

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    1. Sunny (aka Queen Avoidance :-))

      At one time, I didn't recognize my avoidance as part of OCD either. In fact, avoidance seemed like a good thing--I wasn't compulsively doing something, right?

      Of course, it is a compulsion. I get anxious thinking about starting, but I'm doing to have to. I can't turn away from it again.

      Thank you for your encouragement!

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  8. Ooooo YES - avoidance is one of my biggest compulsions. And you're so right - it is hard to recognize sometimes!!! I avoid so many things - a lot of feelings - not only anxiety. I do lots of things to avoid shame and sadness too. Congrats for tackling the work pile!!!

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  9. Thank you, POC. That's a good point about feelings--I think I avoid some of those too! Well, one thing at a time . . . :-)

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  10. Well... I avoid talking about avoidance. :) I so get what you're saying. I still avoid certain things but have come a long way.

    One of the things my therapist helped me with is following through with the fear. In other words, say you find a bill that hasn't been paid. Then what? Is the world coming to an end? No. Will I die? No. Etc. In other words, it's actually the fear that we're most afraid of. The outcome isn't nearly as scary when you look beyond it. If that makes sense. I agree with the other commenters. You've got a good therapist. He is gently challenging you. It sucks but it's how we grow. Bravo girl!

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    1. Thank you, Grace. I am glad I have a therapist who is challenging me, even though I don't enjoy the challenge! :-)

      I didn't include it in the post, but my therapist led me through what he called a "downward arrow" exercise where I just carried the worst-case scenario as far as I could. That actually had me laughing because I could see how unrealistic my fears were. You're right, I'm afraid of the fear and anxiety more than anything. I will push on!

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  11. This is great. My therapist didn't call it a "downward arrow" but I like that. What I learned (and still learning) from this exercise is that in the overall scheme of things, most of my fears are quite small. And the others are simply out of my control anyway. This is where trusting a higher power comes in. I couldn't do it without faith in God. He takes care of all those big fears.

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