Tuesday, April 17, 2012

OCD and depression: starting on a new path

Is this one step forward and two steps back?
That’s what I was thinking as I left my therapist’s office yesterday evening.
Today I considered the possibility that it was a leap to a new path.
I will be starting a new course of therapy tomorrow, one that will focus not on obsessive-compulsive disorder, but on another problem that has accompanied me for most of my life: depression.
I have written about my battle with depression before, but in my therapy and my own work with exposures, I’ve been focusing on improving my OCD symptoms. The OCD is getting in the way of my living a full life.
But depression is getting in the way of the OCD therapy.
My therapist is very perceptive. I wrote about how he called me out on my avoidance of the paper pile.
Yesterday, he cut to the heart of things again.
He always begins a session by asking me an open question like, “So, how are things going?”
I talked about what I had done and hadn’t done and how overwhelmed I felt. The words kept coming. And then I started crying.
He reminded me of our discussion in the past where he said other things like anxiety and “stuffed” anger and emotions can feed OCD.
He believes it’s chronic depression that is feeding the OCD, and as long as I don’t deal with that, I won’t get very far with the OCD therapy.
I knew he was right. I knew intuitively, right away, that he was right.
Chronic depression, especially when it’s early-onset, which mine was, is particularly hard to treat. Medication has helped me tremendously, but some people have drug-resistant depression. I am, my therapist said, one of those people.
Though I was never diagnosed as a child, I probably suffered from dysthymia, which Medline Plus defines as “a chronic type of depression in which a person’s moods are regularly low.”
My therapist said in those with chronic depression, the more severe depression episodes improve only so much—to that same low level.
He said the best therapy for chronic depression is called Cognitive Behavioral Analysis System of Psychotherapy, or CBASP.
He wrote it out for me, and I focused on one word: psychotherapy.
I’ve been through talk therapy before, and it was helpful, but it was also a meandering, nebulous experience with no end in sight.
But my therapist said CBASP is a very active and practical type of therapy. The treatment usually lasts approximately 26 weeks, but it could go faster for me, he said.
CBASP can put people into remission from their depression.
I’ll always be on medication, but the medicine provides a floor for me, he said, that enables me to do other therapy more effectively.
I’ll still work on the OCD, but we won’t spend time in our therapy sessions on it while I’m doing the CBASP.
I feel like I’m starting over. I’m almost 49 years old, and I still have to work on depression. But I could also experience remission for the first time in my life.
Those are the thoughts I’ve been having today and the hope I’m clinging to. Remission. An ebbing away of the depression that causes me to feel hopeless, helpless, fatigued and irritable. Hopeless and helpless.
I imagine the depression as a dark knot down inside me, surrounded by the more visible OCD and anxiety. Getting that knot to come loose and work itself through the OCD and anxiety is my goal.
Here I go: another therapy, another path, a new hope.

32 comments:

  1. Tina,
    I too suffer from dsysthymia and depression and have dealt with it all my life. luckily meds have worked for me without a lot of going from one to the other. I hear the hope in your writing but also hear the frustration and 'well crap!' and it's okay to have both. Go into it with the great attitude I sense...and may it bring awesome results. YOU are worth it and your life is worth it...
    thinking of you....

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    1. Thank you so much, Tracy. Yes, I'm hopeful and frustrated, but I'm trying to focus on the hope!

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  2. Sorry Tina. That's rough. I'm sure it'll be better in the long run. It's good that they're wanting you to treat it instead if just masking it. It may feel like you took a few steps back but you'll be able to get up and run that much faster towards your other goals once you get through the depression. I'm praying for you and I know everything is going to work out great! And just think about how much better you're going to feel! :)

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    1. Thank you! I like that image of getting up and running faster toward my goals--I'll try to keep that image in my mind.

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  3. Oh Tina, I'm so sorry that you have suffered with this. I will pray that your hope will grow as you work your way along this new path. I pray that you can work your way beyond this and into joy.

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    1. Carolyn, Thank you for your support. Many people have struggled through this and have done well, and I'm doing to do my part to make sure I'm one of those!

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  4. I know this is tough for you, but I see something else: I see a woman who has peeled enough layers of the OCD to start dealing with an underlying issue. From here, it looks like a sign of healing rather than a setback. I continue to applaud you for sharing your journey and working through the challenges week by week. I also think you have a very cool therapist!

    I hope this makes sense. I'm not trying to do some pollyanna cheerleading, but so often in my own recovery, it was hard to see my improvements when I was "in it." There are still times when I have to remind myself of how far I have come, because I forget when I'm feeling anxious.

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    1. Nadine, This comment touched me so much. Thank you. I like the idea that I'm actually showing signs of healing. You're right, it's hard to see when you're in the middle of it.

      I do have a very cool therapist! He's smart and knows a lot, and I feel comfortable with him.

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  5. Well, the thing about psychotherapy is, it's as effective as you and the therapist are together. So if you don't have a good therapist, it's not going to be good therapy for you. But you sound like you have an effective therapist, so maybe this program will make huge differences for you. And although 26 weeks seems like a long time, in psychotherapy it really isn't. So I see lots of positives for you :-)

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    1. Thanks, Lisa! I think I have a great therapist. I am blessed with that. We had our first session of the CBASP today, and it is very goal-oriented and focused on taking care of what needs to be taken care of.

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  6. I have a really good feeling about this new therapy for you. I am cheering for you.

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    1. Thank you for cheering, Elizabeth! I value your support so much.

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  7. I am happy to hear how open you are to a new step; the new therapy and your doing whatever it takes to move forward. I had severe depression at one time, and I remember thinking "how could anyone have OCD and not be depressed?" That was back when I was caught up in hours and hours of rituals that literally ate up my whole day. It was such a cycle of despair, and trying to get out of the depression and out from under OCD was too much and too overwhelming. Thank goodness I got the help I needed and once my deep depression lifted I was able to make progress on the OCD. Like it still stinks to think I probably will never be cured of OCD but at least my life is productive and I can enjoy things.
    I am really rooting for you Tina.

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    1. Krystal, Thank you for your encouragement! My therapist said my OCD and depression are probably linked in some respects, but the depression is impeding the OCD therapy. You're right--it's easy for me to feel overwhelmed if I try to take on too much at one time. I'm still working on the OCD, but I realize that the depression needs to take precedence right now.

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  8. Tina, I'm really excited for you to start this new therapy. I am sure you will be seeing major results from it. It's exciting because we can watch you (well, read as much as you write) go through all this and provide hope to people who may be feeling a little hopeless. Chin up girl, you can do it!

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    1. Alfonsia, My chin is up! :-) Thank you for reminding me to do that. I'm feeling a little stronger about it now. Writing about it and sharing with you guys helps me tremendously.

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  9. I, like everyone else here, am cheering you on. You are doing such a service for others by sharing your story and the paths you are choosing. Your therapist sounds great, and I look forward to hearing about the positive results that I'm sure are to come.

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    1. Janet, encouraging words like yours mean so much to me. I really like my therapist, and I've built a trust up. I had my first session of the new therapy today and got a better idea of what to expect. I am beginning to feel better about it. Thank you!

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  10. One of my doctors told me once: this is you, you have depression, you are born depressed and will be all your life. It's in you. I got so angry, but after all isn't he right? no medication has ever helped, so I guess he said the truth. I admire your courage Tina. You talk about it, you take your medication, you follow therapy, you do all you can to get better. All that has one explanation: You love yourself, and that is what I don't have. I am happy for you

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    1. Nikky, I don't think anyone has ever told me that I love myself. I actually have pretty low self-esteem. I have just reached the point where I want to live more completely. Please remember all the people who care about you. You are a courageous person with such a sensitive heart.

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    2. Nikky, I can't tell you how upset I am that a doctor told you to expect to be depressed all your life. What a bunch of nonsense! There is ALWAYS hope. There really is. Look, I'm not saying that it is easy or that there is a quick fix. I've struggled enough with depression for over two decades to know that is not true. But there is hope. Perhaps this new therapy Tina is doing is worth looking into. I also know that Cognitive Behavioral Therapy is used for depression and that may be worth looking into as well. If you live near a university, they are often great sources of top-notch, cutting edge help. The National Alliance on Mental Illness (NAMI) may also be a good source of info.

      In any case, YOU ARE WORTH THE EFFORT. Just because some doctor didn't have the vision to see the possibilities for your life does not mean they don't exist.

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  11. Hey Tina. Very interesting. This is the first I've ever heard of CBASP. I'll be interested to hear about how your doc applies this to your day to day treatment. Just when you think you know all about this stuff, you find out you actually know very little!

    I'm really glad your doc is helping you to deal with the depression. It is so difficult just to live life when your heart and mind are weighed down like that. When the majority of my depression lifted I found that overall life did not seem so overwhelming and I was better able (well, usually better able) to handle anxiety and all the stuff OCD throws at me. That would be so awesome if you went into remission! Can you just imagine?

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    1. Thank you, Sunny. It's hard to imagine remission--I don't really know how it would feel. But it would be like a miracle!

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  12. There was a time that I was daunted and angry when another diagnosis and another therapy was added to the pile. But now it actually gives me hope. Anytime there is something new to try, it reminds me that, well, there are still options and new paths to healing I haven't been down yet. I'll try anything to feel better, and some of them have certainly helped. So I wish you luck as you go forward!
    Adventures in Anxiety Land

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    1. Blue Morpho, thank you! That's a good way to look at it--another opportunity to get better. I am grateful for options, too, and the chance for healing. Thank you for your comment!

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  13. I have to wash every single drinking glass ten times after soaping and a plate at least five times. Reading the hunger games, I have become better thinking that if I had to live in a place like the people in the book, what will I do? It is helping me with my OCD a little.

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    1. I rinse my dishes a lot to get the soap residue off too--and end up running too much water doing it! It's like there has to be a certain rhythm in the rinse or it's not "right."

      I have not read The Hunger Games. That's great that it's helping you with the OCD. I will have to look for it.

      Thank you for commenting!

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  14. Always keep hope alive! You never know, it might be the 1,068th thing you try that is the magic one! I admire your strength. None of this is easy, but hope is paramount. It gets us through.

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    1. Thank you! Yes, hope is sooooo important. I've probably tried about 1,068 things, but the next thing or, more likely, a combination of things, will be the one.

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  15. I have just published my first book, and believe me my negative obsessions held me down for a year. If not for my wife I would have never pulled the trigger on the publication. Im still doubting the whaler thing-did I add who I should of? Did I insult? etc.

    THE COPARAZZI

    AMAZON.COM
    BARNES-NOBLE.COM

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  16. I missed reading this post when you first wrote it, but I sure associate with it. I liked how you described psychotherapy as a "a meandering, nebulous experience with no end in sight." I've been focusing on my depression more than the OCD in therapy for... most of the time I was in therapy for OCD, after the first few months. I've been dealing with depression or dysthymia for a long time, maybe since I was 9 years old (throw in a few good years or months). It's not as funny to write about, though. I can laugh at how I stare at my care to make sure the lights are off, but hopelessness doesn't usually strike me as funny. Anyway, I'm back to psychotherapy. I'll have to look into the particular kind you mentioned here.

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    1. Abigail, That is so true--nothing funny about hopelessness. I've just started the new therapy, CBASP, but I think it will be helpful. I will write more as I learn more!

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