My paper battle

I started to throw down the old bill and run away from the table, literally run away from it.

I could feel the anxiety build to probably an eight, and I told myself that I had to stay until it went down.

That was last Monday as I worked on my pile of mail and paperwork on our dining room table.

I have written about my problem with the stack of paperwork and the way my therapist is leading me to confront it as a part of my cognitive behavioral therapy.

So I stayed and forged ahead. I didn’t clear the table, but I made some headway. I also learned a lot about my reasons for keeping some of the paperwork.

Examples

 Bills: I had to have minor surgery last August, and bills come with surgery. You don’t just pay one person. You pay the hospital, the doctor who performed the surgery, the anesthesiologist and the lab.

The bills are all paid. They’ve been paid. But I haven’t filed the bills and my notes of when I mailed the payments because I like to check afterwards and make sure the payments were received.

I haven’t called. And those papers have been lying on the table. I’ve used the excuse that they’re serving as a reminder that I need to call.

On Monday I thought about that: I wanted to check to see if the payments had been received. I wanted to check. Was that OCD checking?

I think maybe it is in my case. I have not received any notices of nonpayment or phone calls asking for money. My checks have gone through at the bank. That most likely means the payments were received.

So I decided I would not check. I would file all the paperwork in a file folder relating to the August 2011 surgery.

 Requests: I’ve been periodically receiving notices from a national animal welfare organization that I’ve sent donations to in the past, asking me to renew my membership.

This is a wonderful organization, and I don’t fault them for asking me to renew. They depend on donations.

However, I have made a decision, for the time being, to support organizations in my local area. I’ve held onto those renewal notices, though, thinking, I’ll read this and think about it later.

Monday night I considered this: if I’ve decided not to renew the membership right now, there’s no need to keep the notices. When I decide to pick back up, I can find them easily online and send in the money.

So the notices went into the trash.

 It's called avoidance

To aid in the cleanup, I bought some extra file folders and a pack of banker boxes for storage.

I know that waiting to buy what I think are necessary accessories before tackling more of the paperwork is clearly avoidance on my part.

I will do more this week. I need to report back to my therapist. Most importantly, I need to face this.

I don’t officially have my next CBT session until May because my therapist is so booked up, but I’m on the cancellation list, and my therapist told me to call every week to ask about canceled appointments.

Have you ever realized, in the middle of an exposure, some of the OCD thinking that has led you to that place? What did you discover?

Even if you don’t have OCD, have you had to face down tasks that seemed insurmountable? How did you do it?

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?

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.

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?

CBT session #1

   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.