Help your OCD by acting differently

“You have to be willing to act differently than how you feel.”

When my therapist said that to me during a recent session, I knew he had spoken wisdom to me and that I was going to get a lot of help from those words.

With obsessive compulsive disorder, I often feel uncertain, guilty, afraid and hopeless. I’m not always steeped in those feelings, but I often have them.

When I’m feeling like that, I don’t always act in ways that move me towards improvement in OCD.

For example, if I’m feeling uncertain, it’s easy to give in to a compulsive urge to check to make sure the lights are out in the basement.

If I’m feeling afraid, I may check the coffee maker again and again to ensure that it’s unplugged.

If I’m feeling hopeless, I’m close to giving up on resisting compulsive urges.

To act differently than how I feel is to refuse to check the lights again. It’s to walk away from the coffee maker. It’s to fight a compulsive urge one more time.

Those actions I take are going to be what changes me and improves my OCD.

Dr. Jeffrey Schwartz speaks of this when he discusses refocusing in “Brain Lock.”

I recently wrote about the four steps that Schwartz outlines and explains in his book.

After relabeling and reattributing the OCD obsessions and compulsions, the next step is to refocus: “You walk away from the sink without washing your hands and do something worthwhile that makes you happy. You do not attempt to make the OCD go away through some kind of magical understanding of what it is and what it means (p. 72).

Schwartz also writes the following: “The key to Refocusing is to realize that you must go on to another behavior even though the OCD thought or feeling is still there. You’re not going to let those thoughts or feelings determine what you do (p. 73).

Those words were life changing the first time I read them, and they still are. For me, they mean that I don’t have to be a victim to how I feel.

My therapist’s words reminded me of how important actions are.

Acting differently from how I feel is not always easy. Schwartz incorporates the idea of a 15-minute rule in the refocusing step: “The idea is to delay your response to an obsessive thought or to your urge to perform a compulsive behavior by letting some time elapse—preferably at least 15 minutes—before you even consider acting on the urge or thought (p. 212).

At first it might be necessary to set smaller time limits, Schwartz said, but you shouldn’t give in to the compulsion unless some time has gone by.

The time should be spent in doing “any pleasant, constructive behavior,” and after the 15 minutes have ended, “reassess the urge. Ask yourself if there’s been any change in intensity and make note of any change. Even the smallest decrease may give you the courage to wait longer. You will be learning that the longer you wait, the more the urge will change” (p. 212-213).

Actions are what count, Schwartz said.

Some might call this “fake it until you make it.” Do you ever do that? What kind of results have you had?

How I use "Brain Lock" to fight my OCD

   I’ve turned off the shower, but I want to push on the water turn-off again to make sure it’s off.

I’ve turned off the light in the laundry area, but I want to turn around and check and make sure it’s off.

I’ve turned off the ceiling fan, but I want to check one more time to make sure the blades aren’t moving anymore.

Are those blades moving?

I want to pray again for forgiveness, for the safety of Larry and the cats and my relatives and the whole world. And again. And again.

I want to drive back and make sure the pothole in the parking lot that I see everyday really isn’t a person that I just hit with my car.

The role of “Brain Lock”

These all are daily, or almost daily, compulsions that I feel the urge to do. Slowly, but surely, I’m following through with the urge to do the compulsions less and less.

The steps that Dr. Jeffrey Schwartz outlines in his book “Brain Lock: Free Yourself from Obsessive-Compulsive Disorder” is helping me to do that.

When I started cognitive behavioral therapy, I wrote about how my therapist uses a form of the four steps Schwartz advocates in fighting OCD: Relabel, reattribute, refocus and revalue.

Basically, to relabel is to recognize obsessions and compulsions and call them what they are, OCD.

To reattribute is to name the cause of the obsessions and compulsions: a medical condition.

To refocus is to do something else instead of giving in to the compulsion. It’s learning to shift the attention elsewhere and tolerate the anxiety until it goes down on its own, without doing the compulsion.

To revalue is to place a lower value on the obsessions and compulsions because you know what is causing them.

My therapist taught me to combine relabeling and reattributing and then move on to refocusing.

How I do it

Here’s an example of how I do that.



Is the water turned off?

   After my shower, I turn off the faucet. I want to keep pushing on the turn-off handle. I’m afraid if I keep doing that, though, that I’ll break it. And it’s unnecessary and takes up time. Most importantly, it’s giving in to a compulsive urge.

So after I turn it off, I make myself get out of the shower. I feel some anxiety because I am afraid it’s not turned off properly. I want to reach back and push it one more time. Instead, I focus on drying off and then start blow-drying my hair or getting dressed.

Another example: I turn off the light in the laundry area in the basement. I see the darkness. I turn around and start walking up the basement steps. I really want to turn back and look again. I feel anxious, and I think I won’t be able to relax or forget the light unless I do.

But I keep moving and don’t allow myself to look back. I get to the top of the steps, turn off another light and close the basement door behind me. Then I go off to do something else.

What I’ve learned

What I’ve discovered is that the anxiety doesn’t last very long and I actually forget about the obsession pretty quickly.

If I do give in and perform the compulsion, I still try to tell myself that it was the OCD that wanted me to do it, not me. That’s something that Schwartz recommends.

If I give in to the compulsive urge, I have also discovered that I get more anxious and it’s harder to turn away from it. It’s just not good for me to give in.

I’ve learned the following:

*I can tolerate more anxiety than I thought I could.

*Uncertainty is not fatal.

*I don’t have to have an in-depth thought session on every obsession and compulsive urge. I don’t have to resolve anything about it. I just have to move on.

*The anxiety will eventually go away if I don’t perform the compulsion.

*Focusing on something else is the key to my forgetting about the obsessions and compulsions.

*It’s not the end of the world if I give in and do a compulsion. It just means that I will learn better for the next test.

Have you tried the “Brain Lock” steps? If so, how did it go? How have you learned to tolerate and deal with anxiety that is a part of everyone’s life?

The imaginary shield of prayer

“Please forgive me for anything I did wrong today. Please forgive me for what I did do that I wasn’t supposed to do and for what I didn’t do that I was supposed to do.”

   I wish I were home. I wish I were alone in my bedroom, with the door closed. I’d be able to close my eyes or bury my face into my pile of stuffed animals, be alone with the whirl of prayers in my head.

“Please forgive me for not being happy where I am. Please forgive me for not focusing on you.”

I’m on the van that is carrying me home from school. I have to keep my eyes open so that the other riders won’t know that I’m praying. Everybody is so noisy. I can’t keep the rhythm of the prayer going.

“Please forgive me, Lord. Please forgive me for everything I’ve done wrong. Please forgive me for the mean thought I just had about the kids in the back of the van. Please bless them. Please bless them. Please forgive me for all my sins.”

Those were my prayers when I was a teenager, when I kept the journals that I wrote about in my last post.

I don’t pray like that anymore. I don’t feel like I’m physically straining to get the prayers right anymore.

I’m not all better. But I have begun to understand.

Late last night, or early this morning, as I got ready for bed, I knew I was too keyed up to fall asleep right away. My husband was still up, in another room. I sat in the dark on top of the bed and meditated.

When I meditate, I concentrate on the sounds around me. Starting out, I hear the larger sounds, the furnace running, perhaps, or the train passing through town.

But as I continue to listen, I hear the smaller sounds. The faint tick of something rolling around in the dryer in the basement, in the load I put in before bed. Or one of the cats munching a midnight snack.

Last night, as thoughts distracted me, I pictured myself apart from my thoughts. I pictured my hand holding a globe, with the thoughts swirling around in it, in pictures. I tried to be that Impartial Spectator that Dr. Jeffrey Schwartz writes about in “Brain Lock.”

My thoughts slowed down. I felt calmer. I felt like my mind was empty enough to go to sleep.

I put my head down on the pillow. But my mind wasn’t empty enough, after all.

I don’t remember now what I was thinking. I don’t even remember what I prayed, but I prayed one of the “spurt prayers,” something like, forgive me, God, or help her, God, or oh, Lord, be with him.

They’re not real prayers. They’re not directed at God. They’re compulsive chants. They make me anxious, restless. They’re meaningless, but necessary to quell . . . what?

I wanted to think. I wanted to answer the question. Why did I feel like I had to pray like this?

I’m beginning to understand that it’s because somehow I don’t believe that I will live a good life, in the care of the grace of God, that my loved ones will be safe and well, unless I think these meaningless chants.

It’s not for my salvation from an eternal hell. It’s to build some kind of shield against all that might hurt my family and me.

Somehow, I don’t believe God can take care of it all, that nature will run its course, that life will happen. Somehow, I believe I can control it all with my compulsive thoughts in the form of prayers.

I’ve been working on that shield for most of my life, and it hasn’t done anyone any good.

I feel like I had a brief moment of insight last night. Perhaps it came because of the stillness and quiet that I experienced during meditation.

It’s time for me to work on refocusing, on letting go of the imaginary shield. Do you have any ideas on how to do this? How do you deal with OCD when it’s all happening in your thoughts?

Conscientious

On her blog “Into My Own,” Elizabeth recently wrote about her experiences in school as a student with obsessive-compulsive disorder, and she reminded me of my own experiences.

There’s a word that appeared multiple times on my report cards as I went through school: conscientious.

“Tina is very conscientious with her work,” my teachers would write.

And I was. I always wanted to do well in school. I loved school for the most part. I was the type of student who got excited when I picked up my textbooks for the new school year, and read as much as possible in them before classes even started.

I loved to learn, and I did very well in school. I realize now that it became part of my identity. Tina was the smart girl. Tina got good grades. Tina was conscientious.

My OCD symptoms started when I was a child. I was worried about being “saved” at church, washed my hands compulsively, counted compulsively and confessed my sins, real and imagined, to my mother. But my OCD symptoms didn’t affect my schoolwork at first.

That changed when I entered seventh grade.

That year my conscientiousness became extreme. I read and reread passages in assigned books, waiting until I felt like I’d thoroughly read the words before moving on to the next paragraph or page.

Obviously, it took me longer than usual, and longer than necessary for a student of my abilities, to finish reading assignments.

I also became very slow in completing my assignments, reviewing my work repeatedly and beyond necessity to make sure everything was correct.

The curriculum the school used incorporated self-grading. In other words, I had to check my own work against the answer books.

This slowed me down even more as I struggled to make sure that I really did have the right answer. If I made a mistake and counted an answer correct when it wasn’t, then I would be cheating.

And if there was any hint of discrepancy between the answer book and my work, I sought out my teacher for reassurance, over and over.

So I became the problem student. My parents and my teachers thought that I was being contrary, deliberately working slowly or not at all.

I didn’t know how to explain my fears, or even that I might have an explanation to give them. I agreed with them: I must not be trying hard enough, and I must be bad.

I was no less frustrated than my parents were. I knew that they couldn’t understand why I just didn’t read the book, or finish my schoolwork. I couldn’t understand either.

I didn’t know why, if I didn’t reread a paragraph at least once, I felt anxious and guilty. I fidgeted or daydreamed, trying to avoid the torture of never being sure that I had “really” read what I was obliged to read because it was a school assignment.

I also developed obsessions regarding writing. In high school, when I began writing research papers, I became obsessed with the possibility that I would plagiarize.

My writing became painfully stilted as I carefully and sometimes awkwardly worded sentences in response to my fear of not giving proper due to my sources.

These reading and writing symptoms have remained in varying degrees since then, and I still struggle with them.

These symptoms break my heart. They get at the heart of who I am and what I love: reading and writing.

I have been studying “Brain Lock,” by Dr. Jeffrey Schwartz. Reattribution and refocusing make sense to me. I want to use the steps to deal with my OCD symptoms.

But I think deep down I’ve been thinking they would be most helpful with my contamination and checking issues.

This evening, as I read about the importance of refocusing, one of the patient examples was about a person who had issues with reading.

I really considered for the first time that the reattribution and refocusing of the CBT could be used for my reading and writing. I felt more hope than I had been feeling.

I’m determined. It won’t be easy, but I want to get back to a healthy conscientiousness and a full enjoyment of the things I love.

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.

Paying attention

“Mindfulness has to do above all with attention and awareness, which are universal human qualities. But in our society, we tend to take these capabilities for granted and don’t think to develop them systematically in the service of self-understanding and wisdom. Meditation is the process by which we go about deepening our attention and awareness, refining them, and putting them to greater practical use in our lives.”

-From “Wherever You Go, There You Are,” page 10 in e-edition, by Jon Kabat-Zinn

Recently, while in the shower, I’ve been thinking about being aware and what it could do for me.

It’s not that I do all of my deep thinking in the shower. The problem is, I often get lost in thought. The time gets away from me, and I take a long shower and end up running late for work, for church, for everything.

I think that’s part of the cause of my tendency towards procrastination. I don’t stay in the moment enough, but lose myself in thoughts of what I’ve done, what I might have done, what I want to do, what I should do, etc.

I think I’m doing this at least partly to keep at bay anxiety in the present moment, or things I want to avoid in the present moment.

And I have some issues about the shower. I worry that I won’t rinse the soap out of the bottom of the shower and leave it slick, and then my husband might slip and fall. I fill my hands with water and splash it around until it looks OK. And I compulsively push the shut-off handle to make sure it really is off. (I have gotten that down to pushing it two times.)

What I’ve read so far about what Dr. Jeffrey Schwartz advocates is that it can help with OCD if you pay close attention to doing what you know will bring about obsessions and compulsions.

Say I have a problem with making sure lamps are turned off (I do). If I am aware that I am turning off the lamp, I create a mental picture I can later pull up to help me deal with anxiety about it.

In other words, I can tell myself, yes, that’s OCD, because I remember turning off that particular lamp. I don’t want to check the lamp again. I have a compulsive urge to check it.

So back to the shower. I found I got through the process faster if I kept telling myself things like, “I’m in the shower. I’m taking a shower. Now I’m going to wash my hair.”

Sounds kind of crazy, but I think it may be helpful to me, not just in hurrying myself through the shower process, but in learning to pay more attention.

Does anyone else have this problem with keeping the mind in the present? Do you see it as a problem? What do you do about it?

It's not easy being mindful

Remembering to be mindful, or aware, is not easy.

It’s one thing to read about something. It’s another thing to actually do it, or even to remember to do it.

Relabel. Reattribute. Refocus. Revalue.

Those are the four steps created by Dr. Jeffrey Schwartz to use in cognitive behavioral therapy for OCD.

Now I haven’t read his entire book, “Brain Lock,” yet. I’ve read a good overview of the steps I found online. I have a lot more to learn, and I have a therapist who will lead me through this.

But I want to do something while I wait for my next appointment, so I thought I’d start trying to catch myself in the midst of the obsessions and compulsions and practice the four steps.

I have found that some of my OCD habits are so ingrained in my routine that I don’t always realize I’m in the midst of a ritual until I’ve done it. I’m sure I didn’t even recognize a lot of them today.

I cut down a little on some of the checking, but I still did the compulsions.

I did have what I would call a small success. When I left work this evening, I didn’t go through my maddening ritual of checking my office lamps to make sure they were off. I turned each off, careful to be fully aware of what I was doing, and then I walked away. As I did, I reminded myself that I didn’t really believe the lamps were still on. Rather, I had a compulsive urge to check them. That was OCD, not me. And I haven’t thought much about it since.

I’ve got bigger issues to deal with, but I guess that’s a start.

I’m also reading the book “Wherever You Go, There You Are,” by Jon Kabat-Zinn. I’ll write a review when I’ve finished. So far, it’s very good, and I think it’s going to help me.

If I can remember to be mindful.

Start of a worthwhile journey

I had my first session with the psychologist today who will be leading me in cognitive behavioral therapy.

I won’t be doing exposure response and prevention therapy after all. Rather, the doctor will be providing what he referred to as the “third wave” of CBT. It’s the therapy Dr. Jeffrey Schwartz outlines in his book “Brain Lock.”

Let me say first of all that I felt comfortable with the doctor and believe we can work well together. He is a clinical psychologist who is very familiar with OCD. He has written about religiosity in OCD in particular.

He asked me a lot of questions, and we talked about what areas of OCD were affecting my life the most.

Just talking out loud about what I obsess about, what I worry about, and how I live my life was revealing to me.

I talked about the “what ifs” that I fear with writing, with cleaning, with checking. I talked about the avoidance and procrastination that I practice in order to avoid the anxiety that writing and cleaning stimulates in me. I also told him about my religious doubting.

He explained how we would work on a focused area that was causing me, on a scale of one to 10, about a six or seven anxiety level. (Based on one being no anxiety and 10 being the worst ever.)

Bringing that the level of anxiety down for that area would in turn help the other areas too.

He said it sounded like I had some social anxiety in addition to the OCD and generalized anxiety. That and the OCD have isolated me in a lot of ways.

At our next visit, in two weeks, we’ll prioritize what I aspects of OCD I want to work on the most. I already know it will be the writing and the cleaning.

The treatment usually runs from eight to 16 sessions. I like having an end in sight.

Meanwhile, my doctor suggested I read the first couple of chapters of Schwartz’s book. He said that when Schwartz came out with his book, it was rather radical because it wasn’t thought that the brain could be changed. That’s why he made his case in such a “long winded” manner, my doctor said. Now, his ideas don’t seem so radical.

I’m still getting my head around today’s session. I will write more specifically about things as time goes on.

I feel like I’m starting a worthwhile journey.