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?