Anxiety Isn't The Boss

Fear doesn't mean you have to stay still.

Sometimes, I'm sitting around watching television, hanging with family, doing chores, whatever, and I have something like a profound thought about my OCD and anxiety. Fine, it may not be profound, but it feels important to me. I had one such thought just now after using the bathroom, because I'm glamorous like that. The thought was this: My anxiety behaves so much better when I'm the boss. It's like a lap dog. If I don't give it proper discipline, it decides it makes the rules. When I don't let anxiety make decisions for me, it lessens naturally. Doing whatever the hell I want in spite of the horrible physical symptoms and emotions that crop up makes panic so much less intense.

(Disclaimer: I know I've said the same thing in different ways many times, but if you have OCD, you know sometimes you have to find new ways to think of the same ideas.)

What do I mean by doing whatever the hell I want in spite of my anxiety? I mean a few things. Firstly, if I'm working and I panic, I try hard not to stop to try to soothe myself. Soothing myself tells my brain something is actually wrong. Instead, I just keep working (sometimes). Another example is perhaps me excitedly planning to go to some event and then later dreading it because of anxiety. I know I actually want to go, so I do my best to do it anyway. I don't want to prove my anxiety right on any account. It rarely ever is, and it is never right about the severity of a damn thing. She's a drama queen, for real.

I know that self care is a much-touted aspect of mental health, but that doesn't mean self-care has to be a week off of work to collect yourself, thought it can mean that. For some people, like myself, stopping to savor the panic only makes it worse. If I "just keep swimming," as a wise fish once said, I tend to make out better. That's not to say I don't sometimes spend the day trying to distract myself from anxiety, but rather to say that the answer may lie in taking note of what you really want out of life when you're feeling well, so you can do it anyway when you're not.


Listen, if there's one thing, no matter how small, that you really want to do, but your anxiety is telling you is impossible–ignore your anxiety. Even if it makes you feel like you could shake out of your shoes and the world is falling in around you. Just do me a favor and achieve one thing that matters to you. Feel free to tell me how much of an ass I am in the comments if it doesn't go according to plan, but don't you dare forget to tell yourself that you're a badass for trying.

Be well, readers.

Panicking on Purpose

The road to anxiety disorder recovery is paved with panic attacks. In order to overcome your panic to any degree, you have to have panic attacks on purpose. You have to put one foot in front of the other down that road and get used to that which gives you distress. It sounds counter-intuitive. Trust me, it is doing the exact opposite of what your mind and body are telling you to do, which is why a lot of us, myself included, have persistent anxiety disorders.

For most of us, the biggest problem with anxiety isn't the thoughts and events that trigger it but rather the resultant, often extreme, discomfort. Once something gives you a panic attack, your brain starts to believe that there really was danger. A panic attack sure feels like danger, so it is completely logical and rational to fear the things that have given you panic attacks in the past. Don't let anyone tell you differently. What you have to do is embrace the illogical. Accept the unexpected and purposely do things that make you panic. Give yourself the freedom to be absurd and belly flop right into that gut-wrenching terror.

Today, I did something my therapist and I discussed with my husband in my last session. I hopped in my car by myself (I loathe driving without another licensed driver in the car.), drove to the local park and went for a walk. On the way home, I decided to take it a bit further. I drove down to the local grocery store and was considering doing some shopping, but by then I knew I was going to have a panic attack soon, so I went home and have been having off and on and anxiety for about 2 hours since. Do I hate it? Yes. Still, I'm proud of myself and know it was like taking my medicine. I'm going to have to do it again and again, maybe for a long time. There will be setbacks. There will definitely be panic attacks. There will also be good times along the way as I achieve my goals and get back to the things I love.

If you're on the road to recovery, I'm both sorry and happy for you. It's not going to be a simple fix. There is no simple fix. However, it's going to be worth it. You're going to be tough, or you'll just endure it. Either way, you'll survive it. That's what we do. We take a deep breath and keep going.

My Therapist is Leaving Me

I know that changing therapists is part of being mentally ill and getting treatment. We all have reason at some point or another to start "seeing someone else." I've done this only once before. After a single session with a therapist who had somewhat outdated ideas, I found the therapist I have now­–K. We've "been together" for about three years now. I know this is the exception. I've met people who have had upwards of 10 different therapists over time. I always hoped that wouldn't be me. During my last session, I learned that K would be leaving the practice where I see her for greener pastures. I have mixed feelings.

When I met K, I was in a similar situation to the one I'm in now. My anxiety was in overdrive. I was having multiple panic attacks a day instead of one or two a month. I was having difficulty eating, working, sleeping, etc. For three years, she helped me get through my ups and downs. She helped me manage to stay sane long enough to marry my amazing husband in a real ceremony and reception! She's done a lot for me, including starting me on exposure and response prevention a few weeks ago. I'm in the middle of that treatment now, and I'm switching therapists.

Now, I'll get into my bag of mixed feelings. On the one hand, I am extremely nervous that it will take several tries before I find a therapist who knows anything about ERP. K didn't, but she knew me. I'm also nervous that this will be a setback. On the other hand, I am so happy for K, whom I think will do great in her new position. On yet another hand, because I have three, this could be a good thing. I'll learn to cope with someone new. This person may have tons of experience with what I'm going through, and maybe I'll like them as much as I like K.

I've shed a few tears. I've had moments of fear over this impending change. I have my doubts about the future, but none of these things are alien to me. All change is a challenge for me, and I've faced so many challenged over the course of my illness. The timing is probably terrible. It will probably throw a wrench in my treatment for a bit while I get to know someone new. However, that may make it more beneficial. I'm going to have to adapt and overcome. What better treatment is there?

I'm definitely going to miss K, though. I hope she'll be okay without me.

Fear of Addiction: One of My Many Intrusive Thoughts

That's me, doing my advocate thing.

Today, I progressed in my exposure and response prevention therapy to one of my harder "triggers," and that is thoughts that I will become addicted to my anxiety medication. There are a few things that make this particular exposure tricky. Firstly, I am on medication that is potentially addictive. Secondly, I have days when my anxiety is too great to function without medication. I have this trigger in my life that I currently depend on, but am afraid to become truly dependent on. This is a field day for my obsessive mind.

I'm not going to go into medication details for now. I know I'm not the only one with medicine obsessions, so I don't want people to equate my experience with my particular cocktail as everyone's experience. This stuff is too nuanced for that. What I will say is that I am on a low dose of my particular medication, but I take it everyday right now because I was on a higher dose in the hospital and we want to make my transition to taking it rarely again super smooth. At times, I know I'm doing well with the taper and I am not abusing my medication. Other times, I'm convinced I'm addicted and I don't even know it. It's been enough to cause bad enough panic attacks that I need my meds, which I'm sure you can imagine fans the flames.

I've been questioning my relationship with my medication for years. Even when, as a person with co-morbid and relatively severe panic disorder and OCD, I was taking a low dose maybe once a month, I would sometimes convince myself I was addicted. Suddenly, my panic symptoms must be symptoms of withdrawal, my need to make the panic stop really just a need for medication. Never mind that my panic exists with or without the medication. It's just where my mind goes. Now, I'm trying to face that fear and live with that doubt. It's not pleasant.

This is probably my most uncomfortable exposure yet. I think that is a good thing. It might finally be working.

Keeping Up With Exposures Is Not My Strong Suit

I should start by saying that while I am sitting here writing this, it is 6:11 p.m. and I have still not done an exposure for today. For those of you who don't know what the hell I'm talking about, I mean I haven't done a bit of therapy where you make yourself anxious on purpose. I know I'm supposed to do this, but if I skip it in the morning, I just don't have the heart by the evening. I'd like to think I'm just too busy, so I have a legitimate excuse, but I'm starting to suspect that I am avoiding it.

Thus far, exposure and response prevention homework has done either one of two things to me, unless I am already anxious (then it works a charm). I either get terribly bored listening to a script over and over, which I know is what is supposed to happen. However, I just get bored by the script. The content or trigger still makes me anxious. I think I'm doing something wrong. The other thing it does is make me mildly upset and really annoyed. It's time consuming and going over the content of my fears is stressful. Still, it doesn't provoke anxiety the way an intrusive thought would.

There are several possible explanations for my current setback in ERP. I may be unwittingly sabotaging it so it doesn't work and I don't have to suffer panic attacks. I may only be triggered by intrusive thoughts when I am already a bit anxious. I may only be triggered by intrusive thoughts when they pop up, rather than when I'm purposefully thinking about them. It could also be that I simply am doing it wrong. I'm supposed to do this at least once a day for an hour and half. That's a lot of time to mess it up. I'm going to speak to my therapist about it on Thursday. Until them, I'm off to listen to a script or watch videos or something. Go therapy homework!

Obsession or Problem-Solving? Rationality or OCD? Am I Doing This Right?!

The precursor to the MAD Magazine guy.

As my incoherent title suggests, I'm a little confused, overwhelmed, unsure . . . doubtful even. It makes sense, since I have the "doubting disease," but it's hard to tell when it's legitimate and I need to work through it or when it's OCD and I should treat it. This leads me to my current conundrum. I'm not sure if I'm overthinking this or if I'm approaching it correctly in an attempt to get the best results.

Because I have Pure-OCD, it is hard to nail down my compulsions–a problem I've talked about before. It would seem that this sort of OCD requires a different touch when it comes to exposure and response prevention. However, the guidebook my therapist and I are working through is slightly generic when it comes to creating exposures for someone like me. They have one example of a woman who is afraid of her baby. The exposures involve the baby. I don't have a baby. What I have are a bunch of evil thoughts that make me feel sick all the time. The only option for this, according to the book, is to write a script, record it and then listen to it for an hour and a half twice a day. Needless to say, I think that approach needs some fine tuning.

Firstly, listening to the script works okay before it gets monotonous. Now, I know the idea of ERP is to get bored by the stimuli that usually provokes anxiety. That's all well and good, but I'm only getting bored by that one scenario. I basically wrote a script like it was a story happening, so I'll get bored by that one possibility regarding that trigger, but there are myriad others. My thinking is that I need to get a touch more general, no less graphic and add some other stimuli in there. For example, maybe I should write, read and listen to the script during exposures. Maybe I could add triggering sounds or pictures into the mix. I've read some suggestions along these lines and I'm a little overwhelmed. I see my therapist in two days, and I'm sure she will have some ideas. Do any of you?

If you have experience with imaginal exposure for Pure-OCD, I really want to hear from you. Leave a comment below with your thoughts or find me on Twitter. Thanks!

The Weirdness of ERP Scripts

I'm at about week two of my exposure and response prevention treatment. (My husband sitting next to me just now informed me that it should be called dedicated exposure and response prevention just so the acronym is DERP.) I've written my first scripts and are using them to expose myself (not like that) for 2-3 hours a day, starting this morning. I dabbled in the scripts before, but now I have a dedicated time frame and it's daunting. Anyway, I just want to say how weird it is–not wrong or unhelpful, just weird.

Those of you who do not know what an ERP script is, it is basically a story you write about your worst obsessions coming true and perhaps even worse than you expected. You write it, record it and then listen to it over and over. So, here I am with this story about something I'm terrified and disgusted by, laying on my couch, listening to me tell it repeatedly. I couldn't help but realize how strange it is. It's like toeing the line between treatment and trauma. Not to mention, it's a little like being insane. Remind me never to record one of my books in e-book format and listen to it back. I'm not sure I like my voice being broadcast to my brain.

The exposure worked a bit. I was anxious to begin with because it was morning, so I was susceptible to the script. It also made me sleepy, maybe because I listen to e-books sometimes when I nap. It was a bizarre combination of boredom, sleepiness and anxiety. I have to do another exposure tonight and I'm thinking it might be time to just read the script instead of listening to it. Any ideas?

First ERP Challenge: My Anxiety Baseline is Pretty High

Last week, I was given my first assignment in exposure and response prevention. It's not one of the big ones and we haven't mapped out a plan yet, but it was something small to get me started. During this assignment, I was to play a video game in a way that I had been avoiding because of my intrusive thoughts. I was supposed to record my anxiety levels and watch as they naturally subsided. The problem is that my anxiety doesn't naturally subside very often these days. Also, my baseline was so high that it was hard to tell if the task was successful.

I started at about a 40 on SUDS, peaked at about 55 and around 45 minutes later was around 40 again. In terms of my normal anxiety, this is about what would have happened had I not been recording or trying to watch my anxiety subside. I'm not discouraged by this, but I'm wondering what kind of numbers I'm supposed to be seeing. I've read somewhere that it should ideally go down by 40 points. In my life right now, that just doesn't happen without chemicals, compulsion or total distraction.

I'll be really interested to see how we address this challenge and come out on the other side. I'll also be seeing my medication prescriber this week to see if we can work on getting that baseline at a better number. Not only would I love to wake up without anxiety, but I would really love to be able to get a foothold in ERP because it has the potential to really change my life.

Are you seeing similar challenges in your treatment? Tell me about it in the comments below!

Finding the Compulsions in Pure-OCD

Worried woman
Photo by kennedy

One of the first challenges on my path through exposure and response prevention therapy is identifying what triggers my anxiety, what I fear about those triggers and what compulsions I use to neutralize the anxiety. Because I have what is misnamed as purely obsessional OCD, it is exceedingly difficult to identify my compulsions. I don't wash my hands, count things, check locks or circle back in my car to make sure I didn't run someone over. My compulsions are subtle, even to me, which made this task interesting.

It turns out, there are a lot of compulsions that people with Pure-O engage in. They include, but are not limited to:

• Mental checking
• Seeking reassurance
• Ruminating 
• Trying to cancel out bad thoughts with good thoughts
• Avoidance
• Escaping
• Confessing
• Prayer
• Repeating a comforting phrase, number, song, etc. 

I realized this morning, as I sat through my morning panic attack and did my therapy homework, that I engage in most of these, and probably more.

When I get a song stuck in my head that evokes an emotion that triggers my anxiety, I try to cancel it out with a song that is happy and upbeat. This makes it worse, causing sh*tty, sad songs I heard at the grocery store to get stuck in my head for days or even weeks.

I constantly gauge people's reactions when I tell them about my intrusive thoughts to see if they think I'm crazy. I am reassured briefly when people tell me I'm not crazy and that I will be fine. I seek reassurance on the Internet about a wealth of obsessions. If I have a self-harm thought, I use my Google-fu to find stats that will tell me the likelihood that a Caucasian woman in her 30s with OCD will kill herself. This behavior ALWAYS backfires because there is always that one page with some alarming statistic that cancels out all of the comforting information I found. I also sneakily seek reassurance from my mental health care providers.

I ruminate for hours everyday. This involves spikes or intrusive thoughts and then engaging with them. I will examine the thought excessively, trying to find definitive proof that my fear will or will not come true. I feel like knowing will make my panic, which is very uncomfortable, go away, so I keep doing it, knowing it is a compulsion that is feeding my disorder.

I escape in so many ways I cannot even list them. Like people who suffer from PTSD (a diagnosis on top of OCD that two professionals have floated my way so far, based on my abuse history–I'm skeptical.), I try to find exits from places, situations and even feelings. I analyze situations before I'm in them to determine if there is a way to escape them. If there isn't, there is a strong possibility I will then avoid the situation, which is another compulsion. Unlike people with PTSD, it's often not a safety concern that drives me to search for an exit strategy. It is the intensity of my anxiety symptoms. I can't stand to feel trapped. My fight or flight urges me to DO SOMETHING, so I can't be in situation where I can't, such as being in a car on the highway. I'm not afraid of crashing. I'm afraid of having a panic attack and being stuck in the car.

I sing the ABCs in my head, with decreasing success. I confess my intrusive thoughts to other people in the hope they will reassure me. I avoid books, movies and people who make me sad or anxious. I stay away from weapons and poisonous household products. In short, I guess I do have compulsions. The question is whether it is possible to prevent them when I do my exposures. We'll see.

If you know of any other compulsions that Pure-O sufferers have, please fill me in in the comments section.

Starting a New Treatment: Exposure and Response Prevention

This is me even thinking about
exposure therapy. 

Anyone with a persistent mental illness who has sought help can tell you that getting treatment just right takes time. That space between getting sick and feeling relief stretches long for those of us with OCD intrusive thoughts. These horrid thoughts can plague us for months or even years before something provides significant relief. Mine has been pretty cyclic, so I have had downtime over the past six years, but I've never actually been treated specifically for OCD because standard CBT helped enough to be encouraging. The OCD has always been treated as part of the larger picture of my mental health problems. Not anymore. My amazing therapist is gearing me up for exposure and response prevention. We're starting full bore next week.

What is exposure and response prevention? It's pretty much exactly what it sounds like. The patient is exposed to her fears and is asked not to engage in the typical response (compulsions). In time, this habituates the patient to the fear and hopefully reduces the amount of anxiety felt in response to it. You can read more about it here, here and here.

I'm excited to try something new and hopefully get a grasp on my life again after a recent upsurge in symptoms, not to mention a healthy dose of depression (maybe that's not the best way to put it *shrug*). I'm a little nervous too. Obviously, I don't want to face my fears. They make me scared. However, I'm crazy willing to do anything they say will work at this point. The other component of my nerves, apart from the obvious I'm scared of everything bit, is that my obsessions and compulsions are not clear-cut. I have "Pure-O." I don't wash my hands to get rid of germs or flip light switches on and off. My therapist is going to have to wizard up ways to expose me to obsessive thoughts and stop me from reacting with my compulsive thoughts.

It's all a little Greek to me right now, but true to form, I'm researching the process and getting ready to take it on. I really hope that I get positive results to share with you fellow obsessers, particularly you Pure-O types who have to put a little extra work into identifying what your compulsions are. I'll let you know how it goes, as long as my anxiety keeps letting me get my writing done. Wish me luck and feel free to share your thoughts and experiences about/with exposure and response prevention in the comments section.