I’m not a Doctor; I’m not a Psychologist; and I’d never describe myself as an expert on Obsessive Compulsive Disorder or Cognitive Behavioural Therapy.
What I am however is someone who has lived and felt the experience of the process, seen the improvements that can be made and suffered the frustrations when they don’t come.
Without going into the details of exactly what CBT is and how it works, the basic idea is that by structured and studied exposure to anxiety causing situations, you will notice a decrease in the anxiety levels felt and this will allow you to attempt ‘harder’ tasks.
CBT cannot be an exact science.
The reality is that we are not taking a car to a garage, plugging it into a diagnostic machine, highlighting the faulty parts and replacing them.
A closer comparison could be made to carrying out maintenance work on an old building.
You can’t just rip it down and start again, you can only work with the existing structure to shore it up and try to return it to something approaching its original condition.
The warts and scars of time are likely to show to a certain degree, but I like to view them as adding character and showing the structure has been ‘lived in’ and used.
All people are different, all minds are different and all problems with minds are different. We are human and we’re not supposed to all be the same.
Psychologists, Doctors and Councillors are human as well. They see things differently to us and to each other. Some we may click with, some we may be wary of and some we may even fall out with.
Human factors WILL influence your treatment. We are not robots.
CBT is not a one stop wonder cure. Sometimes it won’t work.
This may be for any of a multitude of reasons. The patient may not be ‘ready’ to open themselves up to the scrutiny and pain of realising the extent of their problem.
Chances are, if you’ve got as far as the Doctor’s door you have a pretty good idea what your condition is. Whether you are prepared to take the step of explaining in detail the day to day reality of this to someone is something only you will know.
What is clear though is that there is no point hiding your symptoms and compulsions from your therapist as the more information they have to work with, the more chance you both have of tackling your specific fears.
You also need to be at a position in your life where you are ready to try. When I went for my first course of CBT I wasn’t ready for it to be a success. I was aware of my illness and desperately wanted it gone, but was perhaps a bit too ill to allow myself to challenge it properly.
I gave it a good go, but my overall anxiety levels were too high to let me challenge my fears sufficiently.
That’s not to say it was a bad experience. It introduced me to the ‘process’ and workings of the CBT model, making me more ready for any subsequent sessions.
It was also the first time I had fully opened up and admitted ALL of my thoughts to anyone, even myself. When you see it all on paper in front of you, you can see a definite target and really assess the scale of the challenge.
I must also stress that my first 10 week course of CBT was with a Local Authority ‘Gateway’ team member, not a fully trained Psychologist. Whether it would have been more successful at this stage in more experienced hands is impossible to say, but subsequent sessions with a specialist professional certainly felt more organised and targeted.
Both of my CBT experiences have been structured similarly. A weekly hour long session to assess the weeks achievements and monitor progress, ideally some form of actual exposure therapy and then some target setting for the week ahead.
The further towards the end of the programme, the more emphasis is put on the actual exposure work as you have hopefully gained enough strength to really challenge yourself by then.
I remember a specific session we had at the beach which involved me walking the length of the seafront barefoot without checking the floor. Something most would find routine and pleasurable, but a massive leap from 2 months earlier when I was still wearing steel-soled safety shoes most days to ‘protect/reassure’ me from accidental contamination from anything red, shiny or sharp.
If it is possible, the ‘best’ way to get the most from CBT is to simply attack the compulsions. They are the bit holding you back in life and causing you to forego a normal existence.
In reality, I found it very difficult to separate the physical acts of compulsion from the emotional handbrake of my obsessions.
It would take a massive degree of confidence (not in great supply to the OCD sufferer) and separation to go into a first session and not want to talk about the whys and ifs of life and just to say “can you expose me to X?”.
This is where an obsessive mind differs from a CBT patient of perhaps a phobia. To have a fear of snakes or flying is anxiety inducing no doubt, but that fear may only surface if the prospect of being near a snake or flying arises.
With OCD, commonly the fear is of so many different situations that it makes it them hard to target and they are obsessed about constantly, whether they are to be encountered or not.
You cannot therefore roll up to a session after a normal week, have an hour of exposure to your fear, and then switch off again until next time.
My experience, even with my successful programme was that the first couple of weeks involved lots of talking and listening and not much ‘doing’. This is understandable as the psychologist needs to get to know you as much as you need to learn to trust them. You also tend to have A LOT of stuff you need to share, get off your chest or just say out loud for the first time.
What you can slip into if not guided correctly though, is ONLY talking. You can go over the reasons, triggers and background of your life and anxieties as much as you like, but ultimately it’s only once you start attacking the compulsions that CBT will have any true success.
IT’S GOOD TO TALK…..IT’S BETTER TO DO!!
What will you actually be doing?
Don’t panic! If you have contamination fears involving needles, you aren’t going to be injecting people or holding dirty needles.
You are much more likely to be looking at pictures of syringes and of blood, leading onto handling clean needles and, in my case, taking needles and photos home with me to challenge me further and desensitise myself.
We don’t NEED to be exposed to bizarre and extreme situations to challenge our fears. Our anxieties are of real life ordinariness so this is all we need to be exposed to.
Walking down the street without checking the floor; using a public toilet without unnecessary checking; making a cup of tea without washing your hands first; or driving to the shops.
Whatever YOU identify as a good target to attack, is something you and your therapist can get stuck in to.
I will put a copy of my anxiety ‘mini-lists’ that I worked through in a future piece to show the wide variety of compulsions successful CBT can break down.
The true battle with OCD related CBT is not the hour a week where you may be exposed to a specific fear or two, but the other 6 days and 23 hours when you’re flying solo and attempting to challenge YOURSELF. That’s the time when you really have to dig in and grit your teeth.
It’s SOOO easy to cheat yourself and your therapist of your true progress, as there is only your word that you have carried out your daily/weekly tasks. Only you can honestly say how you reacted and whether you snuck in those extra checks, some sneaky hand washes or unneeded looks in that car mirror.
At the end of the day, it is what it is.
It may be the answer to all your dreams and break the chain between you and your OCD.
It may just prove to be too much too soon, or just not happen for you this time.
Or, if like me, it may start you on the right path to freedom, show you what can be achieved and give you the confidence and techniques needed to push yourself and succeed.
Only you can decide that. Your treatment can only last a certain time. You owe it to yourself to try your best, and that’s all you can do, whatever the outcome.
p.s. My CBT sessions ended about 3 years ago…today I went with my wife to the doctors as he needed have a blood test.
On completion, I took the phials of blood by hand, on my own, to the hospital and delivered them to the pathology blood test department…and had NO RAISED ANXIETY!