2 September 2013

Resistance is not futile

When I first went for occupational therapy, back in the mid-90s, I didn't know what was wrong with me - possibly my doctor wasn't sure either. Nor did I know anything about Cognitive Behavioural Therapy (CBT), which is the recognised treatment for OCD. 

As a result, I'm unsure whether my therapist, Dan*, used CBT in my treatment: he certainly didn't name it as such. However, a key element of CBT is exposure and response prevention (ERP), and he did encourage me to do that.

Essentially, ERP entails exposing yourself to your fears until your anxiety subsides on its own, rather than falling back on your usual compulsions to reduce that anxiety - which forms the 'response prevention' part of the process.

The main cause of anxiety for me is a lack of order and symmetry in my environment. Exposure doesn't, though, mean creating a mess in the normal sense of the word. As I need to have objects around me positioned very precisely, it can suffice simply to push something half an inch out of place. 

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It's usually necessary to build up the length of exposure over a period of time; to try to resist responding as long as you can, and gradually increase this period of resistance.

In encouraging me to engage in ERP, Dan provided one reassuring piece of advice: if I really couldn't tolerate the 'mess', I could always put things straight when I reached my limit of endurance. This suggestion was, no doubt, intended to help me lengthen my exposures.

I'm sure he also meant for this carrot - of being able to cave in to my compulsions - to be a temporary prop. Unfortunately, I've never managed to relinquish the idea that I can fall back on my OCD when the going gets tough.

I'm sure that I'll be fighting - or managing - my condition for the rest of my life, and will have constant slides up and down the scale of compulsive behaviours. However, there is a subtle, but crucial, difference, between acknowledging occasional remission as part and parcel of OCD, and using it as an acceptable excuse to give up the fight.

An apparently contradictory proposal from Dan was that I might, sometimes, be happy to engage in my compulsions and, if so, not want to resist them. He told me, 'If you recognise what you're doing, and you're happy to spend your time, at that moment, on that activity, that's fine.'

It’s true that one distinguishing feature of OCD, compared to OCD-type behaviours, is the distress that it causes. If you’re not distressed, it’s not a problem – and not defined as OCD. I still don’t know whether it’s healthy, though, for someone diagnosed with OCD to succumb willingly to any compulsion, for any reason. It seems on a par with an alcoholic claiming one drink won’t do them any harm.

On the other hand, everyone has their own form of stress-relief: perhaps drinking or eating, shopping or exercise. The challenge with any of these is the same as for OCD: keeping them in check, so that they don’t take over, or ruin, your life.

*name changed


Anonymous said...

Interesting post, as it's not an uncommon issue for those with OCD to sometimes not know if the behavior they are engaging in is actually OCD related.I've written about this also, the most recent post at: http://ocdtalk.wordpress.com/2013/08/19/healthy-doubt-versus-unhealthy-doubt/
Glad I found your blog....look forward to following.

Helen Barbour said...

Thanks for your comment - I'm actually following your blog by email and was interested to read the post you refer to last month, but also your more recent guest post by Dr Seth Gillihan, re exposure vs ritual.

There is a great online mental health community - both Twitter and blogs - and I've come across a lot of very interesting and useful pieces recently.

Thanks again for reading and following.