My experience of CBT, again…

A couple of months ago I started cognitive behavioural therapy again and this time I’ve been having a CBT therapist come to my home once a week. I was apprehensive to start this again as this is my fifth bout of therapy for OCD and I always have it going through my head, what can they teach me that I don’t already know?

So my therapist has been trying to break down my safety behaviours which I admit I didn’t really realise I was doing. It’s not something I knew much about before I started talking to my therapist Claire. So even though I do exposure therapy all the time, it turns out I have safety behaviours that stop me from fully exposing myself to harm. Everything from turning away from bins when I’m walking my son to school to avoid having panic attacks, to holding washing away from my body when I’m doing laundry to avoid contaminating myself and my clothes. 

In my first therapy session we made a list of many common issues that I have with my contamination based OCD, and then broke down the issues into stages of safety behaviours. For example, I have a lot of trouble doing the laundry. Many times I would wear gloves, then wrap the washing in a towel to avoid contact with contaminated laundry, then I would hold it away from my body so only my hands are contaminated and in between each step I would wash my hands up to ten times. Each of these steps is a safety behaviour. 

We decided to start with tackling the laundry as it is a basic everyday activity I can struggle with. So after breaking it down into steps my therapist asked me to first take away the gloves and then only wash my hands ten times after putting on the washing without washing ten times after each step. Which admittedly felt like a big step to take away the gloves let alone to stop washing in between each step. 

So then comes exposure response prevention. Time to try it. The first time I managed three minutes before the urge to wash my hands was overwhelming. So I established a routine of doing it every other day as it causes me so much anxiety that it wipes me out for the day and the anxiety takes ages to dissipate. After doing this for several weeks the anxiety still wasn’t coming down but I was able to go up to seven minutes so I felt like any improvement was better than no improvement. 

 However half way through my course of CBT I had a meeting with my therapist and a senior and she felt like because my anxiety isn’t coming down but staying at a high level and then I still get an overwhelming need to wash my hands, that actually she felt like I was reinforcing my belief that I needed to wash my hands.She didn’t feel it was progress. That to me was really upsetting as I’ve been trying really hard with the exposure response prevention and it was incredibly disheartening to realise I hadn’t made the progress I thought I had made. So she suggested that I touch the washing and then not wash my hands at all which I said no to. I felt like that would be an automatic panic attack and I’m not putting myself through that if I don’t have to. So we decided that I needed to do the exposure therapy for a shorter amount of time so that the anxiety didn’t spike as high and the urge to wash my hands wasn’t as overwhelming. That way I’m not reinforcing the belief that I need to wash my hands to decontaminate myself so I don’t get sick.

As I’m now nearing the end of my treatment course I find myself thinking, what now? Well there is an option that i will be referred again to Springfield hospital which is an OCD specialist unit for inpatient stays in london. I was referred to them before but although they agreed I needed an inpatient stay I didn’t meet the requirements in that I wasn’t on the correct medication and that I needed one more bout of therapy. Which is how I ended up having at home therapy instead of having to go to outpatients. I have been switched to different medications that Springfield recommended and now it is up to my team at the CMHT to decide if im to be referred again as if not there is no more help available for me.

Having an inpatient stay for 3 months obviously is not ideal as I have a family, but we decided together that if it was needed I would go as it is the best help available for OCD in the country, but even then the wait list is a year. So essentially I feel stuck between a rock and a hard place. What do I do for the best? I feel as though I have tried all the therapy available to me and I’ve hit a dead end. I don’t want to suffer with this for the rest of my life to a debilitating degree. When you wash 150 times a day it really takes a toll on your skin. My skin is so dry and scaly that I always have cuts on my hands which take ages to heal because of the constant washing and use of antibacterial gel. I check things hundreds upon hundreds of times a day. Doors, plugs, gas taps, all sorts of things and the anxiety that accompanies it gets overwhelming. In between washing my hands and checking things it takes a lot of time out of my day and that doesn’t include intrusive thoughts. Which sometimes are incredibly overwhelming by themselves, luckily they come and go and are not constant otherwise I don’t know how I could cope. Seeing images of death and violence of yourself and family all day is incredibly distressing and I wouldn’t wish it on anyone.

I hope that I get some resolution soon and that the therapy won’t be a complete waste of time. Fingers crossed. So far it hasn’t helped much and even if they say I’ve not made much progress I’m still proud that I’ve managed to do it at all. Any progress is better than no progress. I’m always being told that recovery is a long process and boy is that true, but this time I’m determined to try not to give up. So wish me luck. Even if I don’t get referred to Springfield I don’t want to waste my life. You get one life and I want to make the most of it. Small steps can lead to big changes and that’s what I need to focus on.

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