"You can't heal in the same environment that made you sick." - Unknown
This is one of those phrases that have really changed my mindset and I've kept it in my head throughout recovery and not just about when it comes to where I am physically but my mentality, I can't heal with the same mindset that made me sick. So when it came to my chance to go to university when I was 18 years old, and to be able to move out and away from where I was at my worst (or what I thought would be my worst!) with Obsessive Compulsive Disorder (OCD), I jumped at the chance! Even though I had experienced burnout from my GCSEs and A Level's, as well as that I would've only just stopped and come out of therapy after nearly a year of pain from the illness, and (wrongly) my therapist and I believed that the chance to start over somewhere new and fresh would be the best push and start I need in getting better. Despite the fact that I would be living (for the first time) away from my family, in a new city, still trying to get back on my feet after having really bad OCD, we thought that this would be best for me. Sometimes, I wish I could go back to past Emily and tell her that it's okay to take some time away from education, take a year off to breathe and take it easy but alas I can't but that's a story for another day!
So I probably shouldn't have been surprised when after a semester at university, I dropped out and came back home due to my health and because university is stupidly expensive! And what should happen when I get back?? Yeah, you guessed it, my OCD started to make my life hell again! It had already started to come back around whilst I was at university but being back in the same environment that made me sick, it came back with force. Back were the Contamination obsessions that I had wanted and hoped would be behind me! (And if you're not sure what I'm talking about then you need to go and read my previous blog posts!)
But how do you treat Obsessive Compulsive Disorder (OCD)? Besides resisting the constant urge to scream at your own reflection and to just sit down in a corner and refuse to move? 😂 The most effective treatment for OCD is Cognitive Behavioural Therapy (CBT) and Exposure and Response Prevention Therapy (ERP). Now, what I’m going to discuss and be writing about with therapy and OCD treatment comes from my own experiences and what I’ve learnt during my many courses of therapy. I’m not a professional and urge you that if you have OCD or know someone who has or might have OCD, please talk to your Doctor about treatment and how to get help! You deserve support, you deserve to be listened to, and you deserve to get better! 💜
Now, CBT is the typical course of therapy for those who need help with their mental health because it allows a discussion to be had about the problems that you’re experiencing as well as allowing useful coping mechanisms to be introduced, practiced, and used. It provides a more personal touch with the opportunity to delve into your problems and be able to potentially explain and discuss why these things could be happening, look at possible triggers, and how best to cope and manage what you’re going through. It also helps to teach you acceptance within yourself which I know sounds pretty whimsical when I write it like that but it does help and can work with the right therapist and active participation on the recipient’s side.
ERP stands for Exposure and Response Prevention Therapy, which basically means that you expose yourself to what you're scared of. This can either be done cold turkey style, like ripping off the band-aid and boycotting doing the compulsions completely or it can be done through steps with every step building up to not doing the compulsion at all and each step is something more anxiety-inducing than the last but in gradual increments so as not to overwhelm you. This is one of the most effective ways to treat OCD but is also common in treating other anxiety disorders as well as phobias! How it works with OCD is that you take one of your compulsions that you want to stop engaging in and you list out potential steps you can take that will allow you to gradually be able to stop doing the compulsion. After listing out the steps, your therapist and you go through them and rate them out of how much anxiety you think they will cause you (these are called SUDs, Suspected Units of Distress), you'd then go about ordering them from least anxiety-inducing to most anxiety-inducing with the last step being not engaging in the compulsion altogether (as it would cause the most anxiety). As homework, you'd go about your daily life, ensuring that you're putting yourself into the situations (if safe to do so) so that you can expose yourself to the anxiety. You take it one step at a time, repeating it for however long it takes until you no longer feel anxious doing that specific exposure task, and then you move up onto the next task, the next one that causes more anxiety than the previous. And then you repeat that same method whilst doing all of the other exposure steps, building yourself up to either the most anxiety-inducing exposure or not doing the original compulsion altogether.
For example, I'll use one of my old compulsions and how I challenged it through ERP. I used to wash my hands and count to 20 for every part of my hands (i.e., fingers, back of the hands, fingernails, etc.) because my OCD made me believe that if I didn't, I wouldn't have cleaned all of the germs off of my hands and therefore I would make someone ill. I then listed different ways I could challenge this belief and behaviour and chose to decrease the number I counted to in increments of 5. So when I next washed my hands, instead of counting to 20, I counted to 15. I repeated this every time I washed my hands until I no longer felt anxious doing so, then I reduced the number by 5 again, allowing me to only have to count to 10 whilst washing my hands which is where I'm still at today but I am challenging it now in other ways than just counting! Yay! 😄
The whole point of exposing yourself to what you're scared of is to challenge the belief that the safety behaviour (the compulsion) isn't necessary, it doesn't actually do anything to keep you safe, which is what your OCD is telling you that it does. It's an irrational fear. Even though doing the exposures provokes anxiety, by learning to live with it and allowing the feeling to arise, your brain learns to tolerate the feeling of anxiety and being uncomfortable. It also teaches and allows you to see that the anxiety will go away, the fear and apparent threat of not engaging in the compulsion doesn't stay around and it isn't as bad as the OCD makes you think. Here's the neat thing that I learnt when I was first introduced to ERP, your body can only physically handle having a high amount of anxiety for a certain amount of time and then it will have to release it! It can't handle having too much anxiety and it will naturally (and eventually) regulate itself; which is so reassuring to think of either in the moment or upon reflection because we get so stuck in the idea that the bad stuff and negative feelings are going to last forever, and knowing that the body physically can't hold on to high levels of anxiety is comforting! The problem that does occur, however, is having to sit with the feeling (a key phrase in ERP!), notice the anxiety, and then wait for the level of anxiety to decrease. That's where coping mechanisms can come into play and have a helpful impact on you by allowing you to tolerate the anxiety through either breathing exercises, visualisation techniques, repeating a certain quote or song lyrics, or whatever works and is helpful for you! (In my opinion, the main problem is trying to find coping mechanisms that actually work for you! 😂 It took me ages to find ones that work and are effective! I'm still figuring out new techniques and what works for me. And that's okay, I'm human with a unique and diverse set of needs, and I'm allowed to figure out what works for me! 💜)
I've written before how I've had 4 rounds of therapy, 3 of which consisted of ERP, for my OCD and I'm currently on my 5th round. The way ERP gets taught and is practiced can change so much depending on the therapist, it's seriously weird! The first time I was taught ERP, I was 17/18 years old and it was explained to me how when deciding and completing the exposure tasks, it's to be done in gradual increments like how I explained it above but that's it. However, when I was 20/21 years old and in my 4th round of therapy, the process of ERP was explained and my new exposure tasks were planned and discussed so differently! My therapist explained that when I was doing an exposure task (for example, during this time I was trying to decrease how far up my arm to clean with hand sanitizer after going to the bathroom), if whilst doing the exposure, I felt too anxious and unable to continue, instead of forcing myself to do it and making it become too much for me, I could meet or do the exposure halfway. So instead of stopping the exposure altogether, I would plan in advance what I could do instead, if the original task proved to be too difficult for me, but still trying to challenge the OCD. For example, with the task of reducing how far up my arms were being cleaned with hand sanitizer, I would usually clean my arms up to and past my elbows and the exposure task would be to not clean the crease of my arm and the elbow but if I couldn't do that because it caused me too much anxiety, I would try to see if I was able to clean just the crease of my arm because that was the part that would be more "dirty" (or so my OCD would have me believe 😂). Learning this trick has really changed my mindset and my experience with therapy and doing my exposure tasks because instead of scaring myself too much and potentially causing an anxiety attack to happen due to how scared and anxious I felt completing the exposure, I could figure out a way forward that was more comfortable to me but still challenging my illness. A win-win situation! I wonder how different the previous therapies that I went through beforehand would've turned out had they taught the exposure hierarchy system that way, that you can meet in the middle and take smaller steps in completing the exposure tasks and that that was okay to do so! Whatever helps you to challenge your OCD is great and is a step in the right direction! 💜
Another way to manage OCD is through medication. Now, I've grown up and been around medication as a treatment for mental health problems all my life, and I used to never be a big fan of it for me when I was younger. This was because I was worried that if I started taking medication to help with my anxiety, I wouldn't be able to come off of them. After all, the people who I knew and had around me that were on medication, had been on them and had taken them for years and were unable to come off of them so I thought that would be the same for me. However, everyone is different and that’s what's best for them and they're fine with it! And that's great because whatever helps the individual to manage their illness and to keep living their life is amazing! However, I have changed my opinion on medication since I was younger and that's because when I was 17 years old, I was beginning to have serious issues with my OCD and was struggling to cope with it and go to college every day that when I had an appointment with my GP to discuss what I was going through and what would be the best course of action for me, we discussed anti-anxiety medication. I've had discussions with doctors in the past about me taking medication for anxiety but as I said, I didn't feel comfortable doing so. However, at this point in my life, I was struggling so much and was so scared of what was happening to me and what I was going through that I would've done anything to help! Whatever I could do, I would. So when we discussed medication, I seriously thought about it and asked him for his outsider opinion and perspective on the matter and what he thought about me taking medication and whether it would be beneficial. He agreed that for how I was feeling and what I was going through that taking medication might be helpful for me. He had also referred me to therapy and since I was still classed as a child, he had to be the one to refer me for therapy instead of me doing a self-referral. He explained and calmed my nerves about taking medication by saying that I shouldn't see it as something that will be with me for the rest of my life but to see it as a crutch until I was in therapy and doing better because there was a long waiting period and I needed assistance there and then. Now even though I started taking the medicine as a way to help me make it through until I felt better during or after therapy, I am still actually on medication for my OCD and you know what? I'm completely okay with it! The fears I had when I was younger about me being on medication have gone because it's helped me so much! Obviously, medication by no means solves and takes away all of my problems, it doesn't stop me from performing my compulsions and suffering from OCD altogether (oh how I wish it did! 😂) but it does help with the general anxiety that I feel and it reduces how bad it gets which 1, is helpful in itself, but 2, if the anxiety is lessened then when I'm doing my exposure tasks, I'm able to tolerate the uncomfortable feeling more and being able to listen more to my rational thinking, therefore, allowing me to combat the OCD better!
I have tried 2 or 3 different types of anxiety medications because, like antidepressants, they can all work a little differently than the others. Also, I'm only able to take liquid medication as I'm unable to take tablets, so it makes finding the right medication a little more, uh . . . Fun? 😂 I've been taking (or meant to have been taking) my medication since I was 17 but in recent years, I started to find it difficult to actually take my medication because, ironically, my OCD made it difficult to do so! Which is just ironic! The illness itself that I need the medication for makes it difficult for me to take it! 😂 This was because since I have to use a spoon and have to touch the bottle, my OCD made me believe that it was dirty and taking it would require me to have to clean myself down again afterward which I did not want to do! If you've read my previous post about my worst time suffering from OCD and how it took me so long to get changed for the day and to do basic things, then you’d especially know that by adding in an extra task plus the potential extra cleaning that would need to be done with it, I would not be pleased and wouldn’t be having it! 😂 Also, another reason I found it difficult to take is probably linked with my Depression, that after going through and battling doing the things I needed to do for my basic human needs (e.g. going to the bathroom, eating, etc.), I did not have the energy to try and fight to take my medication. Also, what was the point? I was still going to be in pain, I was still going to be suffering, if I had to choose between putting myself through more pain to take my medication or having more time for the small amount I had to rest, eat, and drink then, yeah, I'm sorry, I choose to do that! Now, thanks to one of my therapists I have now, I've found a way to incorporate taking my medication into my normal morning routine which has helped me so much with taking the edge off of the anxiety that I feel throughout the day and allowing me to not constantly feel like I'm on the edge of my seat!
All in all, treating OCD (especially mine! 😂) is no easy task and isn't always straightforward, it can be different for everyone! It can take multiple courses of therapy and also having the right therapist that you trust and can get along with that can make all the difference and go a long way in how helpful the treatment is. Like I mentioned before, I wonder how different things would be if from the beginning I had been taught that you can meet the OCD halfway when doing your exposures so that the tasks are more doable but you're also still challenging the disorder! Also, I’ve realised that I'm a bit of a badass for actually looking my fears in the face and allowing them (and essentially giving them permission) to do their worst to me! Take that OCD! 😂 If I'm able to face my illness head-on, then you can do or be able to do the thing that scares you! Refer yourself for therapy, ask for help, ask that cute person out, tell that person to get lost! Take life by the balls and own it, and if it doesn't work out well, hey, see if you can meet it halfway! 💜
So even though my therapist and I were wrong about me moving out and going to university being better for my mental health, I’ve still come a long way from where I used to be. From not being able to sit down without a black bin bag under me, constantly going back and forth repeatedly cleaning myself with hand sanitizer and soap, and difficulty in walking around my flat (and much more! 😂)! All of this has been achieved by me challenging my illness through exposing myself to what my OCD tells me I should fear, and guess what? I’m still alive! And that’s got to count for something, right? Even if I do still wonder, “Hey Universe, Did You Forget About Me?”
A new post will be out next Monday where I'll be talking about where I'm at with my OCD recovery, my plans for the future, and also why I created this blog! Don’t forget to follow me on Instagram at @heyuniverseblog and TikTok at @emilypardey for more content and updates on new posts!
Sending hope, kindness, and good vibes!
Emily 🌌
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