March 2022 will mark five years since I was discharged from the mental health service after undergoing high-intensity CBT for OCD. A lot has changed in those five years – I’ve bought a house, I’ve changed jobs, I’ve gotten tattoos, I’ve spent two years living through a pandemic – you know, usual life stuff. I always like to try and post some sort of mental health update every so often, so given that this week marks the start of OCD Week of Action, I thought now would be the ideal time. I struggled to come up with a specific topic, but in the end, I settled on some of the most important things that I learned during my recovery. As you’ll read, I largely draw experience from the high-intensity CBT, but there’s also a few snippets of other forms of therapy I’ve had over the years. If you’re a new reader (first of all, welcome), you can follow my backlog of therapy for various mental health issues by checking out my Therapy Diaries series, and you’ll very quickly get an idea of what I’m banging on about.
Trigger Warning: I briefly mention suicide during this post.
Honesty is the Best Policy
It’s such a cliché that I feel it sting my fingertips as I type it, but it’s true. In my many different forms of therapy I’ve had over the years, both before and after my OCD diagnosis, I’ve learned that you’re not going to get anywhere if you’re not honest with your therapist. There can be many reasons why you may not want to be 100% honest with them, but for many, it’s the feelings of shame. Shame in particular is a big thing when it comes to OCD, especially if you experience intrusive thoughts around sex, religion, or violence.
For me, a recurring intrusive thought I had was that I had cervical cancer (because at the time I was too young to be invited for screening), and at one point I managed to convince myself that I had contracted HIV and would subsequently develop AIDS from using a dirty toilet in a pub I went to. It was something I told my husband about, because he was just there for the whole thing, but that was about as far as it went at the time. At the same time I was worrying about having cancer or HIV, my brain was also telling me that I was being insulting to anyone who had or had loved ones with these illnesses. Every time I saw someone with cancer on the TV or heard someone talk about it, my brain would remind me of what an insulting little twat I was being. Then, just to add insult to injury, it would pepper in thoughts for the rest of the day which would cause me to carry out my “touch wood” compulsion (that I unfortunately still do to this day), otherwise I, or someone I loved, would get cancer. Brains are little fuckers, aren’t they?
When I hit the proverbial rock bottom just before I started treatment, I felt as though I had nothing to lose anymore – my sanity had certainly gone – so when I sat down for my first session, I came clean. I told my therapist that, alongside my main fears of contagious illnesses, I was also terrified that I would get cervical cancer because I was too young to get a smear test. I even told her about toilet-gate, something which me and my friend I went to the pub with are now able to laugh about.
The treatment I’m referring to was my 6-month period of high-intensity CBT, which I still think (combined with medication) is my most successful one to date. While I feel that medication is a big factor, I also have no doubt that the success also came from my honesty. I told her things I still haven’t told anyone, because I was at such a low point I didn’t give a shit anymore.
TW: The next paragraph briefly mentions suicidal ideation, so feel free to skip ahead if you need to.
Yes, it’s difficult, especially when you’re asked the weekly safeguarding questions of “have you had any thoughts of harming yourself or ending your life?” and yes, there were times where I would be sitting in the waiting area worrying that I would be sectioned because I had a few bad days that week and had thought about ending it. But I still told her. And I went even further and told her that I had no intention to act on said thoughts because I’m terrified of dying and, knowing me, I’d probably fuck it up anyway.
Of course I don’t condone getting to such a low, but my point is, if you’re upfront and honest with your therapist from the get-go, you’re more likely to get the outcome you want from treatment. Your therapist is there to help you, and remember, no matter how awful they are, your intrusive thoughts are not a reflection of your personality or your intentions.
Make Time For Your Homework
While I was the little goody-two-shoes at school always doing her homework, it was much more difficult to keep it up when I was having CBT. For those who don’t know, homework is a big part of cognitive behavioural therapy, and involves carrying out behavioural exercises and experiments in settings outside of the treatment room. As the name suggests, they can be at home, or they can be in the workplace, during social occasions, or just generally out and about. The idea is you make a prediction of what you think will happen, rate your anxiety at the start, during and after the task, and write what actually happened. In the case of OCD, these can usually be exposure tasks. In my case, I had to do a whole bunch of fun things:
- Have a cup of tea at work (bonus points if I used a ‘communal’ mug rather than my own)
- Only checking that my car was locked once
- Not Dettol wipe my phone after going out
- Washing my hands just the once when I entered the house
- Checking the door just the once when I left the house
- Clean the bathroom without having a shower afterwards
Despite them being so simple to someone who doesn’t have OCD, I knew these tasks would require a LOT of effort, and of course, that made it far more difficult to get the motivation to do them. It was far easier to wash my hands until the skin peeled off them rather than wash them once and deal with the anxiety that would inevitably decline over time. However, I knew from experience that if I didn’t bother, then these sessions and the long wait I endured to get them would be worthless. I was desperate to get my life back, and that was what I had to focus on.
However, back when I was undergoing exposure for my emetophobia in my late teens, I wasn’t quite as motivated. I did a number of exposures in the therapy room (including having to eat vegetable soup out of a cardboard vomit bowl), but I was given a number of tasks to do at home too. Don’t get me wrong, I did some of them – including sniffing the big chunk of parmesan cheese in the fridge once a day – but others I just didn’t. I wish I could say I had a proper excuse, but I think maybe it was because I was a stupid kid and didn’t really realise that these stupid-ass tasks were for my own good.
There were a number of reasons why that particular stint of therapy went to crap, but I feel that my reluctance to actually put 100% effort into the homework was something that contributed. My point is: homework in therapy isn’t the same as homework at school. It doesn’t involve a worksheet full of fractions that cause you to have a full-on blazing row with your Mum at 5pm on a Sunday (just me?). It’s set for your own good (okay, I get the logic behind homework in school, but let’s be honest, even as an adult I still see homework as something that was set to ruin my evening), and the theory is that you need to learn to apply it to your life outside of the treatment room. Plus, the more you do it, the easier it gets. So, make time for your homework.
It’s important not to go into treatment thinking that it’ll be a magical fix. It might seem obvious, but the amount of times I’ve been triggered in between therapy sessions and then got angry with myself because “it’s not working” would probably say otherwise. We’re all bound to have setbacks, whether it’s an event that we have no control over or just slipping back into old habits. Even though it might feel like it, it doesn’t necessarily mean your treatment isn’t working.
Being realistic is also something to bear in mind when setting your goals at the start of treatment. Put it this way, thinking back to my emetophobia treatment, while I would have loved (“loved” is maybe the wrong word here, but you get my example, I hope) to have been able to say, hold back a friend’s hair while they were puking from too much booze on a night out, it certainly wasn’t something to put on a list of exposures when I had just 10 sessions ahead of me and at that point would turn into a crying mess if I saw someone be sick on TV.
Maybe I can explain it another way – let’s go back to the high-intensity CBT. I would have loved to put “wash my hands once and only once after going to the toilet” as one of my goals when setting my exposure tasks. However, with my compulsions as severe as they were to the point where I was throwing away clothes I felt to be “contaminated,” it didn’t really seem something that was feasible. I was washing my hands so many times after using the toilet that I often lost count. If I had to give it a number, I’d say it was at least 10. On a good day, maybe slightly less, but generally, that was the ballpark. So, we settled for three times. For some, three times may still seem excessive, and yes, it is. However, for me, it was a huge step, and I was so proud of myself when I eventually got there. I think if I had set washing them just once as the task instead, I would have been so disappointed if I didn’t get there, and that would have no doubt put a damper on the final outcome. Some people may be reading this thinking that what I did was akin to people taking the lower offer on The Chase, and that I was silly for not pushing myself further. But I knew my limits, and my therapist agreed with me.
The final thing is to be realistic with what things will be like at the end of your treatment. I would have loved to walk out of my final session feeling “cured,” but that was never going to happen. I could have had another full six months, and another, and another, and I still wouldn’t have been cured. That’s because you have to work at it. I felt as though I was coming out of my final session “in recovery,” and that’s definitely a much better way to look at things. I felt positive and most importantly, I felt better, but I knew I needed to keep working and doing my exposures.
Now, for those of you who are regular readers, you’ll know that my OCD has slipped since I was discharged, and I’ve since had recurring issues with depression and anxiety. I could sit here and tell you that the pandemic is entirely to blame for that, and while it certainly plays a role, I can’t put the sole blame on it. It was a combination of stress and deep unhappiness in my job, but I feel like in some cases, it was me being a lazy bitch. Yes, I still made the effort to take my medication, but generally, it was once again easier to just check things and wash my hands just one extra time than to deal with the intrusive thoughts, and it was even easier to drink heavily and binge Normal People on repeat. I’m certainly not in the same place I was in 2016, but I’m not in the same stage of recovery as I was when I was discharged six months later. So, feel free to call me a hypocrite after reading all this. But at the very least, I’ve recognised it. One of my goals for this year is to start working towards that stage of recovery again, so I’ll keep you posted.
For general mental health information and support, please visit the Mind website.
If you’re in the UK and need support, you can call the Samaritans, 24 hours a day, 365 days a year on 116 123. If you are in crisis and need urgent help, call NHS 111, phone 999 for an ambulance, or visit your nearest A&E department.
For those outside of the UK, mental health charity CALM has a great list of international organisations you can contact if you are in need of support.