Friday facts: OCD 

Right now I’m writing this blog post about reducing obsessive compulsive behaviours because I’m doing it as we speak. I like repetitions and even numbers, that way I know I’m doing tasks correctly and being safe. My therapist asked me to see how I felt if I only checked once. No repetitions. 

Anxious. That’s how I feel. 

I suppose the theory behind exposure tasks is absolutely solid: the more you are in anxiety provoking scenarios the more of them you can tolerate. It seems so logically to simply wean off doing things that aren’t helpful to me, but let me tell you, it’s pretty damn hard when you actually do it. 

So far these are how I have managed my discomfort:

1. Leave the room. Being physically distant from where you tried out the different behaviour means you are less tempted to go back and “even out” afterwards 

2. Tell someone. Hearing from others that the fears are in your mind is a useful reassurance when you feel on edge

3. Accept anxiety. You’re uncomfortable, just like me right now! But that’s normal. Having feelings makes you human. Just let them be. 

Therapists being people

I had a session the other day, and while waiting beforehand someone I knew came in.
It was the low intensity therapist I saw before being put on the higher one. I was shocked that she remembered me after so many months!
And then it hit me: THE ONLY 2 therapists in that building today were my old one and my current one.
I know that therapists are professional and don’t blab about people, but as I left, I couldn’t help but think about what they would be saying about me. Do they talk? Do they like me?

What is therapy anyway?

I had therapy today and had some thought provoking, and emotionally challenging discussions. I have seen quite a few different people over the years: a youth counsellor, a support worker, an eating disorders nurse, a low intensity therapist, and now this high intensity therapist ( who is a clinical psychologist.)
My experiences with them have all been very different, and few of them have actually helped me to change my attitudes and behaviours. I guess the problem is that mental illness is totally different to medical ailments; instead of medication, rest or diagnostic tests, mental illness requires time to heal.
The whole world is always racing against time and money, and so I’ve no doubt that there are millions of people who, like me, have been through several short interventions, only to find that nothing changed.
For me, the hardest part of therapy is being honest. In that hour a week, I have to answer questions that spark deeply emotional reactions that are supported by negative beliefs I’ve had since childhood. There are many things about my illness- such as weight, self harm, and feelings of fear that are almost impossible for me to be talk about. My body tenses and my words become short. It’s like there is no explanation strong enough to describe what I feel. Obviously, it is vital that I’m able to overcome that difficulty in order to question my views and take a healthier approach, but it just made me think about the whole concept of therapy. I mean it is basically an optional hour of stress in a way!
I know that left to my own devices I would not be able to make positive progress, yet it is easy to feel stupid for not seeing why my views are warped without needing someone to show me. I know it isn’t normal to do the things I do, so why is it so hard to do anything about it on my own?
I don’t really know. All that I do know, is that therapy is incredibly useful. My therapist is kind and open for a laugh at times too. She is clearly very knowledgeable about the human mind and the effect it can have on our behaviour and self worth, and I am being exposed to many new techniques to change my current outlook on life. I’m grateful for her, but I’m also aware that it isn’t too long until the end of our sessions. Scary times.

To be in control there has to be no rules to break

My relationship with food and exercise is all about hyper awareness of everything. Everything is calculated and judged as good or bad accordingly.
If I feel I’ve over eaten then I would be obliged, based on my rules, to fast for a certain number of hours.
At some point, daily restriction makes me so desperate to eat that I “binge”- usually meaning a normal calorie level instead of my acceptable calorie allowance (again all this is determined by the rules).
So how the hell can the cycle be broken?! Surely if the rules are abandoned then the whole thing just flies out of control and I would eat anything and everything and become disgustingly obese … Or does it?
Therapy this week made me think that maybe if there are no rules, then no food is terrifying or off limits. Food would just what it is: food. Not a punishment or a reward; not an emotional numbing device; not the most important thing in my mind; just food.

IAPT therapy and eating disorders

I am currently being treated in the high intensity iapt service. I hadn’t heard much about the iapt thing until I got referred, and so I did some investigation into it online. Initially I was a little confused, as it seemed that Body Dysmorphic Disorder was as close to ed’s as iapt went. I was psyching myself up for some more pointless therapy.
But then I got there and was utterly surprised. My therapist is a clinical psychologist who has done the extra work to be a HI therapist. Therefore, her educational background is very broad in terms of the kind of psychological issues she has studied. Even so, I know that ed clients aren’t people that she works with regularly.
From personal experience I knew that an ed service probably wasn’t the way to go though. The waiting lists are long and the cases are usually prioritised by physical risk; I’m not dying so they would probably assess me and send me on my way.
Since starting my iapt cbt, I have found documents online about particular iapt services that do specifically say some ed clients are seen in their services. All I can say is that I’m so glad I took this option.
My therapist is warm, kind, organised and helpful. She has books about cbt in eating disorders and is giving me ed specific homework. She also recognises the need for medical input and so I am being monitored by a gp- like I would be in a ed service. She has created a formulation that merges my ed, anxiety, depression and self esteem into one, and has helped me through the hard parts of starting antidepressant medication.
I feel like she might be the person who can really help me 🙂
I’m also totally fascinated by therapists. I kinda find it hard to imagine them as people outside of work! It must be a really rewarding job, and I suppose their own life experiences probably make them better at understanding others.

Hungry for what?

In cbt today I learned that an ed sufferer has to be recovered for around a year before the bodies ‘full and hungry’ reflexes work properly again. No wonder I never know what to eat!

Today I have made a goal:
By Christmas I want to be able to sit and eat something, even if it is just one of everything, with my family.

From this moment onwards, I promise to commit to the tasks my therapist sets me. This week I have to eat breakfast, lunch, tea and one snack. No more , no less, no changes. I can’t trust myself, so I need to trust her and her plan.

Fortunately she is brilliant. Friendly, upbeat , informative and focused. She always has a plan for the session and she always asks me very directly about tricky things. For me that’s good , because given the opportunity to keep any suicidal thoughts or specific food things hidden, I will take it! I think that cbt therapists everywhere could learn from her. I just feel so comfortable talking to her, which makes me motivated to go back next week with so good efforts to report.

Night for now.

Cbt formulation and medication

So it’s been a while since I posted. I have so much to say that I have struggled to order anything that made any sense! So here goes:

Since my last post I’ve started on sertraline. I’ve always had this strong feeling about not taking tablets, but when I’ve started imagining my own death and thinking about ways one could die, I figured maybe the drugs are worth a shot. A bit up and down, but sometimes I am definitely feeling their positive effect.

I’m also starting to make some real progress with engaging with therapy. The thought of being weighed terrifies me so much that I’ve been discharged from treatment for lack of compliance in the past. Maybe it’s the drugs; maybe it’s me, but I’m suddenly understanding why they want me to have regular weight checks.

My cbt is taking place through the uk IAPT service. I know that usually it would just be an ed service, but because of my depression and anxiety, one of the iapt therapists has decided to see me and use an eating disorder formulation ( with additions for other issues). She is a lovely lady and I feel totally comfortable in being honest with her. I like that she will always be honest with me too – like if there’s an aspect of eating disorders that she is not 100% sure about. Most of the time though, I feel like she is helping me map my way through my thinking, and I’ve never felt so clear about how and why and when I do and think as I do.

Obviously, it is early days, and I self harmed two days ago, BUT I am beginning to have hope that I can change. Wow. That doesn’t even sound like me talking!