Judo, Not a Fistfight

by Matt B. on October 15, 2014

In this episode, I discuss the confusion that can arise when we employ multiple treatment methods. Should we expect ourselves to know exactly how to respond to OCD every time? Or is that expectation just a form of OCD-driven perfectionism?

Also discussed: the weirdness of feeling agony and boredom at the same time; the desire to confront OCD in a dramatic showdown; and our right to go easy on ourselves.

Rough Transcript

Hi, everybody, welcome to The OCD Podcast. Today I want to talk about three things. The first is the confusion that can arise when you’re utilizing multiple treatment methods. The second is the tedium that comes with applying those methods day to day and third is the entitlement, the sense of entitlement that can arise when you’ve been suffering all day long and you really just want a bit of a break. So let’s dive into the very first topic right away.

So if you’ve been in treatment for OCD for a little while or if you’re a parent, or a friend, or a loved one, somebody that’s suffering from OCD, you probably aware that there are multiple treatment methods out there. The most prominent and the best supported by research is exposure and response prevention therapy. This is something we have alluded to in the past here in the show and the basic idea is that by exposing ourselves to the things we are afraid of, we habituate to the thoughts, we get used to the thoughts we think but we get become less afraid of them. We get desensitized to the thoughts.

So as we get used to them and less afraid of them, we’re less inclined to react to them and thereby intensify the cycle. So, that’s certainly a world of method all by itself. I’m not going to dig into the details of ERP right now but for those of you that have practiced the ERP and learned about it, you’ll know that it isn’t just a matter of, or rather exposing yourself to fears is both a basic principle but it can be implied and applied in lots of different ways.

So there are exposures we do throughout the day, just in the course of our daily lives, there are deliberate exposures we do at certain times of the day, there are written exposures. There are audio tapes that we make and listen to, there are scripts that we write down and read to ourselves over and over. So there are lots of different ways to do exposures and each of those ways is most useful in particular kinds of circumstances. So even if the only method of treatment that you’re undertaking is ERP, there are still lots of ways that can look at any given moment. And learning which of those ways to apply at any given moment is actually part of the skill that you develop over time and I absolutely feel like I’m still learning those skills and tripping myself day to day, day by day. So that’s one world of treatment.

Then there are other methods that are more heavily focused on mindfulness practice, just being aware of what’s happening without necessarily reacting to it in any particular way or resisting the temptation to react to it. And often times, mindfulness practice can be needed be a method in it by itself, but it’s sort of an adjunct to ERP. It’s a component of ERP in some ways and it’s also an additional set of practices that we can take up in order to increase our awareness, our ability to be aware of the thoughts that are coming our way without reacting to them.

So there’s those two families of treatment methods and then, as I’m discovering in Dr. Schwartz’s book the one I’ve been, Dr. Jeffrey Schwartz’s book, You Are Not Your Brain, the one I’ve been talking about for the past couple of episodes. Dr. Schwartz says there’s another set of method that he calls the four steps, which are responses that you take up when interesting thoughts arrive in order to both reframe the thoughts as deceptive brain messages and then refocus your energy back onto something that you, to think whatever you are doing before the intrusive thoughts arose. So you basically devalue the thoughts that are coming your way via OCD and you redirect your attention back to the things that are more truly a product of your values, and your wants and desires in life.

Okay. So just there, we’ve now have a three different treatment methodologies in play, ERP, mindfulness, and Dr. Schwartz’s methods.

I’ve been in treatment for OCD for probably a dozen years now and in ERP therapy for six of those years. So that’s been the flagship treatment method in my life. And there may well be other methods that I’m not aware of. What I know about ERP and the treatment landscape, largely comes through my exposure to a particular doctor and a particular school of thought about OCD. And what I got from the reading I’ve done, there’s a general consensus that ERP is the gold standard in treatment but I’m also aware that there are both new ones within the practice and lots of other ideas about treatment out there that I’m not particularly familiar with but even just given the three things I’ve already put in the table, ERP mindfulness and the four steps. You can already see that there’s a lot of different tools in your tool belt.

There’s a lot of different options you’ve got when the interesting thoughts arise. And of course, this is a perfect breeding ground for OCD because OCD more than anything wants multiplicity, it wants confusion, it wants ambiguity, and options, and indeterminacy. And, it’s almost a perfect storm. You’ve got the intrusive thoughts are crushing through the door and knocking up the windows. There you are standing in the living room with your tool belt full of 35 different potential tactics and it can be awfully confusing under those circumstances to figure out which one is right.

Now of course, that’s OCD talking right because OCD is going to make the demand that I figure out the absolute perfect treatment methodology and apply that one now because OCD is a perfectionist, it demands that I make the perfect choice but it always withholds the information I need to make those perfect choices leading me, filling shitty about myself.

Now of course, it isn’t really this complicated. There are actually lots of overlaps between the three methods of treatment that I described and there’s some basic principles that they all have in common. Figuring out what those principles are though is – can be can take some more, as a patient attempting to understand this disease and learn about the different treatment methods, you read what you can, you talk to different types of doctors, and because that each emphasize different aspects of treatment because they value the different aspects of treatment differently, it can be difficult to discern what those commonalities are and it can take some really patient and persistent conversations in order to get down to a common bedrock underneath, and even if you’ve done some of that work, and I’ve tried to do some of it in the moment when the OCD stuff is going crazy and your mind is just swirling, it can be awfully difficult to remember what those common principles are and instead, it’s easy for the thought to arise.

Okay. I’ve got, you know, 35 different bullets in the chamber, which the ones, the ones that’s going to kill this beast right now and he’s thinking about killing it even the right way to think about it, probably not, wait, didn’t I learn about something along those lines at some point? Didn’t I learn that I’m supposed to acknowledge the thoughts and allow them to be without reacting, but wait, how do I that? And so you can see how thoughts could quickly spin out of control.

What I’m beginning to think is that the hunt for and I think you’ll see this coming, the hunt for the perfect response is itself a product of OCD thinking. This idea that, I mean wouldn’t it be great if there were silver bullet.

If every time an OCD thought or mood kind of came over you, you knew exactly how to respond and that the response, it was always the same in every situation. So far, Dr. Schwartz’s method, I think Dr. Schwartz describes his method in more or less this way. He may knew it later on the book and I’m having got in there yet, but at the moment, he is, I think, offering his method as exactly that kind of silver bullet and this is what you do each and every time, and it’s awfully tempting to, I mean, that sounds incredibly attractive to me. And it perhaps will turn out to be right. Perhaps, the method that he’s advocating will upon reflection turn out to be both totally consistent with ERP and effective and useful in all situations.

I guess I’m a little skeptical so far and here, I issue all of my standard caveats, and this is just my reflections and my experience that I’m trying to sort through here. I’m no doctor, but it does feel to me that there are certain situations in which that’s absolutely the right approach in which the OCD thought arises and you’ll immediately apply the four steps, you’ll immediately enable that is the deceptive brain message, one that’s unworthy of your attention and you redirect your attention back to whatever it is you’re doing.

But sometimes OCD thoughts are really persistent and attempting to apply the label doesn’t seem to work. The label doesn’t seem to stick, the thought has more persistence in power then the time, than they do at other times.

In those instances, it begins to seem that something else might be more useful that perhaps sitting down and doing deliberate exposure with a script perhaps, perhaps with great repeating of mantra in my head, perhaps just taking a rest, perhaps doing some sitting meditation, perhaps just letting myself feel what’s happening and not trying to fight it, these are responses that each feel like they have their natural emotional ecosystem that they just feel more appropriate at different times and that’s certainly the message I’ve gotten from my ERP therapist over the years that at different times, different methods will suggest themselves are being most useful and in a way that’s of course disappointing right because wouldn’t it be lovely to have that silver bullet.

You might have a first line of defense, you might have a first response but that first response might not be all you need and I don’t want to say it might not be the thing that works because what we’re not trying to do is to defeat the thoughts or berate ourselves for having them.

We are just trying to deal with them without reacting to them, and that can look like a lot of different things at different times and so, I’m beginning to think about OCD management as less a matter of a battle plus a matter of a struggle and more a matter of a judo that the idea isn’t just sort of stand firm and defeat the enemy, the idea is instead to work with it, to work with its energy and power and to move with it in a way that doesn’t mean being taken over by it, doesn’t mean surrendering your life to it, or just, you know, giving over your days, and giving up the possibility of doing any of the things you love, I don’t mean that, I just mean working with it, acknowledging that it works differently, it looks differently, it takes different shapes and form at different times and therefore, different responses are needed and it’s not always going to be obvious which one is best and in the moment, it might not be possible to do a survey of your interior landscape and figure out which one is best instead you might find yourself and I certainly find myself just choosing one, choosing one that feels right.

I’m going with it, and trusting that until I get better with this, and I trusted I am getting better at this over time, that’s the best that I can do; that’s the best that can happen. It would be nice if something cleaner and purer, and more perfectly accurate were available to me, but it doesn’t seem to be and there’s something about adopting that attitude that I’m just doing the best that I’m capable of doing at any given moment and moving on, that is itself, a kind of antidote to the perfectionist OCD thinking that it kicks off the whole cycle and sustains it over time.

So I’ve been talking about OCD today in pretty dramatic terms, struggle, and fight, and enemy, and judo, there’s a sense in which that kind of talk is really desirable. It’s really attractive to frame what we go through in these Hollywood terms. Now, us out there on the battlefield fighting these grief enemies, David versus Goliath and that thing, and I don’t want to minimize that, there is some truth to it. This is a really slippery, elusive, and insidious monster that we deal it and there is real courage involved and standing up to it and responding as best as we can but I have to say that for me, framing those terms in terms of high drama, feels inaccurate because most of the time anyway, because most of the time OCD is just boring, if it’s possible for ping to be boring, this is boring, it’s tedious, it’s the same all the time. It’s the same set of feelings.

It’s a funny thing, if you told me that it be possible to feel both incredibly intense pain and anguish and be bored by it at the same time, I guess I would’ve said that’s not possible but there is this sense that God, I’ve been through this so many times, I’ve seen it so many times that, that’s actually part of the pain, the part of the suffering is that it’s nothing new, it’s another day at another hour, yet another minute spent this way, when I’d like to be spending my time other ways.

It reminds me of an episode in The Sopranos when Tony is dating a mistress, and then breaks it off, and the mistress doesn’t take the breakup well. She begins stalking Tony’s family, and showing up in their lives. She’s what she wants is some dramatic confrontation, this dramatic throw down but Tony won’t give in to her. And instead what he does is he sends this pasty face little henchman out to meet the woman and she’s a car dealer at a car sales woman and he pretends to be a customer and they go out for a ride in a car and then he pulls the car over, and she starts to get nervous and he points a gun at her, and he says, “You need to stay away from Tony and his family; you’ll never going to see them again. If you don’t stay away from them, you’ll see me, and I’ll kill you. And it won’t be cinematic,” and that line, it won’t be cinematic really jumped out at me, but what she wanted more than anything was a big scene.

She wanted drama, and tragedy, and intensity. What Tony was telling her through this pasty face little henchman was you’re not going to get those things, if you don’t seize on the path you’re on, you’re just going to suffer quietly and alone and meaninglessly. It’s just going to be me that you deal with this disgusting small little man. And there’s something exactly the same about OCD that it’s within the throes of OCD, I sometimes feel like I’ll give anything for a one final showdown, a big final battle with the boss at the end of the level, but that has never happened because there is no finality to it, it just goes on, and that doesn’t mean it never changes, it does and it can through therapy and other practices but there’s never that final decisive moment and instead, there’s, in other words, that’s not the courage that’s required. We don’t need to gird ourselves up for one win or take all battle, the real courage, the real struggle, the real fight takes place on a day to day level, it’s the fight that involves gritting ourselves up to lean in again, to lower our shoulder again, and we do that because we don’t have any other choices really.

We can either submit to this thing and let us, let it bulldoze our lives and flatten us or we can attempt to defend our lives to reclaim something that’s worth saving and to deal with it as best as we can in a gentle, and calm, and self-forgiving way.

It’s when we realize, and at least for me, I’m only beginning to realize this that it’s giving up on that dream, that fantasy of the final fight, the final showdown with the villain at the end of the movie. When I give up on that or when I’m able to give up on that and just sort of focus on what needs to happen now and in the moment, there’s plenty to do with right here and this is plenty interesting, this is plentiful, there’s a life being lived here, and I don’t need to look past it to something bigger and more dramatic. There’s the real meaning in attempting to meet my life where it is to meet these challenges where they are.

And then there’s all the rest of life that surrounds it that isn’t totally tainted by OCD and between this challenge in dealing with these handy cards that I’ve been dealt, and, living the rest of the life that surrounds my OCD, that’s plenty, and I don’t think I need anything more than that even if I want it very badly in some of my desperate moments. But in those desperate moments, there’s another feeling that can arise and I want to close by just saying a few words about this.

This is entitlement. We go through an awful lot of suffering day to day, both people that have OCD and those that don’t, maybe those with OCD have in a way have a focal point, have a source to kind of look to and point to, but in an event for me, I go through a lot of suffering everyday and it wears me down.

And there come points in the day when I feel like, I’m beginning to hit my limits, when I can’t extend myself much more, when I’m in need of a rest and a TV show and an ice cream. And there comes a point when I begin to feel entitled to some relief, to some great, some way of cutting the tension and there are plenty of ways that I can give that to myself and when I’m being gentle enough to myself, I do and some of those are just what I’ve mentioned, just taking it easy for a while, not working on the OCD article anymore, putting it away for the day and watching an episode of The Wire or something. And that’s all fun, and those are good things to do.

There are other times though when I feel like I’ve got nothing to get others and those are a little trickier to navigate. So I’ll give you an abstract example at first. So sometimes here in the morning when I’m home working, I work away, I spend a lot of my energy and then at a certain point the OCD thoughts begin to get more intensive and my mood begins to darken and I find myself swirling down and inward. And so I get set to go. I get set to break the tension by leaving the house and just getting out into the world and walking out and going to the gym perhaps. And as I’m getting set to go, I realize all the lights are still on, the other fans are still on and there’s a part of me that in that moment feels like, I just can’t summon the energy.

I just can’t summon the energy to care about, turning all the lights off and saving some tiny amount of energy even though a better version of me would do that or the person I admire more would do that or anyway, even if none of those things are true, the person I want to be would do that but I don’t have that in me and it’s a real back and forth game I play because some days I say I’m unable to say to myself, “You know, this is a small thing and you’re going through a pretty big thing and it’s okay, you’ve got the right, so just take care of yourself even if it means leaving the lights on, even if it means acknowledging that you don’t have the energy to attend to and care about one more thing.”

My friend Jenna explained her thoughts on this to me and that way, she said, “When you go through trauma, people who go through trauma have earned the rights to, and she didn’t finish the sentence, but she said something like they’ve earned the right and she left the sentence for me to fill in the blanks. They’ve earned the right to give themselves a break to respond a little differently to the world than others might or than others might want them to. And I don’t know what to say about that, in terms of the big moral calculus and in terms of abstract ethical considerations. I don’t know what any of that would mean to try to catch up those rights in terms of the sufferings we’ve gone through but I don’t think that’s what she was saying.

She wasn’t saying there are some abstract ethical algorithm that we can run to figure out exactly how much of a break you’re entitled to give yourself. Instead I think she was just saying, the time to treat ourselves well and at the point what which we are pushing ourselves and pushing ourselves into the ground and just demanding that we ever more of ourselves in terms of our capacity to respond effectively to the OCD and take good care of ourselves and live in the world as decent citizens, all of that can become a pretty heavy burden and it’s all right to light up a little bit, it’s all right to forgive ourselves, to give ourselves the right, not turn the lights off if it feels like turning the lights off is just as tiny thing as it is, it’s just the bridge too far.

It’s okay to be out in public and be solemn or unresponsive because you just can’t get it together. You don’t have to wear it all. You’re too taken and taken over and occupied by your other thoughts. That’s okay, that’s just sometimes how it happens and we’re all on these journeys. We’re dealing with quite a lot. We’re dealing with as much as we can.

And I don’t think we even need to think of these things as cutting corners or demerits. We’re not perfect people and we’re doing the best we can and if it means, if going easy on ourselves requires us to stay silent or to just rest even in public and conversation or to ignore the recycling and to not separate the recycling from the regular trash one day, that doesn’t seem like the worst thing in the world.

So that’s all for today, as always I’d love your feedback and I look forward to talk to you next time. Bye.

 

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