Obsessive-Compulsive Disorder (OCD)
Unregistered
Hi Tricia
I thought I would start a new posting for the question of whether or not CBT is the best method for getting OCD under control and if one needs to change one's way of thinking first.
Others may want to join in on this subject and comment on if they feel that medication is more effective or whether a combination of both can help. Also has anyone who has tried CBT felt it made their OCD worse.
Best
Anne
Hi Anne -
please allow me a brief comment. I would say that the answer to your question would be: it depends on the type of OCD one has.
In cases of checking, medication (SSRI's) may work pretty well. In cases of ordering and symmetry, CBT could be very helpful: a good clinical worker could help one learn that leaving the house with not everything in meticulous order won't harm at all.
I'd say: first, estimate whether your OCD is of a phobic nature. Afraid of germs? Afraid of heights? Afraid of spiders? (the latter two are there for comparison, they are not pure OCD types). If that is the case, then CBT could do a lot for you, and perhaps you might be able to avoid meds and their side effects. I recently came across a case where a girl was helped with her washing obsessions. She used to shower all night long. A good worker came to her house, and eventually she could be brought to the insight that 5 to 10 minutes did the job as well. Same with the spider. People who are mortally afraid of spiders can learn to hold a non-poisonous spider in their hands and even caress it, with proper guidance.
Hoarding seems to be a much more difficult-to-treat OCD type. It's hard to un-learn senseless staring at some bill, or old letter, and deciding whether it should be discarded or not. This is a pure form of decision-making, and it seems to me that meds won't do much good; and that there needs be a precise 'click' between patient and clinician.
So: there are no exact answers here, it is highly personal. Consider: often forms of OCD overlap, and the patient has two separate forms (e.g. checking and hoarding, as in my case). If you see it this way, there are as many forms of OCD as there are patients.
A key step for the clinician therefore is: make a very exact profile of the type(s) of OCD the patient has... and dare break through the patient's walls of shame. If constantly ruminating about God and/or sex are present, they should be identified. And so on, and so on.
I hope I could shed some light. I wrote it in a bit of haste, so a correction or two may be there soon.
Stay tuned, Cuthbert.
Hello Glad, i know you have received treatment from the Bethlam just like i have myself (cbt etc)....dont you think that if we are no better now after going there for 12weeks that any other form of cbt therapy is pointless, because after all said and done we did go into the best hospital possible.
I am waiting for further treatment but i am not expecting any miracles, when you have suffered as long as you and i which is for me nearly 50yrs i have become to think acceptance is the best medicine.
All my very best wishes to you Ann,
Love Brennie x
dont you think that if we are no better now after going there for 12weeks that any other form of cbt therapy is pointless, because after all said and done we did go into the best hospital possible.
If you think it's pointless - then how is it going to help anyway.
Going to the best hospital doesn't mean anything - does that mean they have all the best doctors - NO
You need to put in effort and sometimes you need the right time
Unregistered
Dear Anne, Firstly, continuing on from your message on Bubbles’ thread. Thank you so much for your words of support regarding the Bethlem. I know you would support me throughout and that means a great deal.
Cuthbert, You stated that you believe the effectiveness of CBT depends on the kind of OCD one has, but I think it is more complex than that even. I would agree that some symptoms tend to respond better than others, but it’s still an individual thing. You mentioned that hoarding is difficult to treat. There are scientists who now consider this to be separate from OCD, with different faulty genes responsible. A psychiatrist at Yale treating a friend of mine, remarked that even her contamination issues would be harder to treat because she is also a hoarder.
You also wrote, ‘…a good clinical worker could help one learn that leaving the house with not everything in meticulous order won't harm at all.’ But, for so many of us there is no consideration of harm of any kind, even with phobias of germs and other contaminants. Some with OCD have told me I am very lucky not to have a fear of harm. They wrongly believe that if you don’t worry that there will be a consequence to your actions then the fear is less, or should not be classified as a fear at all. I can say that my fear of germs, which I did believe would kill me, was no greater than the current fear of nothing.
You also said that there are no exact answers, and I certainly agree with you! I would also say that one individual may respond very differently at various times of his or her life. I have multiple obsessions, including pure ‘O’ and hoarding, but contamination has usually been a feature, and this began instantly at the age of seven (following a talk at school on germs). I found my contamination fears subsided very quickly when I faced exposure, five years on. Certainly I was ‘cured’ of this obsession within two weeks maximum. Now a different contaminant is causing high levels of fear and is not responding to exposure at all.
Cuthbert, You wrote about the lady with the washing obsession. I had a friend who was afraid of contamination from buttons. She didn’t know what the contamination was, but it terrified her. She avoided any clothing with buttons. Her therapist placed buttons in every area of her home, even her bed. He also placed them in her car, so there was no escape. She bravely lived like that for over a month, by which time she was at breaking point. She had decided to remove the buttons and decontaminate everywhere. I offered to help, but as with so many of us, it was a procedure she had to carry out herself. Maybe this was a case similar to the ones Blake Stobie was speaking of. My friend’s thinking had not changed and no amount of exposure seemed to help her.
Anne, I believe that Blake Stobie meant I had to receive and obviously respond to good cognitive therapy in order to benefit from the exposure. He spoke of patients at the Bethlem who had followed the therapists’ advice to the letter, with regard to various contamination obsessions. He explained why, after twelve weeks of being exposed to their fears, some were no better. His actual wording at one point was ‘It’s no use just gritting your teeth and bearing it, the fear won’t go.’ He added ‘You could go toilet dipping for the rest of your life and still be as afraid of germs. You have to change your way of thinking.’ He used that as an example, for I don’t have a fear of germs and ‘toilet dipping’, though no longer one of my pastimes, wouldn’t cause me that great a fear when carried out in one of the immaculately clean toilets used for that purpose. It sounds as if I am being facetious, but it was an odd quirk I had as a toddler, I would dip my hair and as much of my head as possible down the toilet and in puddles.
Returning to whether or not we need the support of family or friends, or even a therapist, in order to overcome our fears, I would certainly say that we can succeed alone. I managed without any support when I was twelve. However, I think support helps greatly and my problem now is not so much a lack of support, but great opposition. I am not saying I was in some way stronger than those who need support, because now I am failing to respond at all. Although determination and a strong will can lead to a successful outcome, it distresses me greatly that those who don’t respond well can be deemed as weak, or lacking in some way.
It was an interesting ‘experiment’ when a fellow OCD sufferer and I went to visit a friend. We all share the same phobia of contamination from dogs. The mutual friend had the same fear, although he owned a dog (nothing odd in that, for I used to as well). Our different responses, while causing extreme discomfort at the time, seem interesting with hindsight. Firstly, the man with the dog couldn’t clean up after his pet, because of his fear, and allowed a build up of excrement to spread over his garden. This alarmed me and my other friend. My way of dealing with the fear was to clean up after my dogs immediately. My friend’s poor animal was unable to avoid its own mess, and you can imagine the state my other friend and I were in when the dog jumped all over us. The interesting thing is our different reactions an hour or so later. We left to drive home, both visibly shaken by our experience.
My friend dropped me off and continued home (60 miles away). By then he felt so comfortable with the jeans he had been wearing (which at the moment of contamination he felt were only fit for burning!) that he wore them in the house and took them off later and placed them on his bed. When he told me this I was shocked. My jeans came off in the garden and were waiting for a lengthy decontamination process (which eventually I faced outside. It took several hours before I deemed them even fit for the washing machine).
I believe my friend is relatively lucky. He reminds me of a lady Professor Toates wrote about in his book on OCD. He was helping this young woman, who had severe contamination fears, and he was allowing her to stay in his home for a while. She ran out of clean towels and was desperate, as yet another had become contaminated. Although she was not prepared to use one of Fred Toates’ freshly washed towels, she did ask if he had any that had been washed a while ago. I believe she was OK with anything that was two weeks old. I am still panicking about contamination that is 25 years old, so it would seem that my mind views things very differently. My friend, for whatever reason, believed any contamination on his jeans had some how vanished after a few hours. He became quite impatient with me for not responding in the same way.
Unregistered
Hi Brennie and Nicola
I can see both your points. Nicola, it really depends on how ill you are, how long you have been ill and whether or not you can summon sufficient energy to face your fears. It is also, I think, a case of having to unlearn bad habits.
This takes great courage and trust and depends very much on whether or not you have a therapist you can trust. Unfortunately, without support from one person at home and a good therapist no amount of effort will necessarily help you to succeed. It is a very hard battle which takes a long time to win and you need to keep up the therapy for the rst of your life. To do this you need encouragement from your spouse or a family member and some rewards for your effort.
Brennie, it is indeed far harder to get better when you have been as ill for as long as you and me. I had learned a lot of bad habits and had very entrenched views. I also had a naughty habit of thinking that I was the only one who was right and refusing to take on board criticism. I had countless different therapists before I went to the Bethlem and CBT did not work. Nor did medication. I guess that the most important thing I learned at the Bethlem was the coping techniques and the willingness to take on board other peoples' opinions.
I did not have the option of acceptance as I have noone around to support me.
Had I not had another go at getting better last November it would have been the end for me as I can't cope with the fear and isolation that my OCD has caused me.
Brennie you may well find that your new therapsit is better for you than the one at the Bethlem. So I would not throw in the towel just yet.
My very best wishes to you both
Love
Anne x
Unregistered
Dear Nicola, The Bethlem is one of the best OCD centres in the world.
I’m not sure if you are saying that Bren needs to put in the effort. I was in touch with her at that time and she tried so hard. Her health deteriorated because of the high levels of stress. I don’t think she will mind me saying that she went there with a very positive attitude, dressed smartly in a suit and left in a terrible mental and physical condition.
I cannot cope with anyone judging another. Please, not one of us knows the full extent of another’s pain, nor their personal battle with this illness.
I’ll say this until everyone is sick of it, but I was not that strong when I overcame my germ phobia and I was a child. I am so much stronger and more knowledgeable now and therapy just isn’t working.
Bren, you’ve written of this before, but if you’d rather it deleted, ask Caps. Bren and I have faced years of violence and we both coped with that better than our tortured thoughts. Physical pain is nothing compared with this hell.
Love, Tricia.
Hi Tricia -
thank you for your elaborate post and all the additions. You are right: there is a movement in psychiatry that would like to nominate hoarding as a 'separate nosological entity', a posh term for removing it out of the series of pure OCD disorders. It is also likely that hoarding has different genetic associations. I did not want to confuse people too much, but you are perfectly right here.
Second: you are right, OCD type and response may vary over one's lifetime. It may waxe and wane, and behavioural compulsions may alternate with more pure obsessional ruminations.
Cheers, Cuthbert.
Unregistered
Hi Tricia
I would have responded to the dog situation the same way as you and your friend. When my cat was dying she continuously pooped all over the stones and gravel in my garden and I had to scooop it up and put it into the side beds each day for fear of walking on it. Depending on how brave I was feeling I would leave my clothes on or wash them and have a shower.
As regards your situation, I would have responded in my own special way when I got home. If I thought I was contaminated I would not have believed that the contamination would just vanish. I would have put the jeans straight in the washing machine with biological powder and made myself believe they were clean when I took them out. The reason for this is that if my washing builds up in the basket I start to freak out. I used to wash things twice or up to 4 times when my OCD was at 100%. And i would watch the washing go round the machine for the entire cycle. This made me so anxious and tearful and angry that, in the end, trusting the machine was the preferable option.
I guess what I am saying is that I had to get better, not because I was braver or stronger than anyone else, but because I could not go on as I was. I did all this on my own with virtually no support from anyone other than a CPN and the staff at the Bethlem. But support from a family member would have helped.
If you can cope with dipping this is clearly not one of your fears as I would not do this under any circumstances. But putting your clothes in the kitchen at the Bethlem would be a useful form of therapy. Sharing a machine with others takes trust. But I got a huge amount of support from the other 'inmates.'
Not sure if any of this helps. keep on posting.
Love
Anne xx
So all the kids and the people who haven't had it so long - have it easy.
I'm so sick of the - I've had it longer so mine is worse/harder to treat etc
You need a good doctor and maybe the right meds.
Just because The Bethlem is one of the best - doesn't mean they have all the best doctors.
If I had a chance to go - I wouldn't.
Sometimes people don't put in enough effort - I know I haven't.
But it's nice to see the forum back to how it was last time - so much like the school playground - guess I'm in the wrong clique right.
Unregistered
Dear Brennie
I hope you do not mind me writing again in response to Tricia's message. I am so very sorry that the Bethlem did not work for you. I have not had to cope with domestic violence. Had I, it is unlikely that I would have made so much progress. Shouting and criticim used to floor me - and they are still the two things which bring on an anxiety attack. But nowadays saying 'whatever' and leaving the room tends to bring harmony back into the home.
Please keep coming back to the forum so we can continue to help one another.
Love
Anne x
Unregistered
Dear Anne, I’ll get back to you!
Nicola, it’s nothing to do with cliques. We are all friends here. I’m sorry if I’ve upset you. I know I’ve upset Bren when I’ve said things to her about you. I don’t want to upset anybody, but at the same time I have this fault of not being able to shut up when I feel something is being said against someone else.
I am very fond of you Nicola, but you know I say things how I see them. At least you always know I mean what I say!
Love, Tricia.
Unregistered
P.S. No, the kids haven't had it easy, it's probably the worst thing in the world being a child with OCD. Sorry, have to get on xxxx
Unregistered
I would never stab you in the back, Nicola. I just thought you were saying Brennie needed to put in effort. You may not have meant that. Didn't mean to have a go, I'm sorry. Stressed out, but that's no excuse if that's how it came across. Talk more soon.
Unregistered
Hi,
I agree the kids have not got it easy. It's awful being ill whatever age you are. That's why we are all here to help one another regardless.
I also try my hardest not to upset anyone and wants to be friends with all of you equally. So please let's all be nice to each other so we can get better.
I have to go now too as I have spent far too much time on the forum today.xxxx
Unregistered
Nicola, whatever I said to you I said it to your face. let's not dig up old conflicts, please. We are all very troubled. Love, Tricia xx
Unregistered
Hi folks
Before I go, I would like to close this posting of mine. It is a shame it has ended in such a conflictual situation. I will be back tomorrow.
Please will someone open a new posting.
Love
to you all
Anne
The conflict will pass, is my good hope. Cheers to all, Cuthbert.
I think we all agree that OCD is one of the most destructive and damaging illness there is and while on this forum we value the opportunity to speak freely can we please keep it to OCD and not bring personal perceptions into the discussion.
We are all individuals and all have our own individual views on all subjects and however right or wrong others may feel those views are can we respect them please. With OCD destroying so many lives we don't need to bring personal conflict into the equation. Please use your energies to combat OCD and not each other and concentrate on the many positives in this thread. If the thread deteriorates into conflict or argument between individual members it will be closed.
Caps
My two cents:
thanks Caps for, er, 'intervening in style'... and remember folks: OCD can bring with it impulsive emotionality, i.e. an urge to bring up something that hurts, but in a manner that one can regret almost instantaneously. Well, at least I recall many moments in my life that I had that. More or less successfully I tried to apply the rule 'First Count To Ten!' to myself, and it's really starting to work.
Hi Cuthbert,
I agree with you, with OCD we can be extremely emotionally impulsive. And it's at those times that it's not so much what we say it's the way that we say it that can either offend or rub people up the wrong way. I have on many occasions been guilty of that and so I like you I now tend to try to count to ten before I speak, so has to be able to express myself when I'm not in such a heightened state of emotion.
I hope that I have managed to do this when on the forum.
Trudy
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