Always Look for the Next Mountain
I had written previously in this blog post that OCD recovery is not a “state” - it is a mindset. There should never be a moment where you think: “I am complete. I no longer need to practice ERP/ACT/Mindfulness/Acceptance/etc…” Instead, you should always be hungry to improve and get stronger by implementing these practices in your life. I’ve said it many times before on this blog, but the skills you learn through ERP and ACT don’t just end once you recover from OCD - they are applicable to any challenging or difficult situation you may find yourself in. And much like how our physical fitness starts to degrade if we stop working out regularly, our mental fitness too can dull over time if we don’t routinely practice mindfulness and acceptance, or seek out opportunities to put ourselves in uncomfortable situations.
Being OCD About OCD Recovery
Towards the end of my recovery journey, I experienced something very unique: getting OCD compulsions about my own recovery process! Instead of getting compulsions related to the “usual” fears (such as washing my hands excessively due to fear of contamination, or negative intrusive thoughts about my family and loved ones), I observed that I was getting intrusive thoughts about my own recovery practice. I would have thoughts like: What if you’re not doing ERP or ACT correctly? What if everything you learned in ERP/ACT was a lie? What if everything that you’re doing to beat OCD is actually making it worse?
Basically, my OCD was attacking my recovery process in a last ditch effort to keep itself alive. The “old” fears and compulsions no longer held any control over me nor caused me any anxiety, so by attacking my recovery efforts, OCD was still trying to retain one last foothold in my mind.
How Can I Tell What’s an Intrusive Thought? (and why this is a trap!)
Something that I struggled with during the worst parts of my battle with OCD, and something which I’m sure many others have challenges with, was asking myself: how can I tell if the thoughts I’m having are intrusive thoughts? Of course, it’s easy to say: intrusive thoughts are unwanted and you should just ignore them. But I would often second guess myself and wonder: do I secretly want these thoughts? Do I actually enjoy them? Maybe they’re not intrusive thoughts and they’re actually “real” thoughts that I want to happen! Oh no, what does that mean about me??
If this sounds like you, then my advice is to take a step back, breathe, and continue reading.
Do You Need Medication?
A couple months ago, I wrote a blog post titled Do You Need a Therapist?, which addresses my thoughts on this oft-asked question by people suffering from OCD. As a follow-up to that, I also wanted to write a short blog post specifically on another frequently asked question: do you need medication to recover from OCD?
The 5-Step OCD Recovery Primer
I’ve been wanting to put something like this together for a long time - basically a “primer” on key topics that everyone should read and understand as they go through their OCD recovery journey. This is not meant to be an exhaustive and fully detailed recovery plan, but more of a rough outline covering the key topics and steps along the way. I’ve created the 5-Step Primer below, with links to other blog posts I’ve written on the various topics, which will help keep things organized and direct you to the most relevant topics. Use this as a resource to help structure your own personal recovery plan and/or to help supplement any formal therapy you are receiving from a licensed mental health professional. As a disclaimer, I am not a certified psychologist or psychiatrist, but I believe this 5-Step Primer will be helpful for anyone going through the OCD recovery journey.
Can ERP Become a Compulsion?
I was inspired to write this blog post based on a conversation I had with someone about ERP, particularly when it comes to forcing yourself to face triggers/exposures (the “Exposure” part of ERP) so that you can then practice eliminating the compulsions tied to those triggers (the “Response Prevention” part of ERP). When first starting therapy and practicing ERP, this is a pretty typical exercise. You sit down, identify your triggers (sometimes ranking them in a hierarchy from “most” to “least” triggering), identify the compulsions you would typically perform in response to those triggers, and then try purposefully putting yourself into exposure situations so that you can work on preventing those compulsions.
Do You Need a Therapist?
A question that I see commonly asked on OCD help forums and social media communities is: do I need a therapist to recover from OCD? Whether due to the cost of treatment, availability (or lack thereof) of qualified professionals, or even the perceived social stigma of “having to get help for a mental illness,” many people seem reluctant or unable to get a therapist to help them recover from OCD. Hence the question - is a therapist really required?
It’s a bit of a complicated topic, which is why I wanted to dedicate a blog post to it. No, a therapist is definitely not required. Many people (including myself!) have recovered from OCD without seeing a therapist. Can a good therapist be helpful and beneficial on your OCD recovery journey? Absolutely, and if you can find a knowledgeable and qualified professional, they are worth their weight in gold. But - and here is a big caveat - seeing an unqualified therapist, or someone who is not specialized in treating OCD, can actually make your disorder worse - so be very careful when selecting a professional for treatment.
Perfect is the Enemy of Good
I work in Information Technology and I feel like sometimes, we have a tendency to try and deliver the “perfect” product to the customer. Whatever system, application, or customer experience we are trying to deliver, it has to meet every single requirement, be delivered under budget, on time, and have no bugs. The problem is that “perfect” is pretty much close to impossible to achieve in real life, and if we spend too much time trying to create the “perfect” product, we will lose in other areas (for example, we could take an extra 6 months to fine-tune and polish a product that’s already 95% complete, but is that 6 month delay worth missing out on months of sales? What if a competitor releases their app into the market and by the time our finely tuned & perfect product is released, the competition has already snatched up all our customers?)
The Power of Positive Thinking
It’s been a few weeks since I last posted on my blog due to a bunch of life changes - my wife and I bought a new house and have been busy moving in, I got assigned to some new projects at work which have been challenging but rewarding, and…. I injured my foot and have been busy doing physical therapy and rehab. So there’s been quite a few new changes in my life recently (mostly positive) but also a major negative change which has impacted my normal way of living.
Recovery is an Action
A common question that I see from OCD sufferers is: “How long will it take before I achieve recovery? How long do I need to practice ERP/ACT before I consider myself recovered?”
My (somewhat cheeky) answer is: you can be recovered now! Recovery is a choice that we make; it is an action that we do. We can choose to do compulsions, or we can choose to spend our time and energy focused on value added actions. One choice takes us deeper into OCD, and the other choice towards the path to recovery.
The “Mission Accomplished” Fallacy
The title of today’s blog post comes from the (now infamous) speech that former US President George W. Bush gave on May 1, 2003, declaring the end of major combat operations in Iraq whilst a giant “Mission Accomplished” banner was displayed proudly in the background. Looking back in hindsight, this was a major gaffe as the United States’ involvement in Iraq would drag on for nearly another decade, with thousands of more deaths, both soldier and civilian. Declaring that the job was done so prematurely ended up aging incredibly poorly in retrospect.
What does this have to do with OCD recovery? It relates to the tendency that some people have to abandon their ERP and ACT work once they start feeling better, without necessarily having fully recovered from OCD.
How to Practice ERP - Stairsteps Model
I’m not sure if the “Stairsteps Model” is an officially recognized term used by therapists when it comes to practicing Exposure Response Prevention (ERP), but it’s how I like to term the process of gradual overload - that is, over time, gradually exposing yourself to heavier and more stressful triggers so your brain can learn to better handle OCD triggers and improve your mental capacity.
I believe that when OCD sufferers first start out with ERP, they often believe two major fallacies:
1) ERP MUST be an all-or-nothing approach - either I do 0 compulsions (SUCCESS) or I do compulsions (FAIL)
2) I have to tackle my biggest, worst triggers and fears first - if I’m not practicing ERP on a trigger that is a 10/10 on my anxiety scale, then I’m not doing ERP right
Both of these assumptions are FALSE and will actually harm your ERP progression (and hence, OCD recovery) more than they will help. Let’s explore, shall we?
Practice Daily Gratitude
The topic for today’s blog comes from some self-reflection I was doing last Sunday as I was winding down for the evening and preparing for the work week to start again on Monday. Generally, I think it’s safe to say many of us do not like Mondays - they mark the beginning of a long, sometimes stressful, work week, where it feels like you’re climbing the hill all over again and trying to make it back to the weekend. It’s pretty routine for me to spend the last few hours of my Sunday thinking about all the emails that have piled up in my work inbox, all the tasks and deadlines I have to accomplish in the coming week, and just generally dreading returning to the office.
Acceptance and the “Self as Context”
If you read any OCD recovery resource (my blog included), you’ll see Exposure Response Prevention (ERP) listed as the Gold Standard for OCD treatment - and for good reason. ERP is a fundamental Cognitive Behavioral Therapy (CBT) framework for any effective OCD recovery program and if you are serious about recovery, you owe it to yourself to look into ERP and start implementing its practices and mindset into your daily routine.
However - one area that I feel ERP doesn’t touch on enough is the idea of self acceptance, which is the idea that regardless of whatever intrusive thought or uncomfortable feeling we are experiencing, we can still love ourselves and do the things that we care about in life. ERP focuses strongly on identifying compulsions and eliminating them, but the gap I see there is oftentimes people start practicing ERP and will say “I’ve eliminated X compulsion using ERP, but I still feel horrible!” (of course, you could argue that focusing on how you’re feeling is a compulsion as well, but I find this isn’t helpful for people who are still in the early phases of ERP and OCD recovery).
Persistence, Consistency, and Discipline
For today’s blog post, I wanted to write about three key habits that I believe are highly important and correlated with successful OCD recovery:
Persistence
Consistency
Discipline
For those of you who have been reading my blog for some time, you know that I love comparing the OCD recovery process to the process of getting physically fitter (whether that’s in the gym, or running, or whatever other athletic discipline you enjoy). That is because how we improve our mental health and fitness is very similar to how we improve our physical health and fitness - and improving both of those requires that we practice the three key habits which I am about to lay out.
Growth is Not Being Comfortable
I am an avid endurance athlete. I love running marathons and cycling outdoors on my bike. There’s just something freeing about being able to step out the door, away from all of life’s distractions and general busy-ness, and having an hour or two completely to myself and the open road. My daily workout session is always something that I look forward to, as it’s a chance to do something I love, an opportunity to grow and challenge myself physically, and also a time to take a step back and practice mindfulness (focusing on things like my breathing, the pounding of my feet on the pavement, my heart rate, and the feel of the wind on my face).
There are a number of athletes that I follow on Youtube and one of them (Tyler Pearce, aka Vegan Cyclist) made an interesting video the other day discussing how he has “failed” at certain points in his life, but how he was able to learn and grow from those failures and ultimately become stronger. In particular, when describing his personal fitness journey, he says: “Growth is not being comfortable.”
Don’t Dwell on the Past (Live Mindfully)
Something that I believe a lot of OCD sufferers struggle with (at least, I know I did) is dealing with the inability to move on from past mistakes or actions, whether real or perceived. When we struggle with OCD, we struggle with the ability to accept uncertainty and to live mindfully, because we often get too caught up in our heads catastrophizing on “what if?” scenarios. What if I left the stove on and I’ll come back home to find out my house burned down? What if I accidentally typed something nasty in that work email I sent and I’ll get fired tomorrow morning? What if that bump in the road was actually me hitting and killing someone? What if, what if, what if…?
Your brain can come up with a million different ways to create uncertainty and force you into compulsions like rumination and checking, because that’s how it gets relief. The problem with this, as I’ve detailed in this blog post, is that by doing the compulsions, you are reinforcing the OCD cycle in your brain and inadvertently making this disorder stronger. The key to beating OCD lies in mindfulness and acceptance.
Good Habits for Mental Health
When it comes to OCD recovery, practicing the skills and techniques you learn from Cognitive Behavioral Therapy frameworks like Exposure Response Prevention (ERP) and Acceptance Commitment Therapy (ACT) are the fundamental building blocks that allow you to improve your mental health and fitness. ERP and ACT should be your core foundation and the first things you seek to learn about, practice, and master when going through your OCD recovery journey. However, there are also a number of other habits and routines that can greatly help you in improving and maintaining your mental health and fitness. In today’s blog, I wanted to touch on some important habits and practices that, when combined with ERP and ACT, can significantly help strengthen your mental health.
Courage is Not the Absence of Fear
I love this quote by FDR, not just as a general tip applicable to many facets of life, but because for OCD sufferers specifically, it neatly and succinctly summarizes the right attitude you need to be taking when learning how to recover from OCD.
OCD, at its core, is a mental disorder that preys upon our fears. People often think that the compulsions (checking, rumination, etc…) are the cause of OCD, but these are merely the symptoms. The root causes of OCD are the obsessions and fears that are driving us to perform those compulsions. For example, someone who is terrified of getting sick or catching a disease may compulsively wash their hands. Someone who is afraid of burning their house down may compulsively check that the stove is off. Someone who is afraid that they may have accidentally hit someone on their last car ride may compulsively check for dents or bloodstains on their car, or scan the news to ensure there hadn’t been a vehicular homicide in their area. OCD feeds off of our fears.
OCD Recovery vs. Managing Symptoms
This week’s blog post was prompted by an interesting discussion I had last week with someone on the topic of OCD recovery, and on a wider level, I also think this is a common question that deserves its own blog post. The question being: is there a “cure” for OCD? Can you even fully recover from OCD, or can you really only “manage” it?
My short answer is that there is no cure, but full recovery is most definitely possible!
That might seem contradictory, so let me explain. When people think of a “cure” for something, they are typically imagining like a pill or remedy that can 100% fix a health problem. For example, in the United States, Polio has essentially been wiped out via vaccines, and syphilis has also been effectively eliminated via the use of the antibiotic penicillin. These are just a couple of examples of diseases or illnesses that we have devised “cures” for, in the sense that once we take the cure, we no longer suffer from the disease or are essentially inoculated against it from occurring.