Wednesday, April 6, 2016

Starving the OCD Wolf: Exposure Response Prevention

While OCD can be overwhelming (to say the least), there is hope.  Many people have led joyful and productive lives through a combination of medication and Exposure Response Prevention.  It is possible to starve the wolf!

The Wolf

Consuming.  Intense.  Debilitating.  Disabling.  OCD is a ravenous, howling wolf roaming around just searching for something to eat - an obsession to be anxious over or a compulsion to perform for some measure of relief.  When it gets really bad, it feels like that wolf's howl is all we can hear.  If he's that hungry, maybe it would just be easier to give in to the compulsions and feed him already.  At least it will quiet him down, even if just for a second or two.

He's not always noisy though.  In times of relative mental peace, he can even sound a little friendly.  Like a cute little puppy sweetly begging for something to eat.  And so, because he isn't really bothering us that much,  we give in and feed him just a little bit.  Just a tiny compulsion before moving on to something else.

But feeding that wolf even just a little bit always keeps him coming back for more.  And more.  And more again.  Each time he comes back, his howl is just a little (or a lot) louder.

What if, instead of feeding the wolf by giving in to the compulsions, we starved him instead?

Starving the Wolf

Exposure Response Prevention (ERP) is described by The International OCD Foundation as follows:

"The Exposure in ERP refers to exposing yourself to the thoughts, images, objects and situations that make you anxious and/or start your obsessions.  While the Response Prevention part of ERP, refers to making a choice not to do a compulsive behavior once the anxiety or obsessions have been 'triggered.'"

ERP is, essentially, starving the OCD.  Exposing yourself to the intrusive thoughts and then forcing yourself not to give in to the compulsions that the wolf is howling in your ear MUST BE DONE.

Personal Experience

I hope it doesn't sound like I have this all figured out, because I most definitely do NOT.  But I do have personal experience.

I've mentioned in recent posts that I lapsed in November after having over 3 really good years (!).  There were hard days here and there, but overall I totally felt like myself.  I was working 20-30 hours per week (mostly from home), taking care of my (then) two little ones with my husband, and maintaining an active church and social life.  Living well!  Even though the wolf was quieter, however, I still fed him.
  • I wrote down prayers asking for forgiveness to make sure I said the right thing.  
  • I went through my nightly before-bedtime routine of checking and re-checking (multiple times) the door locks, stove burners, candle, wall outlet, and kids.  
  • I checked and re-checked (multiple times) the baby's collar after I put her in the crib to make sure it wasn't too tight and that she could breathe, in addition to checking that nothing except she and her pacifier were in the crib.
Then, on the morning of Monday, October 26, I started praying compulsively (again) for God's forgiveness, and what had been manageable not long before quickly became unmanageable and spiraled into many other obsessions and compulsions.  I was terrified of so many things.  I returned to an intrusive obsession from several years before about the existential meaning of time and how it works.  It sounds so weird as I write that, but it truly became paralyzing.  And unfortunately, it's still a struggle (even within the last week).

My treatment included increasing my medication and starving the wolf through ERP.  I stopped writing down prayers.  I strove to replace false thoughts with true ones.  I determined that trying to figure out time was not focusing on what was lovely and admirable (Philippians 4:8-9), so I forced my brain to refocus on something else.  Eventually the howling started to fade, but not without lots of discomfort on my part.  In fact, it felt like the howling got louder before it got quieter.  But it did get quieter after I pushed through the noise without giving in to the overwhelming anxiety.  And those times when I gave in and fed him?  He got louder.  And louder, and louder, and louder, until the howling became unbearable once again.

Eventually, I had the first time in weeks where more of the day was positive than negative.  And I was able to climb back out of the hole.

Bottom Line

We can have hope even in the midst of mental illness, OCD, anxiety, and depressionStarving the wolf is a daily - and I do mean daily - battle for me.  Intrusive thoughts pop in to my head all the time, and I'd love to say that I always resist every compulsion.  But that's not realistic.

Let me be clear: I believe that the wolf will probably always be a part of my life here on earth, but he will not be a part of my life in heaven.  God's sustaining grace pulls me through those days when the wolf is howling so loudly that I can't hear much of anything else.

My prayer is to be fully delivered by God in this life.  But even if He chooses not to do that, He is still good.  And sovereign.  And loving.  And, I believe, He is helping me starve the wolf.