Taming the Monster
On Anxiety and the management of Obsessive Compulsive Disorder
One of the most common methods of managing OCD, as well as depression and anxiety, is via Cognitive Behavioural Therapy (CBT). On each of the occasions I have been referred to a psychologist for treatment the therapy has had some basis in CBT. The therapy is a talking-based initiative which focuses on the thoughts, feelings, actions and physical sensations and how those items are connected and how negative thoughts attached to those items result in an individual becoming trapped.
The CBT looks at the problems an individual experiences and breaks those down into, what should be, more manageable sizes which are not as overwhelming or terrifying. It is about changing the nature of the patterns of your behaviour to improve your mood. The aim is to tackle those negative patterns and move to a more positive frame of mind. Now, although CBT is a talking therapy you must immediately dismiss from your mind the image of lying on a long couch and recanting tales from your childhood and from where and when you suspect your issues originate. The focus of CBT is on your current problems and how to manage those issues in a practical manner to ensure you can make it through the day; not hammering away at your past.
The first time I was referred for such therapy was in 2008 and when the process was explained to me I will not lie; I was taken aback. My initial thoughts on therapy was that there would be discussion about my childhood, adolescence and the ascent into adulthood and that, via this dialogue, I would reach some form of enlightenment and my issues would be addressed and I would move beyond them and their impact on my life. Wrong. This was when I first encountered the realisation that a mental health issue is a chronic issue and there is no cure, magic elixir or otherwise.
Now, there are some people who may visit a psychiatrist and undertake discussion of their past as part of their therapy for some mental health issues, but CBT generally does not form part of this type of therapy. Some people who undertake a course of CBT may also improve so dramatically as to minimise the effects a toxic state of mind can have on their person. This may, in effect, feel like a ‘cure’ of some type but given the nature of mental health issues, in my own experience and what I have been advised by professionals, they are chronic problems and as such can reoccur at any point. Also; if you are employing coping strategies from CBT every day then could it really be considered a 'cure’ if the process is still being used? If we liken the use of something such as CBT to taking medication then I would say, no.
When I first described the nature of my OCD to the therapist I saw they suggested breaking down the thoughts I experienced and the emotions which were generated. For me, this was not particularly easy. My mind hammers along at, what feels like, an unrelenting pace, and I have often moved into corresponding ritualistic physical acts; turning lights on and off, opening and closing doors, checking taps are off by turning them so tightly they could snap off and so on, before I am able to apply any sort of process to review the initial thought. Whatever I was doing at the time an unwanted thought entered my mind (such as a family member being hurt or a fear of losing my job or developing a serious illness) whether I was dressing, shaving, putting on a DVD I would end up repeating the act multiple times in order to alleviate the feeling of dread and anxiety which accompanied the image.
Forcing myself to stop when I experienced that twinge of anxiety at the back of my neck and the dread filled the pit of my stomach and my adrenaline spiked and I could taste the bittersweet sensation in my throat was incredibly difficult. It was the ultimate exercise in restraint as my attempts to stop only heightened the sense of dread as I was trying to break the ritual acts down, which felt like a betrayal, as I have mentioned in a previous post. Much like any skill which is learned it requires persistence by an individual in order to sharpen the skill. This was another somber realisation as patience has never been one of my virtues. There are also occasions I have not given my all to a course of action believing I could coast through with minimal effort.
I could not allow, nor could I afford, this to become one of those occasions as the process was a course of action which could possibly improve the quality of my life. This is a fact. Living with such extreme dread and anxiety and being unable to pick up and read a book, watch a film, go out and interact with people left me sitting in a chair staring into space for prolonged periods when at my very lowest. Such was the fear of making contact with a surface should a negative or unwanted thought arise. This is to say nothing of the rituals which had been built over years of repetition in regards to how I ate some food items or consumed beverages or washed my hands when in a public place, which had raised more than a few eyebrows. I had to embed this process within my mind to allow me to go on living.
The reason I placed so much emphasis on the CBT to manage my condition was because the medication I had been prescribed in 2008 left me numb and unable to concentrate. At that time I did not think medication was going to be of any assistance as it left me foggy and lethargic. After several sessions I was able to embed some form of process to my thinking when I reached periods of heightened anxiety to the point where I was able to function more effectively, though I was far from what could be considered improved and a lot of my actions still raised eyebrows as they appeared odd and illogical. I was made redundant in 2009 and the CBT proved to be useful in helping me deal with the resulting anxiety and stress of looking for a new job and, luckily, I was not out of work for any prolonged period. Even though I changed jobs a couple of times over the next couple of years I felt more capable in dealing with the situation. I also lost the two people I was probably closest to in my grandmother and grandfather over the same period.
Whilst I was managing the dread and concern which I experienced I always felt the bite at the back of the neck as though the monster was just looking for a way to resurface and in 2015 I was stricken with another period of severe anxiety. There had been a continued increase on the strain I was experiencing from the middle of 2014 onward and it felt as though the coping mechanisms in place were not as secure as they had been previously. I could feel myself slipping back into previous ritualistic obsessive acts such was my determination to repeat such ritual behaviours which made me feel comfortable. After struggling through Christmas and new year and even applying for a new job and successfully navigating the process I was hit like a freight train in the April and had difficulty completing even the most basic of actions. Getting showered and dressed became time-consuming exercises, shaving was out of the question given my efforts to repeat the same motion and always having an obsession with numbers it made even getting out of bed difficult as I would only get out of bed at times I believed felt 'correct’ to me.
Following the collapse I experienced in 2008 I did not expect to be hit even harder after therapy and employing coping mechanisms. On this occasion I thought it would be prudent to try medication again as well as using the CBT to combat the anxiety. In addition to using meditation and CBT I started a course of a drug called Sertraline. This seemed to make a difference and I felt as though it had curbed my anxiety and I did not feel as frantic as I had on occasion. Combined with the CBT I felt as though I was more capable of dealing with situations which caused a spike in any anxiety I experienced. I muddled through if I’m honest though. I felt less creative and as though I had been subdued in some manner. I was still able to think clearly and felt as though I was contributing but I was at a remove from the world or at least it felt like that.
This malaise, if I can call it that, lasted until the end of 2016 when I noted that I had become quite badly out of shape and far larger than I remembered being at any point in my life. It is strange what events provide clarity. I developed a bad flu and having Asthma the responsible thing to do is to visit the doctor and I was prescribed antibiotics. While I was there I mentioned about trying something else for my anxiety and I was prescribed Fluoxetine. I was in a sort of feverish state during my GP visit and I can’t remember whether I had thought specifically about asking for another medication for the anxiety or if it just occurred. When the flu had passed in addition to taking the new medication I started exercising at the start of 2017 as I thought I had to do something about how terribly unfit I felt and big and heavy I had become.
Most people who suffer from a mental health issue will have been advised to take more exercise, in whatever form, as it can help with your frame of mind. It is true. Last year was the first year I truly committed to taking regular exercise for the first time since my twenties. I would go an sporadic runs now and again over the years but last year I started running regularly as well as going swimming and to the gym to use the spin bike and the rowing machine. It’s true; regular exercise can truly improve your frame of mind. I lost in the region of four and a half to five stone in weight and noticed an extreme change in the size of clothes I was able to wear. I also felt far healthier by maintaining a proper balanced diet and eating varied cuisine and more vegetables. I also stopped drinking carbonated soft drinks and the change in how I felt physically was incredible.
This really does have an impact on your mental health and as a result I felt far more capable in dealing, not just with spiking anxiety, but with any problems I encountered in general. It is something I would recommend to any person who experiences anxiety or depression or any other form of mental health issue. If it is possible for a person to eat a balanced and varied diet as well as take regular exercise then I would recommend they implement this as soon as possible as the benefit can be extraordinary. Since January 2017 I have continued to run regularly and eat a balanced diet in order to maintain the weight and size I had reached.
Despite taking such positive actions and feeling the physical and psychological benefits of such dramatic changes I am still unable to outrun the anxiety which has plagued me. January and February tend to be difficult months for me as they can be for a lot of people. As I move towards the end of March and my birthday I tend to be in a better frame of mind although I remain a little agitated around my birthday. This year, however, I have been unable to locate an even keel and have felt off-balance for a majority of the time. Still running, eating better and taking the medication and implementing the CBT where possible but seeing little benefit. My Fluoxetine dosage has been increased on two occasions; first to 40mg and then to 60mg. It was reduced back to 40mg but after feeling a spike in the anxiety coupled with a depression I have not experienced before I have now changed medication again.
I have only been taking the new medication for a short period of time and I was advised by my GP, and know from experience, these medications can take anywhere from four to six weeks to have any real impact. The anxiety had been bad enough but coupled with a depression, lows the likes of which I have never experienced before, each day has been more challenging. This depression which I am experiencing at the moment is incredibly dark and feels as though I have become locked within a void of some nature. I have struggled to rise in the morning, I am eating less as I quite simply can’t bring myself to prepare food and have spent longer periods sitting staring into space without even the mildest urge to move. At points the OCD and anxiety made it difficult to get out of the chair but at least there were things I wanted to do, now I appear to have lost any will to interact with the world. Although I have a tendency to isolate myself (primarily having solitary pursuits such as running, reading and writing do not really allow for company) this feels more as though I have nothing of any value to add to any social interaction. I am also aware of an urge to ignore the phone when it rings such is my determination to avoid conversation.
I do not consider myself to be a negative person, though there are those who would say that I am, but I do admit to being macabre. I do not believe that a person who is macabre or morbid can easily be categorised as a negative person. When presented with a problem my initial reaction is to solve it; this is a positive action rather than a passive or negative one and there are those who may try to avoid the problem or circumvent it rather than search for a solution. Although I can be sullen I do not believe this makes me negative and I would classify such comments as an unfair criticism of my character. During this depression, however, I feel as though the only way to describe my behaviour has been negative. Perhaps because when faced with this problem I feel unable to create a solution. The techniques I have used previously to manage the anxiety and the OCD feel futile against the shadow of depression in which I now reside. In trying to make light of the situation I have come to term this my 'Blackest Night’ such is my love of Green Lantern lore. Some may find this mawkish or cheesy but each of us derive strength from different places and perhaps embracing that which gives us strength is as important as any strategy for management of such issues.
























