Over the last few years, I have had many conversations about OCD with people who have called Relief for a mental health referral. Those conversations form the basis of this fabricated dialogue. OCD sufferers will find this conversation very familiar, and those who do not have experience with OCD will find it remarkable and informative. Let us now begin our discussion with Ora Chana Devora, or O.C.D. for short.
Rabbi Azriel Hauptman: Thank you, O.C.D., for making time in your busy schedule to share your story with us. Can you tell us the basic timeline of your OCD?
Ora Chana Devora: Before I begin, I would like to thank you for spreading the awareness of OCD. There are so many misconceptions about this debilitating disorder and public education can be enormously helpful.
Now, here is my story. Even as a child, I was on the cautious side. But my various anxieties never led to any serious impairment. I definitely had some limitations (like never playing with sand out of fear of germs) but nothing too serious. My teenage years passed by blissfully, and I went to seminary like everyone else. A couple of years later, I met a wonderful fellow who is now my husband. A year after our wedding, our son was born. This is when my life started to spiral out of control.
I was nervous about the health of my child. I was never so neurotic about my own health, but when it came to my child’s health, I felt that it was my responsibility to protect this vulnerable baby from all of the possible dangers that he might face. My primary concern was germs. I insisted on switching the flooring in the entire home to hardwood, so there would be no carpet anywhere that might harbor germs. I was nervous when my husband held our son if he had left the house and did not wash his hands vigorously on his return, since he might be carrying germs from the “outside world.” When I finished my maternity leave, I did not return to work out of fear that the babysitter would not maintain my standards of cleanliness and hygiene.
I stopped letting people into my house unless they left their shoes outside the door and scrubbed their hands with antibacterial soap as soon as they entered. I would only go shopping when my husband could babysit, since I was petrified that my baby would be exposed to germs in public places. Basically, I became socially isolated and my baby never left the house. OCD was completely in control of my life. Initially, my husband accommodated my anxieties, but eventually he said that he had had enough and demanded that I see a therapist.
AH: What was the proverbial “straw that broke the camel’s back” for your husband?
OCD: My husband is an incredible person and really put up with much more than an average person would have been able to manage. But the final straw was when our son seemed to be coming down with some sort of infection and I refused to bring him to the doctor out of fear that he would be exposed to germs at the doctor’s office. When my husband found out about this, he said that our son’s health is being threatened by my anxiety about his health!
AH: Isn’t that ironic that your efforts to preserve your son’s health were actually putting his health in jeopardy?
OCD: Incredibly, yet this is quite typical of OCD. The irrational obsessions often rob a person of common sense, and the anxiety can bring about the very thing the person was trying to avoid. This would be similar to someone who is so overly anxious about getting into a car accident and checks the rear-view mirror so often that he gets into a collision since he was not looking out of the windshield!
AH: Was your therapy successful?
OCD: That is a whole story unto itself. I had no idea how to find a therapist. A very close friend confided in me that she had had a wonderful experience with a therapist who helped her overcome very serious issues she was going through as a result of severe trauma she suffered in childhood. Based on her recommendation, I started seeing the same therapist.
The therapy was somewhat helpful. I began to understand the nature of my anxiety and why my anxiety latched onto my child’s health and safety. It gave me real insight into my inner psyche. I enjoyed the deep work, but my OCD symptoms were for the most part unaffected. My therapist insisted that with patience, I would see small increments of improvement as I explored the nature of my thoughts and fears. This went on for about two years. I did see slight improvement but nothing significant. I terminated the therapy as I felt as if I reached a plateau.
I began to realize that insight into your psyche is not nearly enough, since OCD persists even if you are completely aware that your obsessional fears are irrational. The “part” of your brain that has OCD is not governed by rational thoughts. Therefore, traditional forms of therapy that help you understand your thoughts and feelings are insufficient in treating OCD.
AH: Did this give you a sense of despair?
OCD: I think ambivalence is a more appropriate word. I became resigned to my fate of always being a nervous wreck about my child’s health and safety. It would certainly not be the first time in history that a child was raised by a neurotic Jewish mother!
AH: What ultimately helped you overcome your anxiety?
OCD: Some time later, I bumped into an old high school friend. As we were catching up, she mentioned that she had kept hidden from her friends that she was suffering tremendously from OCD. She did not find relief until she discovered a form of therapy called “exposure and response prevention,” ERP for short.
AH: What is ERP?
OCD: Basically, anxiety is perpetuated by avoidance. For example, if I am afraid that the bridge will collapse, each time I avoid the bridge, I am reinforcing in my mind that the bridge is dangerous. In order to “rewire” the brain, one must be exposed to the trigger of the obsessional fears, which is the exposure part, and then refrain from engaging in any efforts to reduce the anxiety, which is called response prevention. During this process, the OCD sufferer is instructed to be fully aware of any feelings of distress that result from the exposure. As the exposure is maintained, the feelings of distress tend to subside. This rewires the brain into realizing that the obsessional fear is not as dangerous as it seemed.
AH: This sounds very simple. Just face your fears and you will be cured.
OCD: I wish it were so simple! When one does ERP without the guidance of a therapist, it often does more harm than good. The reason for this is very simple. If I expose myself to my trigger, I might engage in some type of activity to reduce my anxiety such as clenching my fists, distracting myself, turning my head away, and similar methods of anxiety reduction. This actually reinforces the OCD, since I am still sending a message to my brain that this is dangerous and scary. ERP only works if you fully embrace the feelings of distress and anxiety without any form of physical or mental avoidance and you stay with the feeling until it subsides on its own. This is very challenging and usually requires the guidance of a therapist who understands ERP.
AH: Why did your first therapist not treat you with ERP?
OCD: For some reason, many therapists are unaware that ERP is the gold standard of treatment for OCD, so they use their general therapeutic modalities. That is why whenever I talk to someone who has OCD, I always tell them to make sure that their therapist is knowledgeable in ERP.
AH: Can you give me some examples of ERP techniques that you did under the guidance of your therapist?
OCD: Let me first point out that I was never asked to do anything that normal people would not do. I was never asked to actually put my child’s life in danger. I was told to do things that the OCD part of my brain would interpret as dangerous. For example, one of my exercises was to go shopping with my son safely strapped into the shopping cart and to experience my anxiety about the germs of this public space. I was instructed to make sure that I stayed focused on my anxious feelings. As I mentioned before, you are supposed to be totally aware of the anxiety that builds up inside of you until the anxious feelings subside on their own. It is not uncommon for the therapist to accompany the client on the exposure exercises in order to coach them through the process.
AH: So I guess your OCD has been healed.
OCD: OCD is never healed. It goes into remission, but in periods of stress it can rear its ugly head. Personally, I see my therapist twice a year just to review the basic principles of OCD treatment and have a “check-up” to make sure I continue to be in a healthy place. Also, I am still an anxious person, and my OCD is never absent. Rather, the symptoms have diminished to a level that minimally impairs my life. This is partly because many of the tools I acquired through therapy have become second-nature. I guess you can say that ERP has become a way of life for me.
AH: Is ERP the only type of treatment you needed to overcome your OCD?
OCD: Not at all! My bout with OCD left me with feelings of worthlessness and shame. It triggered a bout of depression, which, although it was caused by my OCD, took on a life of its own and needed to be treated separately. In my case, I was not motivated to do the work of the ERP until my depression started to subside. In general, OCD often co-occurs with other mental health disorders, so therapists really need to have a variety of “tools” in their toolbox. Even in the treatment of the actual OCD, the ERP is usually more effective when combined with other strategies, such as psycho-education, mindfulness meditation, and self-compassion.
AH: Did you take any medication?
OCD: Yes. Very often, the ERP treatment is nearly impossible to do without medication since the anxiety level is so high that the OCD sufferer refuses to engage in the exposures. Medication often helps to take the edge off the anxiety, which allows the OCD sufferer to participate in the therapy. I no longer need medication, but there are people with OCD who need to take medication for the long term.
AH: Thank you for sharing your story with us. I wish you see much hatzlacha on your journey.
Rabbi Hauptman is Director of Relief of Baltimore, a mental health referral service. Contact him at firstname.lastname@example.org or at 410-448-8356.