How I Deal with OCD Backslides
One of the defining experiences in my life so far is my struggle with obsessive compulsive note taking. A few years ago at a relative nadir in my life I decided I’d reach out to someone to do something about it. I ended up on a very positive trajectory. That moment years ago was a great decision that I talk about elsewhere, but isn’t the subject of what I want to talk about here.
Today I don’t have to do much to actively manage residual OCD… but I still have moments of backslide. I’m very lucky today to be where I am. Many people struggle with OCD for a long time and don’t seek help either because it’s undiagnosed or any of a number of other reasons. My biggest concern at the beginning after seeing some positive momentum in my battle against OCD was stepping back from my counselor. At my worst we would meet weekly. I knew for a lot of reasons that it wouldn’t be like that forever, but I was nervous about making the step back from weekly to bi-weekly and to less frequently. This made sense to me because at it’s core OCD is a disorder that deals with discomfort (to put it lightly) as a result of uncertainty.
The first thing I did to deal with a backslide, was to do my best to prevent a backslide. I’m not perfect and I certainly can’t guarantee against a backslide. However, I can increase the chances of success. In my case I was patient with myself and my progress. There was no rush to reduce the frequency of my visits. I should scale them back when I feel like it’s a manageable next step (note: not when I feel 100% comfortable, but when I feel like I can handle any added anxiety).
For me it was probably 4–6 months before I started to scale back. Today I’m 2 or 3 years out from when I started and I still see my therapist every 8 to 12 weeks. The difference is that today I choose to see my person. Maintaining the relationship with my person may not be critical to my success, but I use it as a guard rail to protect against a backslide. Usually if I start to backslide I can email my therapist if it’s particularly disconcerting or I can wait until I see him again a few weeks down the road and course correct. Personally, I plan to maintain the relationship as long as I can because the financial cost is very much offset by the long term benefits of protecting myself from my established inclination towards OCD behaviors when left to my own devices.
Of course that doesn’t mean that I don’t have my own tools that I use on the day to day to help with any struggles. I didn’t invest the time seeing a therapist to become dependent on the therapist. I invested the time to get better and to equip myself with the tools to be manage the tendencies I can have that lend themselves to OCD.
The first and more important tool I have today that I didn’t have at the beginning of my journey is awareness of my tendencies. Being aware and being honest with myself when I start spiraling helps me recognize earlier when I need to start actively engaging with active “Exposure and Response Prevention (ERP)” rather than passive ERP, for example.
I do very little active ERP today. In general I won’t let it get that far. The last mechanism I have that enables me day to day and I consider next most helpful thing is certain mantras. I’m happy to share some that I have internalized, but I think of them as very personal things that resonate with people as a result of their intentions. There’s nothing magic about them.
I’ll leave you with a couple examples.
When working my way up the “Fear Thermometer” from things that cause manageable anxiety to things that trigger overwhelming anxiety I started with the little things in my ERP. This is something that is pretty much standard practice. The thing is the brain chemistry related to the anxiety when I delete an article from pocket (low anxiety) is just the same as when I talk to someone on the phone and don’t write down any details about the phone call (high anxiety). That’s it.
Whether I’m dealing with small manageable anxiety or big manageable anxiety remember, the brain chemistry is the same.
The brain chemistry is the same.
The reason I’m doing this is so to be able to spend more time moving towards my values. What do I value? List the things I value…
Anxiety is fear of a future undesirable outcome. Another thing I try to do is focus on just this one present moment and live in it. The word I’ve heard tossed around a lot is “mindfulness.” Mindfulness is great. It’s hard at first, but cultivate it.
I also like to educate myself about OCD either in fiction or non-fiction. I’ve read different books about it and that’s helped me too. Sometimes it helps provide strategies and sometimes it helps me feel less alone, less weird. Both are good outcomes. (It took me a while to get to where I could read without being constantly interrupted with by the OCD. Don’t feel like you need to press this if it’s triggering more than you can manage. For me the interruptions were very triggering at first).
Backslides are common and are helped by what Dr. Grayson calls “Treatment Interfering Behaviors (TIB). I recommend reading his book “Freedom From OCD” in it’s entirety, but for the purposes of this topic, the section on TIBs I find helpful.
Never give up. It feels like an excruciating uphill battle a lot of the time, but it does get easier. And then when it gets easier and we go on autopilot and sometimes retread old OCD paths that we haven’t missed. A backslide doesn’t mean that you’ll go off the rails. It’s just a natural part for on the journey and personally, every time one occur I feel more equipped to handle it, whether it be through one or many of the ways I’ve codified above. This is just a recollection of my personal journey — your mileage may vary, but I share with the hopes that even one person feels less alone in their struggle and even 1% more capable in fighting the OCD.