ERP Hierarchy and Meeting the Challenge

In therapy, we’ve started working on my hierarchy. What this means is that we discuss the level of anxiety doing certain activities would cause me, using a numerical value between 1 and 100 on a scale called SUDS (subjective units of distress), and then we rank them from low to high. This determines which tasks I start exposing myself to first and each progressing week. I actually hate assigning numbers to these tasks; I’d rather just put them in an order from what I wouldn’t freak out about that much to what would cause me to start shaking with fear. That’s essentially what I’m doing, just with numbers added.

A key element in this treatment for OCD is exposing yourself to the thing that causes you anxiety and avoiding engaging in the response, which is your compulsion. There are many types of compulsions I struggle with that I must learn not to use. Among them are:

  • using my sanitizer after touching doorknobs, my shoes, cleaning, before eating, after eating, after petting my cat, after getting into bed, and so forth
  • washing my hands multiple times
  • avoidance of “dirty” tasks, such as taking out the trash, being in a messy kitchen, or doing the laundry
  • asking for reassurance, such as when I’ve given a presentation or have been in a stressful social situation

Coming up with the list of the tasks for the hierarchy is seriously hard work. When you spend every day living with OCD, may of the things you do become second nature, and it’s incredibly tough to separate what’s normal from what’s OCD. Just the other day, I accidentally checked to make sure I locked my door not because I felt anxiety but because it’s become such a habit. When you start treatment for OCD, you begin analyzing everything you do, and you have to stay vigilant because it’s so easy to fall back into the OCD trap.

So far, we’re taking it pretty easy with my hierarchy. In the first week, I tackled locking my front door myself. I could not let my husband do it (because that’s avoidance), I could not check it, and I had to touch the doorknob. I was successful in this task for the first week. Last week I slipped up one day and had an overwhelming amount of anxiety–I was convinced I had not locked the door. I tried to make myself walk away and made it downstairs before rushing back up to check the door. And of course it was locked. I was upset with myself for this moment of weakness, but I decided to not let it get to me. I’ll just have to be more vigilant and let go. The whole point is to feel the anxiety but let it subside naturally so that my mind readjusts and begins to understand that I don’t need to worry. Since that time, I’ve done better. The anxiety is lessening with this task each day. I almost feel normal when I lock the door now.

For the second week, we decided that it was essential for me to start conquering my use of sanitizer because it interferes with so many of the other tasks on my hierarchy. It’s impossible to conquer cooking and cleaning properly if I’m using sanitizer every few minutes. My use of sanitizer had been extreme. I kept a bottle by my bedside, a bottle in my hallway, and a bottle in my purse. There have been days when I went through half a bottle of sanitizer (the kind with the pump), and this is in addition to washing my hands with soap and water. I remember moments of being in bed and just continuing to use the sanitizer. I would get on the subway platform and use my sanitizer. I always sanitized before eating, after eating, after putting on shoes (if I actually put my shoes on myself), after petting my cat, after getting in the refrigerator, while grocery shopping, while clothes shopping, after changing clothes, after touching something I perceived as dirty, after seeing something I perceived as dirty, and the list goes on and on. My whole day revolved around using sanitizer. You can see why conquering this early was essential.

My therapist and I had a lengthy talk about the best way to implement this task. When you’re working on a hierarchy, you can break things down by specific situations or place a time limit on the activity, among other ways of going about it. We talked about specifying my use of sanitizer, but the fear was that I would find too much comfort in those times when I could sanitize, that I would basically look forward to that time and use it as a compulsion to rid myself of the anxiety that had built up, rather than living with the anxiety and letting it subside naturally. We then talked about specific time frames when I could not sanitize but decided it would have the same outcome. So we decided the best course of action was to go cold turkey. That meant throwing out all the sanitizer. She let me keep the small bottle in my purse in case of extreme emergencies when my anxiety level became way too high to be really working on my hierarchy properly, but other than that, there could be no sanitizer in my life.

I was very nervous about this. She reminded me that not only could I not use my sanitizer, I would have to engage with the things that made my hands dirty–petting my cat, touching my sheets, putting on my shoes, etc. No avoidance.

In the past, I’ve had vacation days when I couldn’t use sanitizer, and I lived through them. We thought I could do this based on this fact.

And I did it. As of today, I have been sanitizer free for one week. I have not used hand sanitizer once, in any situation.

I pet my cat then eat food–without washing my hands. I sat on a park bench and ate lunch–without sanitizing. I put my shoes on and get them out of their boxes in my hallway–without sanitizing. I shop–without sanitizing. I touch doorknobs and see dirty things, and I don’t sanitize.

When I told my therapist, she was elated. It was the happiest I’ve seen her since we started meeting. It’s amazing to know that I’ve made her proud, but it’s even better to know I’ve met the challenge. I’m actually not using sanitizer.

I’ve definitely felt anxiety at times from not using the sanitizer. There have been plenty of times when I’ve wanted to use it but haven’t. I didn’t know I could be this strong. It’s been tough to give myself credit, because I know I have so many other areas to tackle. But it’s important for me to recognize that this is quite an achievement. I mean, I can’t remember the last time I went an entire week without using hand sanitizer. This is a breakthrough for me. I’m still hesitant about cutting down my handwashing, but I’m slowly starting to believe I can do it. This is why he hierarchy approach works.

Other tasks I’ve done: submitting a paper to my teacher without checking it for errors before sending it and not looking at it again after submitting it to analyze it for errors. I struggled with this the first day, but since that time, I’ve discovered how freeing it is to let go of the perceived control over my grade. Maybe my paper will stink and I’ll get a B, or even a *gasp* B-. Life will go on. I’ve also started working on not asking my friends for reassurance in social situations and about school tasks. I actually didn’t ask my friend how I did on a presentation I had. Normally I ask a ton of questions to figure out if I did okay and ease my anxiety. I didn’t ask a thing. But I did ask about a social situation. I realized that’s a tougher one for me, and I’ll keep working on it. Life goes on, even if I act inappropriately, even if someone perceives me as mean or as a bitch or as a snob. Life goes on if I say all the wrong things. Life goes on if I’m not perfect. People will either like me or hate me, and I can’t control their opinions of me. This is hard to accept because I’ve always wanted to please everyone, but it’s getting easier every day.

I wonder if this will eventually help me eliminate my shyness. Maybe if I can stop worrying about saying the perfect thing, I’ll actually be able to converse with people I don’t know well. It’s the start of a whole new me.

And I have to say, I’m happier than I’ve been in a long time.

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One thought on “ERP Hierarchy and Meeting the Challenge

  1. Pingback: 30 Days of Mental Illness Awareness Challenge–Day 3 | OCD For Real

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