How long is a piece of string?
For those not familiar with the expression “How long is a piece of string?” this expression normally implies that the answer is hard to tell, find out or very complex for varied reasons. For example, if someone asks me: “How long will take me to recover from ROCD?” I would have to reply: “How long is a piece of string?”
The important thing is not to focus on a time frame but on the process of getting better. For some people it might take 6 months, 12 months, a year or a lifetime. It does not really matter. What matters is that we learn to live with OCD and as we do this, we will be able to enjoy our relationships. It sounds counter-intuitive, but it works.
So, how does this process look like? In other words, “what do I need to do to enjoy my relationship more fully?” Through personal experience, I found out that there are three different sets of strategies that we can use in our road to recovery from rOCD.
Strategy #1 – Short term solutions (look for immediate release)
- Running away or avoidance
- Thought stopping (not recommended in the long term)
- Worry time (not recommended in the long term)
- Distractions
- Breathing exercises
Strategy #2 – Medium term solutions (look for better understanding of thought processes or cognition and/or improvement of brain biological functions)
- Cognitive behaviour therapies (CBT)
- Acceptance and commitment therapies (ACT)
- Medication for anxiety/depression/OCD
Strategy #3 – Long term solutions (look for desensitisation)
- Exposure therapy (ERP)
- Mindfulness
I propose that the best approach is a combination of different strategies worked out with the help of an experience OCD professional. Of course, there are no easy solutions out of OCD. However, through diligent effort it is possible to enjoy your relationship again. Your ability to focus, be diligent and be patient with yourself will largely determine your progress.
In the next section, I will cover shortly the most common strategies: CBT, medication, mindfulness and ERP.
How can CBT help?
CBT stands for cognitive behavioural therapy and it is a recommended type of therapy in many mental disorders. It can be a complement to medication or used as stand-alone therapy. I will not go into much detail about CBT as there are entire books written about it. Instead, I will try to explain how CBT can help people with rOCD.
CBT intends to uncover the relationship between thoughts, emotions and feelings. In a nutshell, the main aim is to develop better thinking habits. It helps rOCD sufferers:
- Realise that the cause of anxiety is internal rather than external,
- Develop healthier thinking patterns,
- Develop more realistic expectations,
- Understand that latent anxiety can also trigger ROCD thoughts i.e. sometimes we do not realise that having anxiety in our bodies (physical reactions) can trigger thoughts in our minds (not just vice-versa) and
- Understand the anxiety cycle (below).
By gaining a better understanding of our own thinking and learned/automatic behaviours, we are much more equipped to “battle” OCD. The quote below explains this:
It is said that if you know your enemies and know yourself, you will not be imperilled in a hundred battles; if you do not know your enemies but do know yourself, you will win one and lose one; if you do not know your enemies nor yourself, you will be imperilled in every single battle.
Sun Tzu
Drawing from personal experience, I do not believe that CBT is “the” complete approach for rOCD recovery. It is a useful tool to deal with anxiety and depression but it falls short on teaching mental non-engaging practices important for a long-term recovery.
Meds or no Meds
A while ago, I came across a blog advocating the non-use of drugs for mental illnesses such as depression and anxiety. The people behind this blog were trying to argue that pharmaceutical companies do not have the evidence to support drug use in these types of mental disorders and only have interest in their own “agenda”. Funny enough, at the end of the same blog the authors were pushing their own agenda – selling their alternative therapeutic services.
I think this is quite an irresponsible way of approaching the issue of pharmaceutical drugs in a mental health setting and there are indeed numerous studies about the efficacy of medication leading to the decrease of anxiety symptoms and management of OCD.
One thing that many people do not realize is that treating a mental condition is not the same as treating diabetes or high cholesterol. It is much more complex due to the many mental and biological factors. What might work for me in regard to my anxiety or depression might not work for another person. Drugs can be processed by our body differently due to genetic differences between individuals which might explain why certain types of drugs work for certain people and others not. It also explains why treating the same condition might require different doses. A couple of questions that we might have to take into consideration:
-Is the drug treating anxiety, depression or OCD?
-What is the drug supposed to do? (This helps build better expectations about the drugs)
-What are the possible side effects?
-How long will the drugs need to start making a noticeable effect?
-How long is the “weaning” off period?
At the start of my rOCD journey, I decided to take medication. Even though the initial two weeks of treatment were difficult because of the side effects, the decrease in my anxiety and depression symptoms helped me put my mind and body in a better place to benefit from psychotherapy and mindfulness. Will drugs be needed in every case? No. Can drugs benefit certain individuals progress faster? Yes.
How can mindfulness help?
There are different ways of defining mindfulness and mindfulness practice. I like to think of mindfulness as a tool that help us realise that our bodies and minds are entities of their own and that we are not at fault for most of the things that are going own. For example, if you have a bad thought that does not make you a bad person. That does not mean that the thought is true either.
Mindfulness goes beyond raising awareness of thoughts and looks at feelings and other bodily sensations. We start slowly to realize that we go through cycles of feelings, body sensations and thoughts and that all these are part of being human. By increasing our awareness, we also increase our acceptance. By increasing our acceptance, we start to become comfortable with the uncomfortable and our anxiety decreases. We start to see more clearly with this new understanding. The objective is not to feel better but to feel better.
There are thousands of mindfulness articles and videos resources now available online for free – a simple google search will help you out!
How can ERP help?
ERP stands for exposure and response prevention. It is one of the psychological treatments of choice for Obsessive and Compulsive Disorders.
The idea behind it is to decrease your anxiety levels by exposing you to the things that make your anxiety spike. This sort of therapy normally starts by gradual increase of anxiety triggers e.g. start with the things that might you spike less and slowly work towards those that make you spike more.
I read a quote once that said something like this: “It is best to suffer the worse right now than to live in perpetual fear of it”
The same it is with anxiety related rOCD. And this is what ERP intends to do: to take the perpetual fear of something and put it into the present, enabling us to face our fears. The more we do this, the less fearful or anxious we become. There are different methods of delivery for this type of therapy: self-help through books, online-phone sessions and face to face sessions.
How to get better from relationship OCD
“Happiness is not something ready-made. It comes from your own actions”. Dalai Lama
I do not like to consider myself cured from rOCD. I prefer to see myself as symptom free most days and that rOCD has helped me develop a healthier relationship with my wife. Going through the rOCD journey has helped me realize that I had a lot of misconceptions about how love should be and how it should present itself. For that I am eternally grateful to rOCD. I can say that I am a very happy person in my relationship today. It is not perfect (no relationship is) but it is happy because of choice. I am not spiking at every turn and doubting everything all the time.
In any recovery journey, we need to understand three basic principles in order to be successful:
Principle 1 – You get what you put in
You are the only person responsible for your mental health and you will have to find a way to get better. Even with professional help. Accept that responsibility. It takes a lot of hard work and courage to regain or improve our mental health. You can’t expect to get better without any effort but in the end the effort pays off.
Principle 2 – It will take time to get better
Accept that change will require time and that where you are now is most likely the result of a long process and not of an on/off button that was pushed. It feels that way but the real causes have been long time in the making…
Principle 3 – Accept the present
Accept each day as it comes. The present is here, live in it. Nothing you can do about the past. No point about worrying TOO much about the future.
Some suggestions to put into practice
1) Print a mindfulness quote – e.g. “Live today” and have it where you can see it every day for most of the day.
2) Take a deep look at how living in the future, comparing yourself to others or setting high standards (and blaming yourself for not being there yet) is not helping you enjoy the present.
3) Do something daily that will put you in a better mood. e.g. make a playlist of your favourite upbeat songs and listen to them even if you don’t feel like it.
4) Look at your schedule and see what are the things that you can change to accommodate more “battery recharging time” and less stress.
5) Try to live mindfully for the rest of the week e.g. do not engage with your thoughts.
Starting to feel love again
One of the questions that I am asked the most in one way or the other is “How long until I start to feel love again?”. This is a very difficult question to answer for several reasons:
Reason #1 – Reassurance seeking. This question can also be interpreted as a way of looking for reassurance and there needs to be a very fine balance between staying positive and looking for reassurances. This is something that is very personal. Reassurances are not very good in any type of OCD as they “feed” the mental compulsions and the “what if’s”.
Reason #2 – Every person is different. There are no standards in love and feelings. We are all different, so we are bound to feel things differently. We love differently. We think things differently.
Reason #3-Thinking illogically. Think about this example. You have just broken your leg in a car accident. You have not been given any treatment or the right treatment. The first question you ask is “when can I run a marathon?” How logic is this? Maybe a better question to ask is “what can I do to stop feeling pain in my leg” and then “what can I do to stand on my leg?” and maybe after “what can I do to start taking small steps?”
Recovery from relationship OCD is not a sprint and it will never be. It is one of the hardest marathons that you will ever run. I found out that the best way to run this marathon is to take life one day at a time and trying to engage fully in the present moment. Of course, this is not a skill that one can develop overnight but it is well within our reach.