CBT & Me: Learning to live with my dark thoughts
A few months ago, I sat down in front of a complete stranger and told her my deepest darkest secrets.
You know those situations where you go out for one drink after work, end up staying for way more than just one and somehow find yourself giving your life story to a much more sober, and less interested, person than you on a night bus? Well this was totally different from one of those situations.
My doctor had referred me to have an appointment at the Centre for Anxiety Disorders and Trauma. When you already have a slightly anxious disposition, forcing yourself into an establishment with the word ‘trauma’ in its name can be somewhat unnerving.
My imagination of an appointment room at a mental-health treatment centre differed completely from the reality. I had previously envisaged rainbows mindfully painted onto walls and calming potted plants growing silently next to the windows. Instead, I was greeted with a tape recorder and a white board. The subliminal message was clear: I was here to work.
The first appointment I had - with the woman who turned out to become my therapist - was an evaluation session. In other words, I had to tell this person everything about myself, scary bits and all. I told her how, six years prior to our appointment, I had experienced my first panic attack. I told her how these panic attacks had become a somewhat-irritatingly regular occurrence in my life. I told her how they were often brought on by what I believed to be the most negative, dark and horrible things. I would worry about committing the most terribly heinous acts like rape, murder and paedophilia. Let’s just say the session went on for quite a while.
At the end of my first appointment, my therapist-to-be gave me a diagnosis of OCD. Trust me, no one was more surprised than me. We booked in an appointment for the next week, which was to become my first session of Cognitive Behavioural Therapy (CBT).
My first session was mostly centred around learning about OCD, of which I knew very little. Whereas most people will immediately imagine a person who flips their lid if everything is not precisely where it should be, it turns out that is not a fair assumption of OCD.
Everybody will, at some point, experience some sort of negative thought which will just pop into their head. This remains true of both sufferers and non-suffers of OCD. The difference between the two, and therein the diagnosis, is the meaning behind these thoughts.
To give an example, imagine you were watching a scary film. In this film, you watch a knife-wielding lunatic chasing their latest victim. As you watch, a thought pops into your head of you wielding a knife chasing somebody. Whilst a non-sufferer of OCD will be able to dismiss this thought from their head as a strange thought that was simply a reaction to the film they were watching, somebody with OCD will begin to imagine what it meant to have that thought. Was it a true representation of their hidden desires or was it even a prediction of what they might do in the future? Eventually, you will have worked yourself into such a state thinking about the meaning of that thought that you are left feeling a large amount of distress.
Different people’s OCD manifests itself in different ways, but the fundamentals are always the same: the meaning behind a thought. The resulting behaviours are referred to as compulsions. Some people might adopt an avoidance tactic. Using the film example, you could then avoid horror films to avoid the inevitable distress. Other people will touch things, wash, repeat things, look for reassurance, there’s a whole variety of different ways in which people experience compulsions. This is where CBT comes in.
CBT aims to re-wire a patient’s brain. But how do you change something you’ve genuinely believed to be true your whole life? Take, as an example, the colour of grass. We all (hopefully) know that grass is green. We were taught at school that grass is green, when we sit in the garden we can see that grass is green, as far as we’re aware we have always believed that grass is green. Now imagine somebody telling you that your whole life you’ve been wrong and grass is actually pink. That’s what CBT tries to do: dissemble the complex network of beliefs, behaviours and actions you’ve built up for yourself, and re-build them in a different way.
I naively thought that CBT would be the antibiotics for my brain. I went into my first session expectantly hoping that I'd leave miraculously healed and OCD-free. Not to be the bearer of bad news, but it doesn’t quite work that way.
CBT can be tough, really tough. Admitting that you even have these dark thoughts, referred to as intrusive thoughts, is one thing. But then actively doing things to expose yourself to these intrusive thoughts is a whole different ball game. You’re forced to push yourself to your limits, to breakthrough barriers you’ve spent a lifetime building out of self-preservation. But the idea is that you’re constantly learning as you do so.
One theory I’ve learned about is referred to as Theory A/Theory B. Theory A is the bad stuff, the thoughts controlled by OCD. It’s everything you fear you might be. Theory B on the other hand is the good stuff, and everything that you are. So, the idea is to look for evidence that supports both theories. The evidence that I am, say a rapist, is none. This is purely Theory A worrying that I might be a rapist. The evidence for Theory B that I’m not a rapist is plentiful, I’ve never committed an offence of this kind. The trouble with Theory A/Theory B is that you’ve spent your whole life worrying that the bad stuff is true, you think you’ve got the evidence to back it up. Imagine both theories as a piggybank. In a sufferer of OCD, the Theory A piggybank is not just full, it’s over spilling. What CBT aims to do is empty that piggybank and slowly but surely start filling up the piggybank of Theory B, and therein helping you get to a point where you realise a thought is just a thought.
CBT hasn’t been a walk in the park. Well, it was once literally a walk in the park as part of an exercise, but it hasn’t been easy. Over my therapy treatment, I’ve had to watch films about paedophiles, walk around with a knife in my bag, repetitively write down distressing words, force myself to think about things I don’t want to. There have been tears, too many tears, and there have been days where I didn’t do my homework (yes, you get homework from therapy). But never once has there been a day where I didn’t want to go back to therapy. Because living with any sort of mental health disorder can be crippling, so if there’s any chance of alleviating it, you work your ass off for it.
With one final CBT session in the diary, I wouldn’t say that I’ve been cured of OCD; it hasn’t been the antibiotics I wanted it to be. But before I started CBT, I didn’t even know there was anything more to OCD than being a neat-freak, let alone that I was a sufferer. I’ve learned mechanisms to not just survive, like I was beforehand, but actually to improve. My mental piggybanks are becoming more balanced and the future looks a little less intimidating than it did before I started. I think in the battle between CBT vs me, CBT won, and I’m more than ok with that.