Back to the clinic again - and you know I have to take notes and write everything down. This time our therapist is the fantastical Kate.
In IOP - the first hour is meeting with therapist Kate. The entire family meets together on Wednesdays.
The second hour is working with clinical assistants doing exposure response and preventions on Chloe's hierarchy which Kate has designed.
The third hour is DBT as a group with the other youth in the morning program and also one family member or more must be there. This session teaches skills such as mindfulness techniques and so much more.
I took some notes from our recent sessions with Kate.
To better help our family understand what is happening with OCD, Kate gave a hiking analogy - imagine that you are hiking and come upon a gigantic grizzly bear. Your body has a built in alarm system that protects you from harm. It is supposed to do this to help us stay alive. The bear triggers a fight or flight response and the amygdala fires "warning! danger!" so then you are compelled to DO something. Chloe said she would run away, I said I would play dead.
OCD is a malfunction with this alarm system. The body reacts in the same way it would if we encountered a bear - with the same intensity, only our system has placed other things in the "Threat" category that aren't really a threat. So this alarm malfunctions and goes off when it's not supposed to.
She also used the analogy of an alarm clock. It has a purpose and functions well when it goes off at the time we have set. But what if it was broken and went off every hour all night long, same sound, same intensity, never stopping? That is what OCD feels like.
Nonsense thoughts can get stuck in your head and cause alarm. Kate explained that our anxiety system is really simple. We like to think human beings are really complex, but actually our basic brain systems are simple to the point that we can sometimes be reduced to "awkward pigeons". Our anxiety system has only 2 categories: safe or dangerous. The brain learns through association, but those brains with OCD expand definitions of danger really big by creating overgeneralized associations.
Carters threats are: "My loved ones could die and I can't stop it" , and the possibility of not being perfect ie. failing or making a mistake.
Chloe’s used to be the first one on Carters list but we tackled that one last time she was in treatment. Now it’s the second one- perfectionism or fear of failing, making a mistake.
Compulsions are the things a person feels compelled to do to try and lessen the panicked feeling when there is anything associated with what the brain perceived as a threat. IA friend once described this to me as an itch that always needs to be scratched. The clinic calls them neutralizing behaviors. A neutralizing behavior would be to run or play dead in the face of a grizzly bear. That neutralizes the threat.
In Carter’s case the neutralizing behaviors are avoidance, “not going to church , scouts, school or anywhere there may be a threat” or seeking reassurance constantly from mom/always checking in with everyone to reassure himself that they are safe. “heightened and unrealistic sense of responsibility”. These thoughts and panicked feelings have gotten so prevalent that they are preventing him from functioning normally and doing his normal life routines.
Chloe’s neutralizing behaviors are reassurance as well. “Is this right? Am I doing ok? “ And also she will redo things over and over until it feels just right. Sometimes it never does. Imagine an itch that you need to scratch and it never stops.
They both handle these thoughts by trying to push them away and hide them to maintain a normal appearance. So they don't talk about them.
Also, OCD has given them an inflated sense of responsibility. They take on roles of responsibility they don't need to, but feel compelled to "keep everyone safe" or "keep everyone happy".
They also try to neutralize their threats by trying to never being alone, always being with people and keeping busy every second. This is because-
During quiet times their minds can never quiet down with these thoughts, leading to sleep deprivation, restlessness and never feeling calm or at peace. Obviously nighttime and bedtime are the worst times for this. During the day, staying busy keeps their minds off of their worries- I do this too. At night, the thoughts prevent them from sleeping. This happens to me as well. The difference for them though, is that when they are alone with their thoughts it’s torture. Many times their solution to keeping their mind busy is playing on their phones and looking at social media which is full of triggers so the cycle is actually aggravated.
In hindsight, moving Chloe down to the basement all alone was a bad move on our part, not knowing what she was dealing with. She got to a point where she just couldn't take it anymore, felt hopeless, and also the intrusive thoughts were telling her that killing herself was the ONLY solution which led her to a crisis point or breaking point.
Kate explains what happens to a person's brain in crisis. Biologically, the brain is programmed to send the blood and oxygen to the backward areas of the brain, leaving the frontal cortex or the control center ie. executive function of the brain lacking. This area of the brain is in charge of so many things including rational thought, the ability to have logic and overcome instinct, remembering that you are loved, and seeing multiple solutions.
Chloe has a safety plan that is on a laminated card and she keeps it with her at all times. Also, all of us must memorize it and be able to repeat it at any time. It will function as her frontal lobe if she ever enters a crisis point again and she is being trained to do this. On the card are "warning signs", "reasons to live" "people to call, both her important people and safety numbers.
At night or at any time we ask her where she is on the self harm scale 1-10 and have a routine set forth if she is higher than a three. This is the hardest part for us, trusting that she is being honest and also that she will follow the correct procedure.
What’s normal vs ocd?
An article:
Here is the scale they use at the clinic- Carter is suspected to have OCD because he scored high on each one and also because of the hereditary factor. He has already been assessed and diagnosed with generalized anxiety, but is scheduled for another assessment this week to determine if he truly has OCD as well. Chloe is obviously way high to the point that suicidality became involved and requires intensive outpatient treatment. Kate suspects Carter may need intensive outpatient treatment also because of the degree in which his regular life is hindered.
#1 Rule of OCD recovery - NO NEUTRALIZING BEHAVIORS ALLOWED
Why?
Because they confirm that there is danger when there's not.
Exposure therapy retrains the alarm system in the brain to NOT generalize that particular stimulus as a threat.
CONCEPTS TO PROTECT AGAINST RELAPSE:
Solidarity as a family is so important so that we can help support each other and also prevent relapses. If we all know what to look for and what to do, no matter who starts to relapse we will have the skills to help.
Generalizing exposures - whatever the exposure is, do similar things with different stakes and in different situations.
Learning to make exposures fun.
No Caffiene for people with anxiety. Ever. It makes it a million times worse.
Next time I post, I'll write about all of the DBT and Exposure Response stuff from the second and third hours. I I think it is all just fascinating and love to learn more, although I don't love the fact that my kids are suffering from this fascinating disorder.
It also makes me wonder what is wrong with our lives today that is causing so many kids' central nervous systems and anxiety systems to malfunction?
My thoughts wonder if the frequencies from being close to an electronic device so often can upset the balance of the human body? Or is it just our society and all of the adjustments we've had to make because of it? Or the crappy food we eat? Pollution? Or maybe a combination of all of those things. I'd love to see more research about these things. One thing Kate brought up is that scientists are noticing a fundamental, generational crisis of youth not having resiliency - or the ability to bounce back after failure. This makes me think our instant gratification, electronic device driven society may have something to do with it.
Anyway, I'm just a mom trying to figure things out to help her kids. We are all just taking it a day at a time.
Until next time...
