In this blog, we will discuss any practical problems you might have in encountering imaginal or situational exposure and how sometimes a combination of ACT and mindfulness techniques and CBT can work. Sometimes, a grade or step in exposure might be too distressing, or you might fall back a few steps during times that are unrelated to the OCD, such as during times of stress or any other issues. You can discuss the CBT with your psychiatrist and the therapist conducting it during these times. You might need to go on short-term increased dosage of medications, take a break, or step back in ERP. This is common and is not a reflection of the failure of treatment. It happens when there are challenges that have to be sorted out first.
You can also modify the ritual by changing it so that you will feel less anxious. For example, instead of avoiding the ritual, you can modify it to delay it for a few weeks before proceeding with the next step. You could also add a step between grade 1 and grade 2, which would not be very distressing. Still, it would be best if you felt the distress, but it must not be so anxiety-provoking that it makes you avoid that step. Write and maintain a log of why you think there has been a short-term increase in anxiety. Combine problem-solving strategies and exercises outside the CBT session to improve stress resilience. Mindfulness, when practised independently of the ERP techniques, will help overcome any baseline anxiety. When baseline stress and anxiety are reduced, you are better equipped to confront the ritual again. Think about if you are doing the response prevention step correctly.
Are you doing anything else to avoid the anxiety? This means new inhibitory learning has not occurred, and you might be falling back in your treatment progress. Log your thoughts and emotions for the next week before you start your ERP practice. Are you feeling overwhelmed? Acknowledge that it is not a very pleasant experience, but also log into the long-term goals so that you are held in perspective. You should take your logbook to discuss why you feel overwhelmed and check if you perform the experiment and response prevention correctly.
Are you expecting too much too soon and rushing? Reflect on all your internal thoughts and come back to the practice, even if a few steps down. Think about the progress you have made so far. In the following blogs, we will introduce some ACT and mindfulness techniques you can use along with CBT. Even though we will give more details on these therapies in other sections or forthcoming blogs, combining a few strategies will help you persist with the practice without giving up.
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