Facing Feelings: Avoiding Avoidance
Worksheet 9-13 My Climb to the Top Exercise
Activity Anxiety Ratings: 0 (no fear) to 100 (terrified)
You can download as many copies of this form as you want at www.dummies.com/go/adwbfd. If you find the task of climbing your staircase daunting, turn to the following helpful sugges- tions for making your climb successful.
Consider asking a trusted friend or family member to accompany you on your first attempt at difficult activities. Just be sure to carry out the task by yourself later.
Don’t give in to mind chatter such as, “I can’t do this,” “This is stupid,” “I’ll look like a fool,” or “This exercise won’t help!” Thoughts like these are merely thoughts, nothing more. Notice how interesting this mind chatter is, but don’t be seduced into believing it. (See Chapter 8 for more about dealing with mind chatter.)
Consider rewarding yourself for the successful completion of any difficult steps. Treat yourself to something special — you deserve it!
Allow yourself to feel some discomfort. After all, this work is difficult. It’s okay to feel anx- ious at times — that shows you’re making progress. Just don’t forget, “no pain, no gain.”
Tell yourself that you can overcome your fears. Be positive. Beating your fears may take some time, but you can do it.
Don’t use crutches such as alcohol or excessive medication to get through steps.
Crutches diminish the effectiveness of exposure. Try not to distract yourself with chants, songs, or other rituals, either.
Climb those stairs slowly. Exposure takes time, and this isn’t a race!
Worksheet 9-14 My Reflections
If you find yourself avoiding this exposure part of the program, we suggest you flip back to Chapter 3, which discusses ways of identifying and overcoming roadblocks to change.
Exposing Obsessive-Compulsive Disorder
Obsessive-compulsive disorder(OCD) poses a somewhat greater challenge than the anxieties we discuss earlier in this chapter. OCD frustrates and challenges those afflicted as well as their loved ones. Not only does OCD cause considerable emotional discomfort, it also con- sumes a considerable amount of time.
Essentially, obsessionsare unwanted images, impulses, or thoughts that flood the mind. These thoughts may take the form of excessive worry about contamination by germs, chemicals, radiation, and so on. Other obsessions include concerns about whether doors were left unlocked or appliances were turned off. Additional obsessions common to OCD include impulses to hurt someone you love, engage in shameful sexual behaviors, violate your per- sonal religious beliefs, or act in socially unacceptable or highly strange ways.
Compulsionsare undesired actions that people find themselves doing over and over in order to temporarily reduce anxiety. Common compulsions include excessive hand washing, over- cleaning, hoarding objects, arranging objects in a particularly rigid manner, checking and rechecking things (such as locks), and creating strict rituals such as counting stairs or put- ting on clothing in the exact same order every day.
Lots of people experience a few minor obsessions or compulsions, and that’s no problem.
You don’t have a problem with OCD unless your repetitive thoughts and actions begin to seriously infringe on your relationships, your work, or your sense of freedom. You can find considerably more information about this particular problem in Overcoming Anxiety For Dummies(Wiley).
Obsessive-compulsive disorder can be a serious, debilitating problem, and most people who suffer from OCD require professional help. You should only attempt the strategies that follow if your problems are fairly mild; consider using this book in collaboration with your therapist or counselor.
The approach for treating OCD is quite similar to the treatments for anxiety and fear reviewed earlier in this chapter. However, as you can see in the following sections, there are a few minor differences.
Beating obsessions
Because obsessions consist of thoughts or mental images, exposure for obsessions typically takes place in the imagination. Also, imagination is the best approach because many obses- sions really couldn’t or shouldn’t be acted out. For example, if your obsession involves strange sexual perversions, we don’t recommend that you “expose” yourself to them!
In fact, if you have obsessions that involve unacceptable sexual activities or physically hurt- ing yourself or others, you should consult a mental health professional rather than attempt imaginal or real exposure techniques.
Most obsessions are focused on a single idea, so you may not have a Staircase of Fear to climb. However, you can still utilize exposure to help you deal with many different obses- sions. Proceed by answering the questions posed in Worksheet 9-15.
Worksheet 9-15 Obsessional Exposure
1. Write down your distressing, obsessional thought or image.
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2. Rank how upsetting the thought or image is to you on a scale of 0 (no upset) to 100.
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3. Find a comfortable, private place to sit and work through this procedure.
4. Repeat the thought or image over and over and over and over and over and over and over and over and over and over and over (oops, we’re getting a tad compulsive here aren’t we?).
5. Continue repeating the thought or image for 20 to 30 minutes or as long as it takes to reduce your level of upset (in Step 2) by at least 10 to 20 points.
6. Re-rate your thought or image on the same scale (0 [no upset] to 100 [totally disturbing]).______
The act of exposing oneself to obsessional thoughts and images is quite the opposite of what people with OCD usually try to do. They often try to immediately expunge obsessive thoughts and images from their minds when they occur. The problem with that approach is that attempting to suppress thoughts only makes them surface more frequently.
For example, try not thinking about purple elephants. Don’t even begin to let an image of a purple elephant come into your mind! We may even pay you $1 million if you can keep even a momentary image of a PURPLE ELEPHANT from coming into your mind. See, it’s not so easy, is it?
Treating compulsions
Treating compulsions, like the treatment of other anxieties and fears, involves exposure as the first step. You gather materials for a Staircase of Fear, arrange your materials into an actual staircase, and start your climb. The only difference in the treatment of compulsions is that you have to do one extra thing: Not only do you expose yourself to the problematic activities or items, but you also must stop yourself from engaging in the compulsive behav- ior. The technical name for this procedure is exposure and response prevention.The following example shows you how this treatment procedure works for a particular compulsion.
Gina has a common compulsion — washing her hands . . . a lot. In fact, altogether, she spends about three hours a day washing her hands. She does this because she fears coming in contact with germs and becoming ill. However, the compulsion is ruining her life by unnec- essarily taking up huge amounts of time. Not to mention that her hands are raw and oozing.
Gina gathers and arranges materials as well as constructs her Staircase of Fear. In Worksheet 9-16, you see the partial results of her Climb to the Top Exercise, her repeated exposures to problematic events and activities while not washing her hands.In fact, Gina makes a con- certed effort not to wash for at least an hour after the exposure.