During my blogging hiatus I participated in an intensive outpatient exposure therapy treatment program at Roger’s Memorial Hospital for 4 weeks. The sessions were three hour a day Monday through Friday. Roger’s specializes in OCD and is also well known for other anxiety disorders such as social anxiety and panic disorder. The program was recommended to me by my therapist.
Upon entering the program I was added to a small group of patients whose plan of care is overseen by a Behavioral Specialist. The group is small, maybe 3-5 people. Everyone is there for different reasons and at different stages of treatment.
My first day was spent filling out evaluations. Standard scale tests for depression, anxiety, and OCD. I objected to the OCD forms, since that’s not why I am there, but was told was part of standard evaluations and I should just complete them even though they are not applicable. I complied.
Unfortunately, the Specialist assigned to me and I did not hit it off. I apparently asked too many questions as I was confused by the fact that all the forms and evaluations are heavily geared to OCD. The terminology was unfamiliar to me and I had some difficulty relating it to my conditions, my reasons for being there, and therefore, how I would benefit. My specialist was not experienced enough or didn’t have the temperament to calmly and patiently explain things to me in a way I could understand. We butted heads constantly the first two days.
If I don’t understand something or the reasons I am being asked to do something my instinct is to refuse. Seeing my reactions, rather than trying to explain the process to me, my Specialist only seemed to get aggravated. She would drop things off for me to complete then leave the room. Since the terminology was heavily geared to OCD I continually failed to understand how to translate them to my panic and anxiety disorders. I found myself losing patience having to hunt her down to try and understand what I was expected to do and why I was doing it.
My Specialist’s behavior was unprofessional. If the program was being adapted to serve patients with panic disorder, agoraphobia, and anxiety disorders then she should be able to interpret the material in a way that I could comprehend (or the written materials should have been adapted based on diagnosis). I asked to see her supervising doctor as I was rapidly losing faith and interest in the program.
I met with the doctor and he seemed to understand my dilemma and patiently explained the processes of the program and interpreted the terminology to fit my diagnosis. Once that was done I was able to move forward in the completion of the evaluations, paperwork, and begin to formally enter the program. Unfortunately, the personality clash could not be mended so I was assigned a different Specialist.
With my new Specialist, I was able to join the morning meetings with my new group. The morning meetings are pretty much to let the Specialist know how your night went and to report on homework and on your general state of mind. Since no one knows why anyone else is there it’s kept rather generalized. Based on the conversations I was able to surmise that the majority of the patients were there for some form of OCD. After this brief meeting the group splits and everyone is assigned a room to work out of, as a sort of home base. The Behavioral Specialist then visits each of us individually to discuss the days plan of action.
The Specialist, with the help of all the completed forms and my input, put together a hierarchy of situations, places, and things that trigger or exacerbate my disorders; things I find to be most difficult to accomplish. Using them he was able to assign exposure tasks to be completed during each days visits and assign others as homework to be completed on my own time.
My primary focus was on driving, being out in public away from my car and/or my safe area, and pubic spaces like big box stores. I really wanted someone to accompany me driving on the highways and especially to go over a bridge, something I haven’t done in almost a year and a half. Unfortunately insurance regulations prohibited staff from riding in my car and me driving theirs. I was able to be a passenger and during a drive I was taken over a bridge.
After the initial check in my typical exposures would be leaving my car behind and walking in a park or downtown, driving on the highway or in local traffic, and going into some stores. I graduated to more highway driving and began to include overpasses and a little highway traffic as well.
Other exercises they assign are things that are designed to mimic the physical symptoms of anxiety and panic. Things like breathing through a straw to simulate shortness of breath, or walking up and down stairs to simulate rapid heartbeats. I forgot the name for these exercises but they are meant to condition your brain that just feeling physical sensations doesn’t mean you are in a panic situation.
The general aim of all the exercises and exposures is to raise your anxiety, within a tolerable limit, without throwing you into a full blown panic attack. The goal of this is to ride the anxiety continuing to do the task or exposure until your anxiety level drops by half. Then the activity can be stopped and time is taken for anxiety levels to return to baseline before starting another exposure.
I had been doing all of these things in a less formal style for some time with the guidance of my therapist. I slowly increased my exposures, but I did it more conditionally on how I felt each day. This program was more focused, structured, and required me to be somewhere daily for three hours. I’ll admit it was exhausting just in that respect alone. Actually driving there each morning was in itself an exposure since the office was a distance away from my home.
The biggest challenges for me were the commitment to being someplace daily for a three hour block of time and getting there early in the morning, when my anxiety is typically high. The actual exposures weren’t really new or different from what I was already doing. The benefit was that they were out of my control and I was doing them for longer stretches of time. Both of which explain the exhaustion I felt each day upon returning home.
The program I was enrolled in wasn’t quite what my therapist had recommended. She had in mind a program of exposures that would also include other therapy modalities. By the time we figured out that I wasn’t entered in the program she envisioned, I was already halfway through it. It wasn’t quite what I wanted either. I wanted something that would help more with driving. I wanted someone to drive with me during the driving exposures and to help me overcome the fear of bridges. All disappointments aside, I don’t regret going. The repetition and practice of exposures was useful and will help me do them by myself.
I finished just before the holidays, and with the holidays I became more depressed which set back my continuation of the exposures. I am only now beginning to get back out there, putting what I learned into practice.
That sums up my exposure to exposure therapy. My apologies if something isn’t clear, this is not my best writing but at least it’s out there. I would be glad to answer any specific questions regarding my experiences.