Thoughts about an Intensive Outpatient Program

Well, tomorrow could decide the direction of the rest of my life. After my worst OCD episode yet, I'm at a crossroads: Should I attend an intensive outpatient program for OCD?

I'm blessed to live in a city that hosts one of the 10 programs of its kind. Called an IOP, it would likely be 10 weeks of 3-hour individual therapy, group therapy, and exposure and response prevention, and I would be encouraged to leave my job to focus on the task. Attending the IOP would be a radical step in my learning to deal with OCD, and not even 2 weeks ago I was dead set on going after months of desperation. Now, the night before my intake appointment, I'm trying to gather the thoughts and questions that have run through my head since I scheduled the meeting a month ago.

What will I get out of it?
Will it be helpful at this stage, since I seem to be doing better at this moment?
How will the IOP help me to be prepared when unforeseen episodes strike?
Is there a better medication for me in light of my goals for my life?
What kind of ERP exposures will I do given that most of my OCD is pure obsession?
Should I go?

The decision I make tomorrow could mean I'm putting my life on pause for 10 weeks. My husband, of course, is supportive, as he encouraged me to at least go to the intake appointment. I will, with my notepad of questions in-hand.

Life on an Atypical Antipsychotic

The word sounds scary. Antipsychotic. A holistic doctor suggested I seek another opinion because of side effects, but when my psychiatrist proposed adding one to my antidepressant, I thought I'd give it a go. After all, he had known my case for years, and he saw that last month when I began this treatment I was still very, very depressed. Since my last two posts, I'm sure you can infer that things have been bad. The drug is one that's given to people with schizophrenia. Another scary word. But I trusted my doctor, and my husband, who also was up for trying something different. It was hard to tell what would happen. I was up some days, and down others. But the down days were really bad. I could cry for hours. OCD thoughts had taken me down so far, further than I had ever gone; it was terrible. It's been over a month now that I've been on the drug. I'm not planning on taking it for much longer; my goal was to take it long enough to get myself out of the ditch I was in. I'm on the smallest dose prescribed; it's used in much higher doses to treat patients with schizophrenia. I have improved. It was gradual with a few bumps in the road, and I'm still climbing. Counterproductive as it sometimes may be, I know I'm feeling better when I'm plotting ways and reasons to stop taking the medicine! But on my husband's advice, I'm taking it slow and waiting until I see the doctor... I am a little nervous about what happens when I stop, but I can't leave it in anyone's hands but God's.

To Hell and....

...On my way back, hopefully?

My last post makes it seem as if things have been cheery and I've been alright. Not so. This was my WORST OCD episode yet, and it really threw me for a loop. I didn't do a very good job documenting it, but since my last post a lot has happened.

The episode has lasted for a month. I had been to the ER twice. I wasn't sleeping. I had been given Xanex, Ativan, and Restoril (not for use all at once, of course). When I tried to eat, I gagged and sometimes threw up. It was as if I was killing myself, but couldn't stop it.

As always, I felt dissociated. Nothing felt familiar to me. I wasn't me, my house wasn't my house, my husband felt unknown...all scary things. I couldn't control my thoughts. They were going where I didn't want them to go, threatening things most dear to me. Fear overtook me. I had thoughts of death, not that I would do anything to take my own life, but as the ER doctor said, "passive death wishes." If a car hit me on the highway it would have made things easier.

All this happened with the knowledge that it all wasn't real. Something had a hold of me, and I wasn't in control. Just a month ago my life was normal. I wanted it back.

I had been put on Prozac as a substitute for Celexa, the drug that has worked well for me in the past. I believe that the Prozac made me worse--not because it is a bad drug, but because it didn't work with my body chemistry for whatever reason. I have friends who have great success on Prozac, but you never know until you try, I guess. In any case, it had meant that I had lost about 3 weeks of recovery time. Now I'm back on Celexa and am glad that there is a drug that actually works for me. I'm praying it has the same effect it had in the past.

My anxiety had moved from my job to that of things I had obsessed about in the past, plus new things. It moved to scrupulosity, and made me feel apart from God, something that I'm still wrestling with. The job stress was still there, however, and I knew I would eventually need to make a decision: would I stay or leave? Was it good for me? Was I made for it? Probably not was the answer to all of those questions. I was at a standstill, unable to figure a way out of my predicament.

My husband, loving as he is, decided I needed to leave. So I did, and now I'm looking for something else.

He was right--taking my job out of the equation went a long way to helping me to deal with this episode. I still have OCD, but we've relieved one of the pressures. Instead of moping around the house I will be out job hunting, and it will be harder for my mind to be occupied with OCD worries.

On the Slow Upswing

Wow. Over the past few days I have nearly come full circle, but I'm coming back from a freakout...

The job stress was just part of the issue. The other part is some personal family stuff. The issues were all combined and tangled. Where I found peace with one aspect of the conundrum a month before (prompting me go to off meds), I found conflict with another. It all had to fit together or I would be totally lost.

When this happens, I feel life stop. I slept 40 minutes the other night, and I was spinning out of control. With no meds I felt like I wanted to crawl out of my skin, and then there's the lovely physical symptoms that come with panic attacks. When I wanted to sleep I felt horribly alone and panicked. When I tried to eat, I gagged. It's a vicious cycle. I felt like my mind was on overdrive, I couldn't think objectively, I was totally out of control and I couldn't shut my mind off. I hated today. I hated tomorrow. I imagined that it would be easier if someone would just wreck into me out on the road, put me in the hospital, and everything would come into perspective. I was scared that I had gotten this way so quickly, and I KNOW it's because of the stress at my job and mistakenly thinking I could handle it unmedicated.

I talked to everyone: My pastor, my parents, my husband. I took 3 days off work to get things together--I simply couldn't handle anything, and am still not ready to handle work stuff. I have to take care of me. Fortunately I was able to see my therapist yesterday, AND the medicine doctor, so I am on the right track. My therapist found a way that it all fits together--the family stuff, the meds, the work. Honestly, to God be the glory for that because I was utterly incapable of coming to the conclusion she came up with, and Husband likes it, too. It's a decision that gives me the most peace.

Everyone was telling me I had to go back on meds, but it didn't match up with the other part of the puzzle, the personal stuff. I was afraid it meant that I was simply going back on meds in order to work at a job that I find overwhelming anyway. But my therapist helped me to see the big picture. The important thing I learned is that if I ever plan to be unmedicated, I have to take a less-stressful job, and I am 100% ok with that.

Last night I went to a sporting event after not working all day and not having slept more than 40 minutes in 38 hours. It was a good distraction, but work stuff was still on my mind. I had hope in knowing that in a few days I'll have more meds in my system. (I actually am trying a new kind this time.) When we got home I took an Ativan as recommended by my doctor and slept last night. I didn't even hear my husband get up this morning for work until he kissed me on the forehead when he left. I tend to fear sleeping pills and medicine of that type, but I know that I need sleep to start to heal the damage I've caused over the past few days. I'm actually hungry, too!

Some readers of this blog have said that OCD follows you everywhere. Indeed it does. When it is time to take a lesser paying job, I will surely encounter stresses, but my thinking is that they are of a more manageable scale.

Today work is still on my mind, and I keep fighting to let it go. At this point I think I just have to accept that, and use my tools that my therapist gave me when it comes up. I'm tired, but I won't take an Ativan until tonight because I think it's smart to stay on a normal sleep routine.

There is a spiritual aspect that I've realized, too. It always feels like I learn it and re-learn it, but I have never committed to it. I need to learn to relinquish control to God. He created me, He knows what I need, and the whole of my life is in his hands. My pastor says something that I like: "Don't finish God's story." I guess I never realized how much of a perfectionist control freak I am. I mean, from my perspective, I'm in the driver's seat! I'm hoping someone will step out in front of me who is willing to help me learn to surrender.

Totally Freaking Out

I am off my meds. They are completely out of my system. I can't handle job stress anymore. I am completely overwhelmed with work and feel that there is a huge responsibility on me to get everything correct. I have tasks upon tasks and I can't stop thinking about them. I have not slept tonight, and barely the night before that.

I don't even know how I got to this point. Work responsibilities have been ramping up, and I've been frazzled since November. At first it felt invigorating to be so busy--"Wow, look at all the work I can do! I feel alive!" But now I'm worn out.

I have spoken to everyone I know about it: My husband, my pastor, my mom and my in-laws. All have differing opinions on what I should be doing, but the only thing I feel like doing is leaving the job because I don't think I can handle it off my meds.

But then the question creeps in, "What if I leave and it doesn't get better?" Do I need to leave and attend an intensive outpatient program at a Psychiatric Institute nearby? Will it help? It will be expensive...

What do I do today? Do I go to work after not sleeping and use the tactics my pastor thinks will help me get through the day, like definitely taking a lunch, talking to my bosses about my stress, and walking around the office throughout the day? Am I not cut out for a job so trying now that I'm off my meds? Should I look for something more menial? Can we afford it? Will my husband and family be upset with me?

I pray about this all. God has shown me passages in the Bible that echo what I'm feeling, but I'm not sure where he is in all of this. I know my fears surround "finishing God's story for my life," or chasing fears down a path into the future that only He can control. I really want to know that in my soul, but OCD wants me to have control.

I don't think I am fit to go to work today, but I don't know what I would do otherwise. Wallow like I have done all night? Maybe I should go. I will at least be able to get more work done....but then I am bringing work into the picture again.

What would you do?

Thoughts on Being Comfortable with Wanting

...Wanting what?

Anything.

Lately I've gotten myself bent out of shape over wanting things. If I want to get a certain amount of tasks done in a day and I can't because there are simply too many errands and demands, I feel tension in my stomach as I try to wrestle with it all. If I want a particular task to be easy, when it's not I stress about it. If I think, "I'm coming off my medicine and I'm anxious as all hell," I get twisted up inside because I want to be able to handle stress better. It's like an internal temper tantrum, and it's unproductive. All it does is cause me physical distress.

My plan, when this happens, is to remind myself these things:
- I am wasting energy trying to control everything
- The reason I'm feeling physical symptoms of stress is because I'm too caught up in wanting things to be a certain way. I need to let go.

- "Take it as it comes." This is a mantra that, for some reason, hit home for me.

- "It is what it is." There's another mantra that just "clicks" in my mind as a way for me to let go of wanting to control things.

- I would have an easier time if I accepted the want, rather than feeling like I must succumb to it. Ex: I don't HAVE to have that sweater, even though I'm obsessing over it and I feel a real, physical pull to go buy it. Despite that, it is what it is.

When I realize these things, the tension loosens a little. I'm not saying this is a cure-all, but I think I can learn to employ this self-talk in a way that IS productive. It's like I'm taking higher ground over the desire. If I can slow down the now automatic physical response I feel when things are getting out of control (queasy stomach, rapid breathing, obsessions), I can get a better handle on it.

There is a bigger aspect to this all: I feel spiritually driven to come off my medicine at this point in my life. When I put these newly-realized anxiety symptoms into that perspective, it's easier to accept them.

Are there things that you want for which wanting has control of you? What can you let go of?

It's Getting Sticky...

"How do you let things go?" a good friend, Carly, asked. I was embarassed that I didn't have a clear cut answer.

Now, a month after I've started stepping down off my meds and my responsibilities at work are ramping up, the "things" I'm having trouble letting go of are work-related. Work thoughts are getting sticky.

It's not "OMG someone is going to get hurt because of me," but it's trending toward the same types of thoughts. What if I make a mistake that costs more than my own time? What if we lose a customer because of me? Gotta think of all the things I need to do.

It's difficult to leave work at work, and it's upsetting that work issues are more salient in my mind than Christmas is right now. I want to be excited, not stressed. When I realize that at 6:00 in the evening after a rough 9 hours, it makes me angry. I want control of my emotions, whether they be related to OCD fears or not.

But Carly had the answer for me without realizing it. The key isn't control, but relinquishing control. That's what I need to work on.

I'll keep you posted on how it goes. Next up I'm going to think of some concreate ways that I can do it.