By Alexandra Reynolds
When I first began my Exposure and Response Prevention Therapy six years ago I imagined it would be a relatively straightforward process.
After all, I’d finally found an OCD specialist who was an excellent fit, understood the lessons, and worked my exposure ladder as expected. I finished my hierarchy with all the tools I needed to manage OCD successfully on my own and left therapy with the expectation that I’d be successful in doing so.
What followed instead were years of just barely getting by. I was marginally better, but still following my old self-destructive patterns of self-sabotage and substance use, still felt my life and relationships were chaotic, and fell into deep depressions often.
Instead of successful management of my OCD, I white-knuckled my way through life. Rather than accepting uncertainty and leaning into the anxiety caused by my obsessions while resisting rituals, I lived in near-constant fear and compulsions remained a large part of my days.
After unsuccessfully revisiting therapy multiple times, I was referred to a trauma specialist. I knew my therapist well enough to trust his judgment in referring me out but didn’t think I needed trauma therapy. I didn’t feel traumatized or believe trauma could affect my OCD treatment.
I was wrong. It turns out I have Chronic Dissociation and dissociation has a very real impact on my response to ERP. Dissociation can be described as a feeling of disconnectedness from our feelings, sense of self, memories, and thoughts. It is very often a response due to events where our capacity to cope is overwhelmed and is, at its heart, a protective mechanism as it allows us to continue our lives as normally as possible after experiencing trauma.
However, when a person has had to rely on dissociation as a coping mechanism repeatedly, such as in early childhood trauma, there is the possibility of developing chronic dissociation. This is a pattern of escaping or numbing out difficult emotions, memories, feelings and even one’s own sense of identity in a way that is disordered and affects a person’s ability to cope with day-to-day life.
Individuals with chronic dissociation can often have a low tolerance for distressing emotions and dissociate at times when it is maladaptive to do so. Our low distress tolerance is at least partially due to the fact that rather than feel distressed, we dissociate effectively numbing out. These aspects of chronic dissociation turned out to be my biggest barriers to OCD treatment. When attempting to do exposures or perform ritual prevention I would often become flooded by the distress and dissociate. While dissociated, I didn’t feel the distress or anxiety caused by my triggers which meant I was unable to learn the lesson so central to ERP; that I can face my fears and learn to sit with the uncertainty and distress they provoke. I was “checking out” before I could teach my brain to respond to my fears in a new way so I was technically doing the work, but not getting much benefit from it.
Learning I have chronic dissociation helped me to understand why I was gaining the tools I needed to recover from OCD, but was unable to utilize them. I am privileged in that I have been able to see both my trauma and OCD specialists for many months now.
Working together, they have taught me to increase my distress tolerance, reduce my dissociative episodes, and adapt the skills I’ve learned in ERP to work despite my chronic dissociation. A lot of this has come through learning to ground myself and trust that I am safe. It’s easier to lean into uncertainty when you are able to trust the process and remain present. I have also benefited greatly from breaking down my ERP into very small steps and repeating them often. Breaking ERP down into the smallest steps possible has kept me from becoming flooded to the point of dissociation, built my confidence, and aided me in increasing my distress tolerance. Repeating them often has helped me to compensate for any moments where I may have dissociated and allowed for plenty of opportunities to truly lean into the uncertainty.
I’m still learning about myself, OCD, trauma, and dissociation, but I’ve come to understand that, no matter what my challenges are, running from them is not the answer and it’s never too late to reach out for help and get better. I spent most of my life running from shadows in my past, my own feelings, and my fears. I coped through avoidance, rituals, and dissociation because I didn’t learn appropriate coping skills in childhood and my OCD was allowed to go untreated. I honestly felt that I was a lost cause and would never get better so I kept running from everything and everyone. It wasn’t until I stopped running, committed myself to getting good help, and learned to trust my therapist enough to do the work that I was able to learn the skills I need to move from survival to the beautiful life I have now.