Thursday, June 2, 2011

IDGRA what this post is called

Ever read something that made you cringe? That happened to me with my blog. Sorry. When did I become such an inefficient communicator? I hardly ever post and when I do post it's annoying. How about I try to post more and then just delete the shitty ones? Give up being so perfectionistic. I've always been that way. Didn't try to walk until I knew I could do it perfectly. But people like this about me--I don't talk unless I have something awesome to say. Okay, but sometimes it's maladaptive. e.g., procrastination. Maybe I'll not take it to an extreme.

EDIT: That first paragraph doesn't even make sense, but it therefore fits in nicely with the not-being-a-perfectionist theme. k that's all

Moving on. I've had the privilege of attending weekly case discussions with the anxiety disorders crew at SLBMI for a little while now. Awesome. Finally getting some exposure to OCD (no pun intended! lolz). Okay that was actually my boss's joke. Slash 10,000 other people's joke at some point I'm sure. Huh? Oh, sorry. Exposure and response prevention is a type of therapy for OCD. Have I written about that on here yet? Don't know. Anyway, it's all about facing things that cause you anxiety and saying So what? Yeah, this door nob might be contaminated with all sorts of germs. Yeah, maybe I left the stove on and my house is gonna burn down. Probably not, but who knows? My carefulness is interfering with my life, so I'm gonna go to the extreme and see that the only real consequence is extreme anxiety, which subsides after a while and isn't going to kill me anyway or something. It's way more complicated than that but this is a blog, not an encyclopedia. Duh. I'll save the more extensive writing for the future when I have some more legit credentials and experience. (Did I mention that I'm gonna be a doctor? Yeah, it's happening.) Anyway, maybe an ERP-like technique can be applied to pathological skin picking after all. The patient can create a hierarchy of triggers. So suppose she tends to pick at her skin when she's in the bathroom, but simply going to the bathroom doesn't cause much anxiety. It's a few steps removed from the main trigger of looking in the mirror or touching her skin. But the behavior is so ingrained that sometimes simply entering the bathroom is enough to trigger the picking, even without any obvious anxiety and intention to relieve that anxiety. So that will be at the bottom of the ladder. She will need a response prevention tool, such as a stress ball. If the patient can make sure the stress ball is available, then she can prevent the semi-automatic picking behavior. Then we can move up the ladder to things like boredom and general anxiety about life, which often trigger picking. Response prevention: stress ball, maybe some mindfulness or relaxation exercises. Then at the top we have touching and looking at her skin. These, unlike the other triggers mentioned, are things that can be avoided somewhat. Previous treatment approaches have aimed for avoidance. The current approach uses that strategy to some extent; i.e., playing with a stress ball in order to avoid touching one's skin. The problem, though, is that sometimes the intention to pick is so strong and, from the patient's perspective, completely justified. And in some cases, the general population might see it as justified too. I mean who wants to look at a big old whitehead on the tip of someone's nose? Gross. But this is where the patient has to take her so what? to the extreme. No matter how gross it is, the response is so what? This will cause me anxiety, but so what? It will allow me to live in a way that I value. (The values thing comes from Acceptance and Commitment Therapy, btw.) Of course, this is at the very top of the hierarchy. There are other exposures to tackle first, such as more minor imperfections. Gradually, the patient will be able to sit with more and more anxiety and refrain from using picking as a way to rid herself of that anxiety.

(Okay, let's be real. The "patient" is myself, but I use third person because I'm playing therapist here, trying to present the case from an objective viewpoint but with a great deal of empathy for the patient... because she is me... so yeah. No, this is not a sign of Dissociative Identity Disorder.)

Next up (or maybe not): Which group is more hated, atheists or psychiatrists?

1 comment:

  1. Exposure and response prevention therapy is THE SHIT. I mean, it's shitty as HELL to do, but man does it work. Habituation, ftw! The anxiety peaks and then slowwwwly ebbs away until it's like, this used to make me nervous? Now, if I notice anything becoming ritual-y, I try *not* doing it and seeing if it makes me anxious. If it does, then I needs be stopping that. Yep. Cool beans -SBro