15 Minutes at a Time The FlyLady and Exposure Therapy for OCD

In January, faced with increased difficulty finding things in my house, and general chaos, I remembered reading about the FlyLady, and went to her site. Just going there was an exposure for me, since my perfectionism starting raring up, but what I like about the FlyLady is an explicit acknowledgment of how much of the home clutter chaos stems from this very perfectionism. The fear that you have to do it "right" and all at once, and rip apart every closet and scrub every surface.

She advocates doing 15 minutes at a time, and then stopping. That's the hardest part for me. My perfectionism OCD gets entangled in this, and once I start a task, I feel anxiety at the thought of stopping before the task is done, even if there's no clear ending point, and so I keep going until I exhaust myself and it seems preferable to avoid cleaning at all. For someone with contamination OCD the feared consequence may be that nothing is clean enough after only 15 minutes.

The FlyLady is practicing a form of Exposure Therapy. She dares her readers to do housework imperfectly, incompletely, incorrectly. The irony of OCD is that it's all about the anxiety not about reality. Avoiding cleaning altogether is not more "perfect" than doing 15 minutes at a time. A refrain on the FlyLady forums is "I've got so much to clean up that 15 minutes isn't enough time." This kind of thinking is part of why I didn't start actually doing exposures right away when I finally found an Exposure Therapist.

I saw the enormity of my compulsions and anxiety, and I wanted to be better immediately because I was in pain, but also because my perfectionist OCD made it seem dangerous to have a learning curve, to proceed slowly, by trial and error, imperfectly, haltingly, erratically. I needed to do things instantly, the first time, or my feared consequence was that I was a worthless failure. Again, the reality is that avoiding learning or taking small steps serves to give a relief from the anxiety of facing the fear, and yet paradoxically, set me even further behind in getting better from my OCD.

What I have learned in therapy is that anything above zero is good. 30 seconds of resisting compulsions is good. 1 minute. 5 minutes. 15 minutes. It's all good. Exposing myself to something I fear, even if it is the least of my fears, is good. Perfectionism says that you either get better all at once, or you don't get better. This doesn't give me my life back. It keeps me trapped in my compulsions. In 15 minute increments I have cleared through the chaos of my house. The FlyLady motto is that you can do anything for 15 minutes, but for 2011 she's challenging us with a new motto: Let's Go for Seven in 2011

Seven minutes on the timer, because 15 minutes can still be too daunting. The FlyLady says that housework done incorrectly still blesses your family, and in the case of debilitating rituals, this is a powerful statement.

Part 3 The History of Exposure Therapy Hans Eysenck and Learned Behavior

Hans Eysenck was yet another British psychologist who explored behavior therapy beginning in the 1950's, and who wrote a damning article in 1952 about the ineffectiveness of psychotherapy. As Freud envisioned it, a psychotherapist could take the process of psychotherapy and deduce the facts from it, rather than studying what the facts actually were. I am staggered by the traces of this that still affect the practice of therapy in the 21st century. I have vague memories of reading about behavior therapy in social studies class, and the fear that people would be reduced to laboratory rats conditioned to do tasks for food. But there is something immensely liberating in the idea that our symptoms are in part a "learned behavior" which is unadaptive, and which can be unlearned.

It's as if we are running our own little laboratory within our own mind every time we have an obsessive thought, feel intense anxiety, and then apply a compulsion that reduces the anxiety quickly, but then rebounds in the long term.

In 1960, his article, Personality and Behaviour Therapy(Proc R Soc Med. 1960 July; 53(7): 504–508), he explores the uses of BT in "neuroses," a term not as popular as it once was. He cites the study from 1920 about "little Albert," an 11 month old boy who was conditioned to fear rats because whenever he reached for the animal, the experimenter would make a loud noise. This of course is probably where my vague uneasiness comes from, since freaking out small children is not acceptable. These early studies may be the roots of the discomfort many current therapists have about Exposure and Response Therapy, but it is worth stepping back from the old history and consider the even older history of Freudian psychoanalysis which brought a whole tradition of showing patients ink blots, asking what they saw, and building elaborate theories of their personality based on a puddle of ink.

The point that really stuck with me was Eysenck's description of avoidance--if Albert could've been exposed to a white rat for a long period of time, without the loud noise, the fear could be undone, but as he ironically puts it, "Little Albert is a free agent," and is going to avoid even the chance of encountering a white rat, thereby never getting a chance to break free of the fear. If we are willing to risk feeling the initial fear liberty is possible. I know that it feels as if we face the fear every day, we do things we don't want to do, and yet the OCD persists.

This is a frustrating and painful place to be in. I make a phone call, and it actually goes ok, but by the next time I'm anxious again as if I'd never done it before. It's taken me a long time to comprehend that I've had much more practice avoiding phone calls than making them, and what we practice tends to get better. Slogging through the anxiousness of the initial surge of fear without my compulsions sucks, but persistence in practicing strengthens the possibility of getting better.

OCD Toolbox Listening to Scripts Imaginal Exposure

My husband had this habit, when records were still current, to play one side over and over, the arm continually lifting up and going back to the beginning. This drove me crazy, but it's the same principle that helped me to deal with my indecision. Jon Grayson discusses this in his book, and once I started writing and recording and listening to scripts as both exposures and support for doing exposures, I was able to give the healthy part of myself more airtime. OCD usually has a monopoly on all channels, and has worn deep paths into my brain, but scripts gave me some alternatives.

Traditionally, tapes were made on the itty bitty cassettes in answering machines that can loop over and over. I used QuickVoice recording software, which is very inexpensive, and fairly straightforward to use, which enabled me to record my scripts sitting at my computer with no additional microphone or device needed.

I then listened to the script continuously on my iPod Nano. I have about 50 scripts that I wrote and recorded. In the case of decision making, when I went grocery shopping, I would listen to a script I wrote about it never being possible to make a "perfect" decision and that OCD will change the criteria of "perfect" the minute I start to reach for an item, and that my life was waiting.

The key was finding what gave me the most unease about an OCD fear, and directly addressing that in the script, putting it out there, rather than running from it. Yeah, I might choose the "wrong" item and feel my face go hot, and a panicky ache in my chest. I might really screw up, and be haunted by regret about my poor decisions and never have any peace from the obsessing about obsessing.

For about a year, I took the shopping script with me almost everywhere I bought things, and listening to it continuously, logging many hours, and gradually, in combination with flipping a coin when I really felt stuck, I freed up a lot of time in my life instead of circling the aisles of the grocery store, looking at every item, reading every label, picking stuff up and putting it down, over and over.

Related Posts:
OCD Toolbox: Flipping a Coin

My Grocery Store Exposure

I just watched the grocery store episode on VH1's The OCD Project, and could identify with all the fears that get stirred up in that context. I am fortunate to have a wonderful friend, J., who has been a supporter and encourager when it comes to dealing with my OCD. A few months after starting ERP treatment, in July of 2007, I told her about my anxiety when making decisions at the grocery store, and she offered to take me shopping and show me how she does it. Of course she shops at Wegmans, which was the first challenge, since the sheer variety of items makes me nervous, with visions of getting stuck trying to choose.

Shopping with J. was like going to a foreign country. She was excited. For her, Wegmans is a sensory experience, an adventure, game and scavenger hunt. We started in the produce section. J. didn't have a list, and instead moved toward whatever caught her eye, like the red grape tomatoes or the green leaf lettuce. I was already feeling dazed by the multitude of people, since I usually shop early on a Sunday morning to avoid other shoppers, the ambient lighting, and the high ceilings, not to mention the unmoored free-falling anxiety that came when imagining picking up an item in putting it in my cart without second-guessing, thorough analysis or looking at every single variety.

J. made her decisions based on her feelings which she trusted implicitly, and trusted her senses to lead her to feelings and good memories and associations with the item. Does it make you happy? Does it make someone in your family happy? In the cosmetics aisle, she smells a sample of lotion, and since it smells good to her, in the cart it goes. It wouldn't occur to J. to look at every item, because the items "call to her". My OCD on the other hand was screaming,

"What if you miss something? What if you don't choose exactly the right one? What if you make a mistake and regret it?"

On the candy aisle, J. encouraged me to choose a chocolate bar, and as she looked over at me, she exclaimed that I looked terrified. At that moment she said that the reality of my fear was expressed in my eyes. Just having her acknowledge my fear was incredibly helpful, and her encouragement made it easier to take the risk of picking up a chocolate bar in what seemed like split second pace. Then she said, "Take two," and I asked her if she was nuts! To this day she remembers the stunned look I gave her--as if choosing one item "imperfectly" wasn't enough, she asked me to take two of them. . .but I did it!

J.'s imagination was positive--she imagined it would be fun to try whatever she bought. My OCD imagination was all about feared consequences and unpleasant anxious sensations in my chest. In J.'s view, if she doesn't like the item it's not the end of the world. Maybe she might be a bit nervous, but for her it's "Oh, well." For me, a perceived mistake was panic-inducing, and my ritual was to come up with elaborate rationales for making a perfect decision. Choosing what to buy based on my preferences was an alien concept, because I'd let the OCD make so many of the decisions in order to avoid feeling anxious, and because the OCD desire was to know *for certain* what my preferences were. I made a lot of guesses that morning about what I might like or my husband might like, and for how exhausted I was at the end, I was also exhilarated that I'd thrown things in the cart and kept moving.

My OCD gave some backlash later, wanting to figure out the dangers of choosing spontaneously, and then deteriorating into self-condemnation,

"But what about fiscal responsibility? What if my judgement can't be trusted? What if J. needs to be guided more by rational thought rather than feelings? What if I wasted money? What if J. isn't a good example for me? Who cares if you went grocery shopping? Shouldn't adults be able to do this? "

But my friend's compassion for my fearfulness gave me strength. She accepted that I was scared, and that I was working on facing my fears. And I also recognized that I didn't have to become J.--that I would always have a list--but that I didn't have to operate by OCD rituals either.