Dr Jo Edge - CBT for OCD and depression
I suffer with depression and OCD: and was lucky to get referred to CADAT (Centre for Anxiety Disorders and Trauma) where I was given 20 sessions of high-intensity CBT.
CBT is doing therapy rather than talking therapy. Instead of asking ‘what happened?’, CBT addresses ‘what might we do about it?’. I was coming out of a period of severe depression and OCD when my therapy began. We began with weekly sessions which I was encouraged to record – this was really useful for reminding myself what homework had been set and what had been said.
Each session began with setting an agenda for the hour ahead; and then a catch-up and reporting back on homework. I would also fill in both a Yale-Brown Obsessive Compulsive Scale questionnaire and a depression and anxiety questionnaire recording how I’d been over the last week to bring to each session. This proved useful as my therapist kept a record of my scores and I could see the progress I was making each week.
I was given homework at the end of each session. I was dealing with both my OCD fears of harming others alongside depression and very low self-esteem. So I’d do exposure therapy by forcing myself into situations in which I was uncomfortable; while at the same time doing stuff like a ‘positive data log’ where I carried around a pad and made a note of nice things that happened to review when I felt low. I had over 30 years of toxic thinking patterns to undo, so it was really hard work.
Any good therapist will have a range of suggestions of things you might try. I think the key is being willing to give things a go, even if you are skeptical at first. And, don’t beat yourself up for ‘failing’ on homework: it’s not the end of the world if you don’t manage everything. One thing I’ve noticed about people with anxiety and depression is our endless capacity for self-blame; and this can spill over into how we do our therapy. I learned to be patient with myself, and I reached a stage where I decided that I needed to live a normal life rather than base everything around my exposure exercises.
I was exceptionally lucky with my work situation; when I started CBT I was on a phased return and therefore had days off where I could do a lot of homework; and my work were generally incredibly supportive. I also work flexibly and from home so getting to my sessions and doing homework was not an issue. After a while we spread my sessions out to once every two weeks, then every month and then every six weeks, so by the time I’d had 20 sessions I’d been with my therapist just shy of a year. That meant I had the support for longer, and it gave me more time to do homework.
CBT is not a magic bullet and I’m not ‘cured’: I still have to manage my mental health carefully. But the combination of medication and therapy has been transformative, and it has absolutely been worth it. But I can’t extol its virtues without mentioning problems with access. I was incredibly lucky to have a specialist OCD centre a bus ride away, and to have a very informed psychiatrist who knew exactly how to get me onto the waiting list. Many with OCD are put off CBT because they have had low-intensity CBT, which although it can be helpful for some difficulties, is unlikely to be much use for OCD, which needs a high-intensity, targeted and specialised treatment. To paraphrase a well-known OCD specialist: ‘CBT works: where’s mine?’.