OCD vs GAD vs Trauma-based Anxiety

[gcj07a]

Hey all--

I developed OCD in response to the emotional abuse I suffered as a child and the gold standard for treating OCD (Exposure and Response Prevention) worked like a charm. The OCD was a way for me to police my inner thoughts. I know what OCD anxiety feels like--it is characterized primarily by anxiety about absolutely absurd thoughts, things that I know are not even in the realm of possibility. My first victory was to reclaim the sanctity of my mind for myself.

I have been told that I also suffer from GAD and I have had some success treating it with traditional CBT work. But, I often feel like the CBT work doesn't address the swirling turmoil and tsunami of emotion below the surface. Here is an example:

I am a high school teacher at a small, close-knit private school. I often have students in my office sharing about their struggles, especially mental health struggles. They know I am a safe person. I occasionally (in an appropriate way) share bits of my own story that seem relevant to what they are going through. The empathy usually helps encourage them and helps deepen a trusting relationship from which I can encourage them to do what they need to do for themselves. When I open myself up like that, however, I can become consumed with fear that I will be harmed. This usually manifests as dark fantasies of my boss firing me for crossing a "professional" line with my students. I *know* he won't. He and I have actually discussed this aspect of teacher-student relations many times and I am by the book with all of our policies. But that doesn't soften the terror. If anything, it feeds it because I begin to suspect that he is lying to me and is just waiting for the opportunity to fire me when I am least expecting it. It is clear to me that this mirrors the way my M treated me as a kid. She would lie, pretend that it was just against the world, and then use whatever I had allowed myself to share against me when I was least expecting it. I learned to just never be vulnerable with her or anyone. Basically, my defense against toxic intimacy was just to have no intimacy.

I know this isn't OCD because there are no associated compulsions and while my fear is highly unlikely, it isn't absurd on its face. Besides, it doesn't respond to repeated exposures. It just opens the wound all over again, which I know is what a trauma response feels like.

I also don't think it is GAD in the traditional sense because it doesn't seem to respond well to the sorts of logical, thought-replacement, cognitive restructuring of CBT. I mean, the CBT helps enough that I can mostly just ignore the fears and keep going, but it is exhausting. It seems to treat just the surface and just the outward-facing part of me. Here is an analogy: when I cook pasta, it isn't uncommon for the water to threaten to boil over. I simply lift the pot from the stove and it calms down. But, when I set the pot back down, it will boil over again. The CBT work seems like lifting the pot off the fire, but it doesn't do anything about the fire itself.

So, I suspect this is a manifestation of my fear of intimacy, of the danger of opening myself to anyone. I am a flight type, so my immediate impulse is to run away. I start looking for new jobs. I fantasize about quitting altogether and moving to a cabin in the woods. I swear to myself that I will just teach and not have any kind of personal relationships with students. Etc. It is only after a week or two passes and I don't get fired that I calm down. Until the next time.

Anyway, I don't really know what I want. I just wanted to share this and see if anyone can relate.

Thanks!

[Kizzie]

I have a problem with CBT too because you're right, it doesn't address the trauma underneath and often asks us to see rational trauma responses as irrational. And so many T's and insurers are absolutely married to CBT as if it can solve everything.

If you as the survivor don't get better it's not CBT it's that you are not doing it correctly. I recently left an out patient program because of this. They just didn't want to hear that until my underlying pain and trauma are dealt with CBT was only going to "tickle the surface" so to speak.

I fully believe that until the underlying trauma is treated appropriately (i.e., with approaches that acknowledge the trauma responses we have are indeed rational), you can't use CBT alone.

Great analogy about the boiling pasta water by the way! 

[gcj07a]

Thanks Kizzie! Framing the trauma response as rational is SUPER helpful. So often it feels like a really stupid, annoying, ridiculous part of me. But it is fundamentally rational. Here is another analogy: we have two very old dogs who have been on death's door for at least a year. The dogs both dislike my children. This is because when they were toddlers they pulled the dogs tails and ears and such. Now that my kids are older and can be responsible with a dog, they don't understand why the dogs don't want to be near them. The dogs are behaving entirely rationally (these people hurt me, so I will avoid them). In my case, being vulnerable with someone resulted in lots of pain and betrayal, so I'm not doing THAT anymore.

[Moondance]

Hi gcj07a,

I resonate with both analogies.

Thanks! 

[Kizzie]

Yes, excellent analogy. 

I have seen something lately called trauma focused CBT which approaches survivors a bit differently - acknowledging and focusing on our trauma and learning ways of understanding it, working through it and learning to cope. 

I don't know much about it or how effective it is but at least some clinicians seem to understand plain vanilla CBT isn't helpful for us and in fact can retraumatize us by making us feel like we are failing if we can't use it effectively. That's my beef with it. 

[ednasurvivalmode]

I, too, fear intimacy. Arms length for me. I don't mind being kind but actually inviting new people into my life in order to become more acquainted is too much. Something that I have noticed in the recent past is that I overshare my "issues" in order to turn people away from me when I first meet them. Of course this doesn't always work but when it does, I feel like a failure and the rejection is painful. I grew up in a very small area. Rumors meant you were collectively rejected by most, if not all, of the population. (I did move away as soon as I could.) When I do make an attempt to befriend someone, I feel I am constantly on the chopping block. Like if they knew the "real me" that they would drop me. Fear of rejection is real. And I can relate.

[Kizzie]

It makes sense when you think about it that you (and most of us here) fear intimacy. It didn't go well for us in the past so why would it now? I too tend to keep people at arm's length because it is what I know to do to keep myself safe. Rejection is just so terribly painful, Like GC if/when I share I often trigger afterwards, especially if it's a non-survivor. That's CPTSD for you, the fear bubbles up to keep us safe (as in "never do that again"). 

Anyway, I find it's best to go slowly when trying to make a friend and 'test the waters' (can I trust them with this little bit of info, do they respect me, does this feel ok?) as you go. 

[Papa Coco]

I spoke with a new therapist on the phone yesterday. We've scheduled a first session for intense IFS therapy for May 2. On the phone she said "Our first few sessions will be mostly us gaining trust for each other." I almost laughed. I almost said, "That won't be a problem. You're a stranger. It's friends and family I don't trust."

It was people who loved me that did the most serious damage to my brain and heart. I'm good with strangers.

It's friends I keep an eye on.