“Is that a Light, at the End of the Tunnel?”

After all these years, I finally found it… The Holy Grail! To my extreme surprise, the Exposure Response Prevention (ERP) therapy was working. The exposure of looking at a crooked lampshade in my house and not fixing it, clocked in at an anxiety rating of 4, averaging a 5-7 min trial time. By the week’s end, my anxiety adjusted to a 0-1, with a 2-3 min trial time. Five trials per day and I could now tolerate a crooked lampshade in my house, WITHOUT engaging in compulsions to neutralize the anxiety. Wow! The light at the end of the tunnel was faint, but it was the first time I could see it.

Each week, I would meet with Damon and we would assess my hierarchy, as well as current struggles. We would work together to identify x3-4 exposures that were in the 3-5 anxiety rating range. I would complete 3-5 trials of each exposure, daily, recording my anxiety ratings and trial times. I was also expected, and continually reminded, to track my resists and submits to my bans. At the next appointment, I would report my numbers for both exposures and bans. We would cross off the exposures that I worked down to a 0-1 anxiety rating with corresponding low trial times. Then we would identify new exposures, working up the hierarchy, to backfill the spaces of those completed.

Through this process I experienced a mix of emotions. Fear, while confronting a difficult exposure. Disappointment, when the progress of an exposure was slow. Excitement, when I completed an exposure. And, pure joy, when I was able to engage in behaviors that were, prior to treatment, extremely challenging. Overall, I would say it was going well. Until it wasn’t.

At this time in my life, I struggled significantly with contamination OCD. Not only was I fearful of germs and disease, but also toxic, environmental contaminants. I was plagued by the idea that my hands were the vessels introducing these contaminants to my body. I compulsively washed my hands, sometimes 100-150 times per day, leaving my hands noticeably raw, cracked and bleeding.

As Damon and I worked this obsession and compulsion through my hierarchy, there came a time when my exposure was to touch a home toilet seat with one finger and not wash my hands after. I was hesitant, to say the least, but I had been making so much progress with ERP, so I committed to the exposure and began my five trials per day. A few days into the exposure I, unexpectedly, started vomiting around 7:30pm. The vomiting was consistent, and I was unable to keep anything down, including a single piece of ice. Then came the significant “GI distress” around 3:00am. The vomiting, “GI distress” and complete lack of sleep made for a very long night, leaving me pale and fatigued by morning. Under normal circumstances, I would’ve rode it out, but I was eight weeks pregnant with our second child. I called my OB and she requested that I report to the nearest emergency room for IV fluids, IV Zofran and an ultrasound to check on Baby Miller.

Thankfully, our baby looked great and after a dose of Zofran and some rehydration, I was discharged home for a few days of rest. A week went by and it was time for my next therapy appointment. To say, I arrived “upset”, might be a slight understatement šŸ™‚ I may or may not have, marched into Damon’s office, finger pointing, voice raised, accusing him of sole responsibility for my illness and my baby’s safety. “If it wasn’t for the toilet seat exposure, I never would have gotten sick!” “I’m NEVER doing that exposure again!” To my surprise, he allowed me to word vomit all of my “feelings” about the situation, while he sat calmly and listened.

After I finished my tirade, Damon guided me in challenging my thoughts. He applied logic and questioning, in place of my “feelings”. “Brooke, is it possible you picked up the stomach flu from someplace else in your environment?”… “Yes”. “Is it possible you picked up the stomach flu from your 15-month old who goes to daycare?”… “Umm, yes, I guess”. “Is it possible that the toilet seat exposure did not cause your stomach flu?”… “Ugh, I get it, I get it”. “Is it possible that the toilet seat exposure did cause your stomach flu?”… “Wait, what?!?!?”. Well, there it was, the gray. Not black… not white… gray. Maybe the exposure caused the illness, maybe it didn’t. There was no way of telling and I had to sit with the discomfort of uncertainty, no rituals allowed.

Following this conversation, we discussed the progress I had been making with the toilet seat exposure, prior to my stomach bug fiasco. It was evident, in the numbers, that the exposure was working. I was SLOWLY becoming more tolerant to touching my home toilet seat with one finger, without washing my hands… habituation, at its finest! We also identified that my hand washing was becoming less frequent. Seeing the data, I couldn’t deny that there was a benefit to this exposure. So… begrudgingly, I committed to following it through.


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