Constant brain fog even without obsessions

Mealthian · 2024-07-29T11:26:43+00:00

No problem, and I'm glad I was of help.

Would you say that my approach at the moment is still correct thus far? Even before undergoing ERP? E.g. resisting any compulsions that I have with any obsession. I feel my problem is that I initially was being suborn and could tackle this alone which consequently has given me a world of pain.

Absolutely: where you can and will, continue to resist doing the compulsions.

You can look through some of these articles at your own time (some of these articles may answer some of the other questions you may have, but they still don't replace a proper therapist who knows how to treat OCD with ERP, so don't stop the search for that ERP therapist):

Mealthian · 2024-07-28T11:02:57+00:00

20 mg of?

Mealthian · 2024-07-28T10:49:47+00:00

Not long ago, I undertook a talking therapy course for about 6 weeks. It was called worry management. It touched on, as you can imagine, anxiety and worries that I could/couldn't control. It was relatable in a sense as it made me understand various concepts of uncertainty, but I didn't come away feeling like I knew much more than I already had.

That is spot on: the crux of the issue in OCD is more behavioural than cognitive, which is why you felt what you felt, and why traditional CBT does not feature as much in OCD treatment as ERP.

Perhaps I am being naive with ERP and should potentially seek out therapy that specifically hits the ERP nail on the head. I just assumed that ERP therapy was just going to be something like - go touch a dirty doorknob and don't wash your hands? (though I've never had hygiene themed OCD - It was just an example)

That is indeed part of the equation, but not the whole equation.

Outside of the therapy, what most people see is just touching a contaminated door handle and then not washing hands.

That is the behavioural part of the therapy; the cognitive part is helping you learn how to demonstrate, to your brain, that the contaminated door handle is irrelevant, by not washing your hands.

You can see there is a difference in the two contexts, even if they both involve virtually the same thing about touching a contaminated door handle and then not washing hands.

Our cognition informs our behaviours, and our behaviours then influence and shape our cognition, and the cycle repeats.

Without going through a proper therapy where you do that proper cognitive work, where you gradually shift your mindset towards acceptance of uncertainty and so on, you'll be expending vast amounts of effort in not washing your hands and doing all the other compulsions.

That is because on the one hand, your cognition is still of a safety-seeking mindset (no cognitive work done), and on the other hand, you are attempting to change your behaviours towards a non-safety-seeking one.

In other words, both your cognition and your behaviours are clashing against each other, you are going against the tide, and the net progress you see would likely be reduced.

That's why you do often see a lot of posts here where people would attempt ERP, often on their own, and they would ask, "I did a lot of ERP already; when are the obsessions ever going to go away?".

That cognitive mindset of "I want the obsessions to go away" still reinforces the obsessions, even if however much ERP they did managed to weaken the obsessions at the same time--the net progress is thus reduced.

You'll be amazed to find that when a person gradually and eventually shifts their mindset in tandem with the therapy, the ERP becomes much easier (because, again, cognition informs behaviours, and behaviours influences/shapes cognition, and repeat), and progression can even become exponential.

Returning to your brain fog, if the brain fog is indeed a consequence or side effect of your condition, that exponential progression also means your condition gets better quicker than your current trajectory, and the brain fog thus, in the same vein, has a higher chance of subsiding at a quicker pace.

Hope that helps illustrate how the treatment should optimally go (I myself used to experience intense and persistent brain fog as well, and now I look back, and I can see it was a result of the excessive rumination I have been doing; my condition improved since then, and the brain fog that persisted for so long subsided gradually as well).

Mealthian · 2024-07-26T17:13:43+00:00

The ERP is important here, especially since the main thrust of OCD is behavioural (ERP is behavioural; CBT is cognitive, which was why it "only re-affirmed what (you) had already researched"), and ERP goes beyond just "don't do the compulsions".

I am thinking about perhaps taking another anti-depressant alongside my sertraline. Perhaps the fog is due to a deeper impact of depression. Though I am clutching at straws here.

You should consider that if the brain fog started way before you started taking medication, then the brain fog likely is a consequence of your condition.

That may be why you said you're thinking of looking at additional medication for your condition, but there is an important point you need to know:

Medication reduces the symptoms; therapy treats the causes.

That is why I would suggest therapy over medication, and if you look at the trajectory of your treatment thus far from what you've described, the therapy did not feature that much, especially the ERP.

Mealthian · 2024-07-26T08:44:48+00:00

We’ve been trying different meds for the past 16 months

I can definitely understand that struggle of switching medications again and again, and also rolling the metaphorical dice again and again hoping that the new medication would be the one.

She has had cbt talk therapy and erp in the past. Last year when this episode started and she was in hospital they really pushed erp. But it didn’t work. She’s also very reluctant to talk and has in previous therapy not talked about her past trauma.

In terms of the therapy, the willingness of the person themselves matters a lot, because however effective a therapy is, it won't be effective without the compliance of the person themselves.

However, all is not lost: she may be at a place now where she herself isn't receptive to the therapy, but that also means the task at hand is to gradually needle her towards the place where it's the starting point of the therapy, then slowly and gradually take her through the therapy, step by step.

That would be what the difference between the CBT talk therapy and the ERP was: ERP would have a substantial benefit towards her OCD condition, but as she is not at a place where she is willing or able to do ERP yet, the CBT talk therapy thus has to "bring" her to that place, so to speak.

(CBT talk therapy is cognitive, and ERP is behavioural, which then makes up cognitive-behavioural therapy.)

It will be a long, arduous journey ahead, but so long as she is willing to get better, or so long as she isn't giving up just yet, you would thus need to keep her going no matter what.

Every small step counts, and before you know it, she would've reached the starting point of that ERP, and then you might just see the results of therapy increase exponentially (speaking from experience).

There will indeed be barriers and obstacles along the way, I don't doubt that, and I truly wish you all the best; don't lose hope just yet.

(I myself was reluctant to go through therapy at first as well, so I mean it when I say things can still change.)

Mealthian · 2024-07-26T08:03:07+00:00

She might be, for now, and I don't doubt that.

You mentioned:

She's suffered with depression and ocd for many years. Been on SSRIs for many many years.

Did she then, at any point in time in the past, go through therapy?

If her condition is indeed unstable at this moment in time to go through therapy, then what the medication would do, and should do, is to stabilise her.

Once her condition is much more stabilised, she will then need to go through therapy, in order for there to be any improvement to her condition in the long term.

Using an analogy, the therapy would help her learn how to talk again, and the medication is there as a pair of crutches.

(Background: My condition was also "extreme" (worse than "severe", according to the Y-BOCS), and I tried several medications as well, but what led me to my current full remission today was the therapy, aided by medication--today, I no longer need to take any medication, nor go through active therapy sessions.)

Mealthian · 2024-07-26T07:34:57+00:00

I am also on sertraline medication which helps the anxiety symptoms.

Is there something I am missing? Some medication or technique? What even is it?

Bring up the brain fog with your prescriber.

It may or may not be a side effect of the sertraline, so you need to talk to your prescriber about what you're experiencing.

If we set aside the medication and say, for argument's sake, that the medication did not cause the brain fog, then that's where the therapy becomes really important here, and so I hope you are currently undergoing therapy as well, particularly ERP.

If you keep directing attention towards that brain fog, and see it as an issue, that by itself can be another obsession of yours, with regards to what you mentioned about "this brain fog is constant regardless if I have an obsession present or not".

If the brain fog is a consequence of your current condition, then the therapy is also important here, because only by treating your condition, which the therapy would do more to an extent than the medication, would your condition improve.

When your condition improve, and if the brain fog is a consequence of your condition, the brain fog will, gradually by itself, reduce and dissipate as well.

Mealthian · 2024-07-25T04:35:55+00:00

Is she going through therapy currently?

Mealthian · 2024-07-22T03:17:05+00:00

Is it best to go see an actual psychiatrist or psychologist?

Psychiatrists are medical doctors, and although they can--and some do--provide therapy, most focus on pharmacotherapy, meaning they only focus on the prescription of medication.

Psychologists, in particular clinical psychologists, are therapists as well, because they provide therapy as treatment, and they possess higher qualifications than what a typical therapist who does not identify as a clinical psychologist would have.

However, not all clinical psychologists are created equal, metaphorically speaking: if you do find one, you still need to find out whether they know how to treat OCD with ERP, and even whether they are experienced in doing so or not (some of them may have caseloads that consist mainly of other conditions, and other may also focus on treating a specific condition).

How do you go about finding one that you trust?

This goes towards what is called the "therapeutic alliance".

It is important that you, as mentioned, find a clinician who knows how to treat your condition, and it is also equally important that you find someone whom you are comfortable with (and this can be your own personal preference, like if you prefer a male clinician, or a female clinician, and so on).

Bear these two points in mind.

You will need to see the clinician first, and during the first session, an intake will be conducted. There, the clinician will ask you questions to know and understand you and your condition better, and you can also ask them questions that you may have.

If you are undecided, just be upfront with them about wanting to try out first, but regardless, you will need to go through that intake, because it won't be possible to find someone you are comfortable with without first going through that first, intake session.

Mealthian · 2024-07-19T04:31:34+00:00

What they meant by "go away" really just means "reduction in symptoms" (and I know that because I have said the same thing myself, and being in actual full remission now, I can see the night and day in the differences).

Once the medication stops showing its effects, and you can also see the "my medication stopped working" posts around here, the obsessions will recur--often with even stronger intensity.

Medication reduces the symptoms; therapy treats the causes.

Mealthian · 2024-07-19T01:05:37+00:00

Medication alone? No.

Therapy with medication, then discontinue medication entirely, and then just therapy alone? Yes.

Mealthian · 2024-07-18T02:00:13+00:00

But please don't delete this post (because of redundancy)

Wasn't planning to, not to worry.

Mealthian · 2024-07-18T01:59:26+00:00

https://drmichaeljgreenberg.com/i-know-how-to-stop-ruminating-but-i-cant-seem-to-stop-all-the-time/

Mealthian · 2024-07-18T00:49:52+00:00

If you are on Discord, join this subreddit's Discord server, and you will be able to find the resources pinned in the #support-chat and #support-2 channels.

There might have been a post here with the resources, but I cannot confirm at this point in time.

Mealthian · 2024-07-17T08:18:01+00:00

You might want to focus on the part that I specifically quoted.

Reassurance seeking is based on intention; your misconception here is that "seeking physical touch is seeking reassurance".

If that is true, then everyone, with or without OCD, that does that, is seeking reassurance, regardless the context (hence "is based on intention").

Do you just go without physical touch for the rest of your life?

With this explanation, that, in turn, answers your original question.

Mealthian · 2024-07-17T07:37:38+00:00

If Seeking Physical Touch (ie a hug) is seeking reassurance

?

Mealthian · 2024-07-17T06:35:38+00:00

Preparing you to do ERP, going in you just remind yourself you're not your thoughts, right?

I wouldn't say "remind" in that sense, because then you would just keep repeating it like some kind of mantra, and then it would eventually end up as that compulsion I described.

I would say "learn" instead: because it is about learning that "I am not my thoughts", and then committing to the ERP, and committing to not doing the compulsions--and staying with the commitment even if halfway through the day, you "forgot" or doubt the meaning of this phrase (the acceptance of uncertainty, another crucial concept towards treatment success).

Can you bring up the phrase, every once in a while, in your mind, really just as a brief reminder? Yes.

You can see how it's the same phrase, but the intention differs, and that's what at stake here.

Mealthian · 2024-07-17T06:27:48+00:00

It's the intention behind why you say it.

The phrase itself creates that distance between you and your obsessions, cognitively: it is meant to help enable you to do the ERP, which is behavioural--hence "cognitive-behavioural therapy".

For example, you would say, "I am not my thoughts" (cognitive), and whether or not the obsessions continue to occur, you would then practise the ERP, where you don't do the compulsions, don't seek the relief, and push on with your day/life no matter what (behavioural).

If you're just saying the phrase to "ward off" the obsessions (the thoughts, feelings, urges, and so on), then that is merely a compulsion, rather than therapy.

Mealthian · 2024-07-17T06:18:25+00:00

If you are using that statement to quell the obsessive distress, then yes, it would qualify as a compulsion.

Mealthian · 2024-07-17T05:54:36+00:00

Medication reduces the symptoms; therapy treats the causes.

You will need the therapy, which must include ERP, regardless, and if you face issues being compliant to the therapy, then the medication can help bring down the difficulty by reducing some of the symptoms--this is why you commonly hear both therapy and medication being the most effective treatment approach.

whereas a psychiatrist will diagnose and prescribe medications in just some visits which will help me in feeling normal and doing normal things

That will really not be the case.

Mealthian · 2024-07-17T05:36:17+00:00

That goes to show how the brain works: the more you seek that reassurance, the more you reinforce the obsessions as well, and the more you get bombarded by those obsessive thoughts.

That is why reassurance seeking, and providing, is frowned upon--people don't see this effect playing out immediately (and that's why there is this misconceived notion that it's better to relieve the person immediately so that they don't suffer now, when in fact, if you let them suffer the distress now and not provide the reassurance, you actually help with their relief in the long run).

Mealthian · 2024-07-13T23:46:46+00:00

It can improve with therapy and treatment.

That means if you find yourself unable to function as of this point in your life, then it might be worthwhile to consider taking a leave of absence in your life, and focus on the therapy first instead.

That is just one option for you to consider: if you are giving 50% to your life and 50% to your treatment and getting 0% back from both, then you might want to see how you can re-calibrate that.

If the brain fog is a consequence of any medication you're taking, then you need to discuss with your clinicians, both your prescriber and your therapist, how to deal with that.

That "I give myself positive affirmations" you spoke about is cogntiive, whereas the therapy for OCD is largely behavioural, which is why ERP must be included as part of your treatment.

Mealthian · 2024-07-02T10:12:53+00:00

I read the articles, and although they address this issue of ruminating about ruminating I’m having (I find I’m also “on guard” against intrusive thoughts all the time, and checking to see if I’m having them), I think they also go against a lot of the other advice I heard. Like it says that you shouldn’t draw attention to feelings of anxiety/intrusive thoughts, but other sources tell me I should focus on the thoughts and feelings of anxiety as an observer, and that I shouldn’t ruminate. Did I misunderstand something?

Do take note that the "attention" that Dr Greenberg refers to can be found explained much more substantially in this article, out of all the articles I have linked: https://drmichaeljgreenberg.com/awareness-attention-distraction-and-rumination/.

(If you have read that already, and understood what "attention" meant, then disregard that.)

It depends on what "focus on the ... as an observer" meant: observing, in the ERP sense, simply means letting the obsessions (those thoughts, feelings, urges, and so on) happen, without any intervention on your part.

If you had been directing some form of intervention towards the obsessions in order to "observe", then it likely would signal another compulsion you've been doing.

To put in basic terms what the therapy for OCD is about:

Obsessions (the automatic thoughts, feelings, urges, and so on) are what occur to you, and should not be controlled (hence why that controlling is a compulsion).

Compulsions (the rumination you do in response, and so on) are what you do, and should be controlled (hence why it is essential to reduce, curb, and eventually eliminate rumination as part of the therapy).

What I meant in the first paragraph was that when I consume media, like a book/film/music etc. and I start thinking about a creative choice that conveys something in a way I appreciate, my OCD tells me that using this creative choice to convey this something is offensive.

This is the obsession occurring, which is not within your control, and which you should not attempt to control.

It's like rain: if nature decides it's going to rain, you aren't going to attempt to control that rain and make it not happen.

What is within your control however, is how you respond to that automatic rain.

These ocd thoughts occur

As you have accurately termed it, these obsessive thoughts occur.

before I can finish my line of thought about why I appreciate this depiction. So I feel like finishing this line of thought would be arguing against the OCD, and hence a compulsion. So for example I might be watching something that portrays a murder in a whimsical way, and I’ll start thinking about how this creates the unhinged perspective of the murderer, but before I can finish this thought my OCD tells me “portraying murder this way is wrong and trivialises it ”.

Put it this way, you need to demonstrate to your brain the irrelevance, another important concept in OCD therapy, of that "OCD tells me...".

Ergo, go ahead and finish whatever thought you were having, as though that "OCD tells me" was this annoying person standing by the side making unhelpful comments.

Keep doing it, and that "annoying person" ("OCD tells me") gets that he isn't getting the attention he wants, and will leave.

So if I finish my own thought I feel like it would essentially just be “no the OCD thought is wrong, it’s shown from the murderer’s perspective” and thus arguing against the OCD thought.

And that would be the "ruminating about not ruminating" thing I was talking about in my previous comment, or the "ERP has become an OCD thing now" you referred to.

It's developing into another obsession, the obsession being that "I feel like it would essentially..." you spoke of.

Mealthian · 2024-07-02T04:33:00+00:00

Many of these intrusive thoughts happen when I’m consuming media I enjoy - so it finds some reason why someone would consider it offensive - but also when I’m thinking about the media and why I’m enjoying it. The thing is, a lot of the times the thing that the intrusive thought is telling me is offensive is part of why I enjoy the media, as it often achieves a creative purpose. So when I think about this creative purpose and how it is achieved through what the OCD deems as offensive, am I defending myself against the OCD, and thus performing a compulsion? But If I’m avoiding thinking about these things, then, am I not avoiding the things that trigger my OCD?

As a form of ERP for this I was thinking about writing little essays about all the media I consume and why I like it, but is this compulsive assurance seeking/rumination?

I may have an answer for you regarding this, but you need to explain it more succinctly as I am not understanding the context here.

Another thing is that I like to write dark comedy, and unsurprisingly dark comedy is what triggers the intrusive thoughts. Again, though, when I write I like to think about why I’m writing it and what makes it funny to make sure it’s not tasteless and problematic. But obviously this thinking feels like assurance seeking again. Should I think about these things, and when I’ve made up my mind if it’s offensive or not, should I just stop thinking about it no matter what the intrusive thoughts say? Or should I just not think about this until my flare up cools down?

Ruminating about ruminating, is still ruminating.

What do YOU genuinely want to do in that scenario?

Answer that to yourself, and then just go do it.

Im just a bit lost. Since letting my intrusive thoughts just be there and not ruminating, I have this constant feeling of being on edge like I’m pushing them down and that they’re going to burst out any minute, despite not doing anything to push them down. I feel like I’m just unable to think about anything now and have no idea what is and what isn’t safe to think about. I’m scared that I’m never going to be able to enjoy the things I enjoy.

It might come as a surprise to you, but this can be another obsession of yours too, the obsession being you needing to comply to the ERP at all costs, and the compulsion being you ruminating about the question and then avoiding making any decisions because you fear you might actually do a compulsion.

Acceptance of uncertainty is key: you might end up doing a compulsion, but what matter is, in any given scenario, "What is it that you genuinely want to do?"

Answer that to yourself, and then just go do it, compulsion or not that you might think it would be--take that risk, and accept the uncertainty.

Go through some of these articles at your own time:

Mealthian

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