What is it like to be in residential treatment for OCD?

Knock-knock. “Time to wake up!” A residential counselor calls from outside your door. You turn your head to look at the clock. 7:30 AM. It’s too early, you think. You want to snag every second in bed you can get, because once you wake up, you know the residential counselors aren’t going to let you lay down again until it’s time to go to sleep.

Knock-knock. “Time to wake up!” The residential counselor calls again. You reluctantly get out of bed, dreading - yet also strangely, hopefully, looking forward to - the day’s activities. You leave that sacred spot that is your bed, get dressed, and head toward breakfast. I wonder what they are serving today? You wonder. Breakfast quinoa, again? You shudder as you read the menu. You look at the menu again to double-check what you have read. And then you triple-check, quadruple check…Well, I better mark that in my “ban” book, you note as you recognize that you are engaging in yet another rereading compulsion.

As you head to breakfast, the nurse stops you to take your vitals. You’re relieved that your blood pressure is normal, but you sigh disappointedly at the number on the scale. You have gained yet another pound. Why do I keep gaining weight?You wonder. And then you remember one of your peers saying that eating is like a pastime in treatment. For one, you don’t go out very much with it being the middle of winter, and two, you’re in Wisconsin, the land of custard and cheese curds.

You take your morning meds, go to breakfast, and then head for your morning meeting. You think about your anxiety and depression levels and the ticks you have marked in your little Mead “ban book.” Your anxiety and depression are decent, but you’re embarrassed by the number of times you have submitted to your compulsions. For one compulsion - your repeating compulsion - you submitted 20 times and resisted only 5 times. You hope your behavioral specialist doesn’t get too mad at you.

Where’s your anxiety on a scale of 1 to 7? A 4, you think. Or is it a 3? Can I be sure? You hesitate for a moment before declaring that it is a 4.

Depression? 5. You are immediately decided on that. You did not want to get out of bed this morning. You would rather have slept the day away…But, opposite action, you tell yourself. It’s one of the big concepts you are learning in treatment: do the opposite of what your anxiety and depression tell you to do.

After everyone in the group reports their anxiety, depression, and “bans”, your behavioral specialist calls you and reviews what exposures you are doing for the day. Interoceptives? Check. Reading? Check. Writing? Check. Saying hello to everyone in the hallway without repeating in your head what they say? Check.

You know you shouldn’t, but you begin with the exposures that give you the least amount of anxiety: interoceptives. Today, you are working on the one that requires you to shake your head back and forth for thirty seconds. It feels and looks awkward, but you know it is supposed to help increase your tolerance for the physical sensations of anxiety. You move on to your other assigned exposures. You dread each one, but every time you do an exposure, your anxiety becomes a little more tolerable. Sometimes, you have a residential counselor help you with an exposure. Like, the one where you have to tell an R.C. something and then immediately walk away and try to resist repeating the phrase in your head. That one is particularly challenging for you.

You are about half-way done with your day’s exposures when you are told it is time for lunch. What’s for lunch? You wonder. More quinoa, great. You are grateful there are other choices.

You sit with your peers. You are not supposed to talk about the particulars of each person’s OCD, but just knowing that everyone is going through a similar hardship gives you a much-needed sense of community. The best part? You don’t have to explain yourself. No need to describe what OCD is, no judgment on why you do a certain compulsion, no weird looks when you are doing a strange-sounding exposure. Everyone just gets it.

After you are finished eating, you ask for your cell phone. You cherish every moment with it, because you know cell phones are not allowed during programming hours. Not only that, but you are not allowed to use your camera per HIPPA guidelines. So, no pictures of the beautiful lake outside, no photos of you with your new friends. You understand why these rules are in place - you mean, you wouldn’t want someone posting photos to social media of you doing agonizing, odd exposures - but it is a disruption to your daily life. Before coming to Wisconsin, you opened a line for an old-school flip phone (you were surprised the retailer even had one to give you!), and you had the camera removed. You have flashbacks to middle school, when The Razor was all the rage. Between having your flip phone and having to share desktop computers, you feel like it’s the early 2000s.

It’s time to put your phone away and go to your first group class of the day: dialectical-behavioral therapy, or DBT. You appreciate the break from doing exposures. Those are exhausting. In DBT, you learn a different set of skills: how to manage difficult emotions. Today, you are learning the acronym ABC PLEASE, which helps you to remember ways to improve emotion regulation: Accumulate positive emotions, Build mastery, Cope ahead of time with emotional stimulations, treat PhysicaL illness, balance Eating, avoid mood-Altering substances, balance Sleep, and get Exercise. The information is overwhelming, but you find it helpful.

Next on your schedule, you have a block of time for individual appointments and assignments. You don’t have any appointments with your psychiatrist or therapist today, thankfully, so you decide to work on more exposures. You’re exhausted and wish you could take a nap. But alas, because of your depression, you are not allowed to nap; if you did, you might fall asleep for hours in a subconscious attempt to avoid the discomfort of treatment. You work on your exposures for the next couple of hours, until dinnertime. The exposure you have been putting off since the morning is now starting to bite you in the rear. You’re running out of time to complete your exposures. Your anxiety starts mounting. You know if you don’t finish your exposures, you won’t be able to have a residential counselor sign your behavioral goals checklist. And if it becomes a trend, you risk discharge. You know you shouldn’t, but you decide to race through this last exposure, just to get it done.

You’re relieved you are finished with your exposures. Now it is time for your favorite activity of the week: your “belongings” outing. Once a week, the residential counselors drive you to either Walmart or Target to buy any food or supplies you may need. This week, your group is going to Target, which makes you excited. Who doesn’t like Target? With as much time as you spend indoors at the residential center, you seize every opportunity you can to get out. Plus, the Target has a Starbucks. You don’t want to miss your only chance in two weeks to buy Starbucks.

When you arrive at Target, you feel like you are visiting a different planet. At Cedar Ridge, the world seems to stand still. For one, routines at Cedar Ridge are very structured. Two, you have little contact with the outside world. Visitors are only allowed on Sundays. And you are using technology that feels like it came out of the early 2000s. You relish in every reminder of modern technology you can find at Target. Heck, you even buy an Apple Watch! It has no camera, after all, so you are permitted to use it.

You wonder how odd it must look to those around you for a group of 10 or so people to be wandering around Target. _What if they know we are in mental health treatment? _You know it is unlikely, however; besides, if anyone does ask, the residential counselor accompanying you has determined to tell them that you are a church group. You are concerned that this is not the truth, but part of you breathes a sigh of relief.

You buy your Apple Watch, some Pokémon cards, and food items, and then head toward the big white van to return to Cedar Ridge with your group. When you arrive, residential counselors inspect and mark the items you bought, since there are restrictions on certain items, such as sharps. It seems a bit silly, but you know the procedure is in place for everyone’s safety.

Now it is time for your favorite treatment pastime: playing video games. To the enjoyment of the young people in the facility, several patients brought their Nintendo Switch to play and share with others. Luckily, there are two TVs in the facility. You are thrilled. Super Smash Bros. is one of your favorite games. Occasionally, the group gets too loud or something triggers you, but overall, it is a much-needed distraction from treatment.

You notice your intrusive thoughts growing louder as it nears the end of the day. They’re bothersome, but you aren’t too alarmed: your mind often does this as it nears bedtime. You’re thrilled to put another day of treatment behind you. It’s hard work, but each day brings you one step closer to discharge. Little by little, you tackle OCD and regain control of your life!