Case Study of BZ and OCD: Session #3
As BZ and I entered our third session, we were met with a breakthrough, evidence of her amazing inner strength and ability to make positive changes.
For this session, I had planned to address the next challenge on BZ's exposure hierarchy - "Leaving home without checking that lights are off." However, BZ arrived with an unexpected triumph to share. She recounted how, after our last session, she had effortlessly departed her home after checking the lights only once. The following day, she even left for work before realizing she hadn't checked the lights at all. BZ faced a moment of panic but decided not to backtrack and check. This newfound confidence propelled her through an entire week without succumbing to her checking rituals.
Instead of dwelling solely on this particular success, I aimed to explore its impact. I inquired if her ability to leave without exhaustive checks had resulted in an earlier arrival at work. BZ revealed that, while checking the lights hadn't consumed much time, she had noticed a growing sense of self-assuredness. She said, "I suddenly understood what you’ve been saying the whole time. Just because I feel afraid doesn’t mean that something is actually wrong or that I need to do something. Fear is just another emotion, not proof of some truth."
Our session then delved into the vital role of relationships in BZ's life and how OCD had impacted them. BZ expressed her reluctance to have friends and family visit due to her checking behaviors, and the time-consuming nature of these rituals had also hindered her from spending quality time with loved ones. We distilled this sentiment into a powerful statement:
"If I didn't check, I would spend more time with the people I love."
Moving Down the Hierarchy
With this renewed focus on values, we turned our attention to the day's VRET treatment, which aimed to tackle the next item on the hierarchy: "Only checking once to make sure the windows are all closed." As with previous sessions, we set a scenario to evoke anxiety, immersing BZ in a virtual house on a dark and stormy night. I asked BZ about her willingness to endure the discomfort of checking the windows only once before leaving, to which she confidently responded with a "10/10." BZ was ready to take on the challenge.
It’s Just an Emotion
BZ was given the freedom to check the stove as many times as she wished but was limited to a single check of the windows. She headed toward the windows but then shook her head and proceeded toward the stove, and then the door. I asked her how she was able to accomplish this extra step and she relayed that the desire to be closer to her mother and best friend, overcame the anxiety of not checking.
Our session continued as BZ walked me through her entire morning routine, from waking up to leaving the house. When we reached the point where she usually checked the stove, I asked about her willingness to feel the discomfort of not checking, which she rated a 4/10 - a significant improvement from her original 2/10, but still too low for exposure.
I then shifted the focus to checking the stove only once before leaving, to which BZ rated her willingness with a promising "7/10." She successfully checked the stove once and headed out, repeating the exercise several times. By the end of our session, her willingness had climbed to "10/10."
Our session concluded with BZ receiving her homework assignments. She was tasked with continuing the exposure daily at home in real-life. Additionally, BZ was encouraged to complete another Values homework exercise and to integrate the daily use of the mindfulness VR environment into her routine. As we wrapped up this session, it was evident that BZ was taking the lead in her life and bringing herself closer to the life she values most. Stay tuned for the Final Session of BZ’s growth trajectory.
Case studies provide readers with an opportunity to become familiar with Virtual Reality Exposure Therapy. Each case study will unfold over multiple articles. Future case studies will explore a variety of problems. Leave a comment if there is a specific problem or disorder of which you would like to see a case study.