Online Psychotherapy for Anxiety and Obsession. A case example.

Daniel is a very friendly and nice person. He is polite, patient, spontaneous, and easygoing. He plays football, has a stable relationship of 8 years, and works as a lawyer in a bank.

He claims that most people don't believe him when he shares his anxiety problems, and sometimes they even laugh assuming that he is joking. He usually summarizes the problem in one sentence:

"I can't leave my house if I don't visit the toilet at least 3 times"

The anxiety nightmare

Daniel has been diagnosed with irritable bowel syndrome, Chron disease, and Chronic diarrhea by different gastroenterologists over his life. He also tried special diets, pills, and very twisted solutions trying to solve his problems.

As common, the problem started after a very random situation. In Daniel's words:

"I was around 8 years old and I was watching some kind of cartoon. The story was about a fighter trying to become champion, and every time he had an important fight he would feel the urgency to run to the toilet, which made him lose every fight in a very pathetic way..."

From this experience, Daniel's mind found the first obsessive and scary thought: "What if I can't hold my urges to go to the toilet while I'm on the school bus or lectures?".

He was so afraid of this situation, that he could force himself to pee or defecate with his own mind.

When his parents noticed, they began to get angry with him for wasting so much toilet paper, thinking that it was a lie to skip school.

At school, his teacher was angry at him because he was asking to go to the toilet very often.

In his child's mind, the logic was: "If I don't feel any desire to go to the toilet, I'll be fine to endure the trip home of 40 minutes on the bus, without having any risk of peeing myself or worst!".

The curse of overthinking

Daniel was a very clever kid, good at maths and a good student. He tried to ask for help from his parents, but they could not understand the problem. They could yell to Daniel something like:

"you just need to hold it like everyone else! I'm tired of your lies to skip school!"

Ashamed to ask for help outside his family, he started to pretend that everything was fine and hide his problems from others.

The first idea was to time how long takes his body to process the food and liquid. The thought was: "if I can know how long takes the food to be processed, I could time when I should eat and when to go to the toilet. This way I can always go to the toilet at home where it is safe".

As consequence, he stopped having breakfast and lunch at school, to just eating at home.

He also stopped talking to people at school, that way he could go to the toilet without anyone noticing.

He prepared different lies and cover stories to explain why he is not eating, or why he looks so skinny and pale. School trips, summer holidays, long bus road trips, plane travels, the subway, and any kind of activity that involves losing immediate access to a toilet was a threat that he was willing to avoid at all cost.

The problem of overthinking in highly rational individuals is that they always find a way to submit themselves to their fears and symptoms. They find ways to convince people around them to follow their symptoms too. In Daniel's case, even his close friends and girlfriend could help Daniel to hide his multiple escapes to the toilet during his education at the University.

When he turned 25 years old, he collapsed during a panic attack in the subway. The hospital checked his medic history and found his pasts stomach exams revealing wounds in his colon, bad nutrition, and anemia. They sent him to psychotherapy, again.

Daniel could not afford psychotherapy when he was a child. His anxiety problem was not only caused by a silly cartoon, but his parents also used to fight every day; he suffered from bullying and humiliation from classmates that discovered his stomach problems, among other risks factors such as an unstable economy, parents with mental health disorders, and criminality in his neighborhood.

However, as an adult, he could afford psychotherapy, and he meet me in his 3rd attempt to do psychotherapy.

What is the solution?

The solution to this kind of irrational anxiety is hard to achieve because is paradoxical. Daniel had to EXPOSE himself to his fear until the situation is not scary for him anymore, developing immunity to his fears by continuously experiencing pain.

Daniel would never think of this because he was extremely afraid of being that guy who defecates himself in front of everybody. He would use all his mindpower to avoid at all costs the slight chance of going through that experience, and any treatment that involves exposing him to this fear would be too challenging for Daniel. Luckily for him, the idea of fainting and developing more stomach diseases was very scary too, which forced him to try out the exposure treatment through online psychotherapy.

The advantage of online psychotherapy or tele-psychotherapy, in this case, is the safety condition of facing his fear at home to start the treatment. We progressively explored Daniel's fears, nightmares, and worst-case scenarios, and discovered from the process much more than how to overcome his anxiety disorder. It was a life-changing point.

What does the treatment look like?

Emotional and Cognition Analysis:

We identified his fears, and the thoughts around them, and reflect on the irrationality of his beliefs.

Daniel discovered many times that when he was at home all day he didn't need to use the toilet so often. On some occasions, he would "forget" the stomach problem, and just leave his house without any problem.

It is common that in irrational anxieties clients KNOW that the problem may be in their minds and not in their bodies. Sometimes they are even sure that is all a mind trick, but the fear is so strong that they still prefer to not run any risk.

Progressive exposure:

In this step, I prepared Daniel for exposure, visualizing the benefits of overcoming this problem, and accepting the idea of suffering to get there.

I prepared a program of different challenges for him to accomplish, like leaving the house without going to the toilet, holding the urge to visit the toilet due to anxiety, eating meals according to a healthy schedule, and all other maladaptive rituals that he created as a kid to cope with this problem.

Results:

After 1 year of training, Daniel claims to be completely cured. He became extremely good at handling these fears. He eats whatever he wants, travels spontaneously, and sometimes when he begins to worry about toilets again, he just laughs and repeats some exposure exercises. The positive outcome also boosted his self-esteem, freedom, and physical health.

Are you struggling with a similar anxiety disorder and would like to learn to cope with it?

If you are suffering from something similar, please consider booking a free brief session and exploring the problem together.

Life can be better :)

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