‘Oh! I see … Well, I guess all the quick-fire questions were for a reason, then!’ I joke.
Thankfully, Dr G laughs.
‘Of course they were! We have to establish your baseline BDD score, and then any variation to that throughout and at the end of the treatment,’ he says. ‘Do you remember your baseline score, on the Y-BOCS scale?’
The Y-BOCS Scale – or the Yale-Brown Obsessive Compulsive Scale, to give the full title – is designed to measure the severity and type of symptoms in people with Obsessive Compulsive Disorder (OCD). A version of the same scale has been developed for those suffering with body dysmorphia, who exhibit many of the same symptoms as OCD. The Y-BOCS Scale was validated by Goodman et al. (1989), who found that it significantly correlated with two independent measures of OCD. The same study also showed that the scale is sensitive to changes in OCD symptoms and that it has high internal consistency and reliability.*
‘Yeah, it was something in the mid-twenties, I think?’ I reply, remembering that the YBOCS scoring went up to a maximum of 40, and wondering what it would be like living in that invisible, virtual prison.
‘That’s right. Your baseline score at the beginning of treatment was 24. That’s a moderate-to-severe case of body dysmorphia.’
I know! I know that already!
But I don’t want to rush him, especially not on his birthday (if indeed it is). He’s been patient enough to deal with me for the past twelve weeks, so the least I can do is to allow him this moment of anticipation ahead of the Big Reveal.
‘So, on to the results, then. Your Y-BOCS score at the end of this treatment is down to 9. Yes, 9! That’s a massive improvement, Rachel. From a starting point of 24 down to a score of 9. This puts you in the pot with those lucky people exhibiting virtually no body dysmorphic symptoms. If your baseline score had been anywhere close to this on your initial assessment, then we would not have accepted you onto the programme.’
I take a moment to consider what Dr G has just said: my end-of-treatment Y-BOCS score has been reduced so significantly that I barely qualify as suffering from body dysmorphia. I’m officially no longer a person gripped by my Bastard Chimp and his gang of bullying wimps.
‘Oh, WOW! Dr G, that’s incredible!’ I feel like throwing him a surprise party even if it isn’t his birthday today.
Do I have any paper hats or party blowers to hand?
We chat some more about the reality that this is where the real work begins, and I’m momentarily side-tracked by the prospect that I may have to spend an eternity setting myself ‘exposure therapy challenges’. Just the other day I witnessed a woman removing cardboard boxes from her car at the local recycling plant whilst wearing her towelling dressing gown and fluffy slippers.
Will this be me, soon? God forbid! Where will it end?
But for now, this is more than enough. And I know that the assessments don’t lie. The questions are posed in a way that no one can possibly manipulate the answers. Like the game at our local trampoline park where random lights flash high on a wall, and you are required to jump and hit that light before the next one flashes up: flash, bounce, hit, flash, bounce, hit. There isn’t time to think about where the next flashing light might appear; all you can do is bounce and hit.
Dr G explains that it’s not quite over, just yet. There will be an end-of-treatment questionnaire for me to complete (but that’s me scoring them, not the other way around) and I will have access to all my work, my diaries and my modules for a good few months whilst I continue to put into practice all that I’ve learned.
Finally, and only to be expected with Dr G and his exceptionally high standards, there will be a follow-up to the treatment in a month’s time, when I can inform Dr G that yes, I did take a trip to the local recycling plant wearing my towelling dressing gown and fluffy slippers.
Will I officially have a ZERO score on the Y-BOCS scale, then? I wonder.
__________
* Ref taken from https://www.novopsych.com/y-bocs.html.
30
THE CHANGE OF PLAN
My body dysmorphic disorder (BDD) therapy is over and my cycling confidence is soaring! I’m cycling all over the place. I ride sixteen hilly miles to my yoga class and back home again; I cycle fifteen miles to the hairdresser’s in the pouring rain, meaning any blow-drying and/or purported styling I’ve just paid for is completely futile. I’m the only person who sits in the waiting room of the trendy town-centre hair salon with dried snot trails smeared across her cheeks, wearing an adapted version of a sodden nappy. My hairdresser knows me well enough, and she doesn’t bat an eyelid. But instead of the usual, ‘Are you running home today, Rach?’ she has adapted her hairdresser chit-chat to, ‘You riding back to Halifax today, Rach?’ It’s the same when I cycle into town to have my nails done. Although modern ‘gels’ set like concrete, I’ve learned through experience to leave false acrylics alone – and my recently purchased cycling gloves certainly help.
Riding has slowly seeped into my pores, and I’m becoming as familiar with putting on my ‘lid’ as I am with digging out my running shoes. These subtle changes have taken effect over the past six months, rather like the old ‘frog-in-a-pan’ analogy. I stand in the school playground in my cycling shorts and a zip-up cycling jersey. I’m no longer Tilly’s mum, the runner; I’m now Tilly’s mum – the rider.
I’m so grateful to have cycling as a go-to place for my much-needed sanity fix. Knowing how much running broke me down mentally, when I took the wrong turn and looked to it as being the only place I could find any answers, I’m still very cautious of it. Thankfully, I’m no longer stuck there.
I’m also enjoying simple things like riding my bike alongside Tilly on hers. We enjoy cycling along the canal together, or taking a more challenging off-road route around a local reservoir. It becomes another thing we choose to do, sometimes as an alternative to the junior parkruns we’ve grown to love over the past five years. We are learning that we can enjoy new things – including hiking and biking – and so we find more ways to enjoy being active, together.
‘Mummy, can I go out on my bike?’
I’ve just walked in through the front door. I have twenty-four bags slung over both shoulders, draped across my body, and the veins are popping out of the circulation-stopping grooves I’ve managed to indent into my hands by carrying too much stuff around in plastic bags. I’ve also completed an endless list of ball-aching chores, including getting cash out to pay for one of my daughter’s various activity clubs/school trips. It might be something to do with a farm, or bowling, or it could just be protection money. I’ll pay it anyway – I don’t honestly care.
‘Sure, Tills. Go and get changed and I’ll fetch your bike up from the cellar. Give me ten minutes.’
I know with absolute certainty that this bike ride with Tilly will be the best and most enjoyable part of my day, and possibly hers, too. We both love the fresh air and the feeling of movement. Her little legs have become familiar with walking perhaps further than is entirely normal for a very small child ever since she was three years old, when I would collect her from pre-school, and we would then amble the mile and a half back down the hill, stopping on a bench halfway to eat a jam sandwich and read part of a story book. Now that she’s a little bit older, we’re enjoying time together on two wheels.
We’re both ready to go. We push our bikes to the top of the drive – it’s a bit too much to expect her to manage a hill start – and we turn right, onto the pavement. It’s a quiet road, but I know that she’s not quite ready for heavy recycling trucks thundering past her, just yet. We set off riding, and for the next mile and a half I have the concentration and focus of a lioness watching over her cub. I don’t take my eyes off her for a second. I’m riding right by her side, hollering ‘brake … BRAKE!’ as she freewheels down the hill, grinning from ear to ear. She knows where we’re going: we’re off to play ‘cycling bingo’.
‘So, remember the rules,’ I say, as she stands poised, ready to cycl
e off at speed to find the correct number in one of the old factory car parking spaces. ‘And if you hear or see a car coming, you stop. If I shout to you, you stop immediately. Is that clear?’
‘Yeah, Mum. I’m not stupid!’
We made this game up whilst out exploring on our bikes together. Realising that very little traffic ever turns into the derelict old factory car park, it’s perfectly safe. I stand and shout out a number to Tilly, who then pedals off to find the correct square. She gets ten in a row and bingo! She has a ‘full house’.
‘Fifty-four!’ I shout. Her eyes dart around the enormous numbered squares and then she’s off, her plaits swinging frantically from side to side as her feet push down hard on the pedals.
‘Got it!’ she beams, waiting for me to call out the next number like a collie dog primed, ready for the whistle. I watch her laughing as she rides frantically around, giggling because she’s ridden to number 63 instead of 36, and I know that she is filling up with joy. She is happy. Fresh air, movement and freedom … This is the magic formula she is learning, along with her confidence and skills riding a bike. A few rounds of cycling bingo later, and I know what’s coming.
‘Can we push our bikes back up the hill, Mum? That was ace, but I’m tired now,’ she smiles.
‘Sure. So am I, Tills!’ I reply.
I feel so happy, inside.
* * *
Before all this happened, my year was split into two distinct parts: spring and autumn. Why? Because – as any self-respecting marathon runner will know – these are the two main marathon racing seasons of the year. My spring marathon was London, and we all know what happened there: precisely nothing. What I failed to mention is that I had another plan in mind – this time for autumn. In October 2017, I was due to take part in the first ever Tanzanian Impact Marathon. The idea with the ‘Impact Marathon’ series is that these events take place in disadvantaged communities worldwide – and a focus is placed as much on contributing to the development within those communities as to running the marathon itself. I think that perhaps this was my attempt to put something in place to give myself the vague hope that I might still be able to run a marathon later in the year, once my body had been suitably admonished and decided to behave itself. In fact, it was a pipe dream; a pie-in-the-sky delusion that some invisible FACTORY RESET button could be pressed and everything would return to normal. But having lost running for pretty much the whole of 2017, I knew that I wasn’t in any place to run a marathon. No such magic return-to-factory-settings option presented itself, and so the likelihood of my being able to take part in the Tanzanian Impact Marathon was disappointingly eradicated shortly after conception.
I email the race organisers and explain my reasons for having to withdraw. ‘Ahhhh, what a shame! You must come back and run it with us next year,’ the lovely lady replies. Next year? NEXT YEAR? But next year seems like such a long time off. What about this year? I panic. I need to do something now; I need to put something in the diary for THIS YEAR. I simply can’t wait a full twelve months until a time when my body may decide it wants to run again, because what will my head do in the meantime? I don’t know, but perhaps my new love affair with cycling might offer me a solution.
I have another motivation for setting myself a ‘big’ challenge. I know that I’ve come such a long way in managing my debilitating body dysmorphia, but ironically, I’m now having to adapt to my life becoming increasingly visible. I’ve completed my therapy treatment, and I’m about to put it to the test in possibly the biggest and scariest ‘exposure therapy’ challenge EVER. In just a few months’ time I will be placing myself in the spotlight with the publication of my first book, Running For My Life. And as much as I’ve learned how to intercept and challenge my damaging thoughts, the paradox of having such mental health frailties whilst at the same time putting myself and all my flaws on the pages of a book for public consumption is simply unfathomable. How can I do it? I simply don’t know. How can I open myself up to be judged like this? I have absolutely no idea how I can put myself through the comprehensive PR and media pantomime around the release of the book: a book about my life. I don’t know how I will be able to appear on live television and radio programmes and talk about the very thing I have spent my entire life being fearful of other people’s judgements about: myself. Call it diversion, deflection – possibly even smoke-and-mirrors – but my deep desire is to do something so big and scary which will take up so much of my headspace that I simply won’t have the capacity to fear any of the fiery pits of anxiety I will soon be required to walk through. Enter stage left: CYCLING.
* * *
‘I’d like to put something in the diary in place of the Tanzanian Impact Marathon,’ I say to my Other Half, who is busy researching garden sheds online – we need somewhere other than our modestly proportioned kitchen to store our ever-expanding collection of bicycles. He understands why. And he is up for the challenge.
Meanwhile, I decide to reacquaint myself with my old friend Google and we are once again collaborating on forming a plan. Cycling adventures; cycling tours; international cycle challenges; adventures on a bike; mountain biking challenges; the best cycling challenges; epic cycle rides of the world … The beloved search engine has never worked as hard in coming up with ideas. I research various possibilities – riding North America’s Pacific Coast, cycling down the Danube, even exploring the foothills of the Indian Himalayas on two wheels.
Hmm … let’s see … Riding from Seattle to San Francisco sounds incredible! But requiring the best part of three weeks to cycle 980 miles down the West Coast of America may be a problem. It’s a long time to be away from my daughter, Tilly, and so I look for slightly less time-intensive options. What about cycling down the Danube? My research is proving to be highly educational, and informs me that the mighty Danube is Europe’s longest river. I suddenly wish I’d listened to my uninspiring geography teacher instead of gazing out of the window wishing I was somewhere else. On this trip, we would ride through Germany, Austria, Hungary, Serbia and Romania. Wowsers! Why cycle through one country when you can experience five?! But hang on a minute … my research goes on to suggest that the trip is best taken between April and October (I’m looking for something in November and December) and it also points out that mosquitos are rife during the wet months – ‘… And you’re best to check in with the Austrian Tourist Board about possible flooding prior to departure.’ I decide to return to my searching.
Cycling in the foothills of the Indian Himalayas sounds both exotic and culturally intoxicating. My thirst for knowledge draws me towards an unlikely book I have sitting on my bookshelf. I don’t even know where it came from, but I pick up Lonely Planet’s Epic Bike Rides of the World and I read a feature written by avid cyclist Matt Swaine who has taken this incredible trip. He describes sitting cross-legged on the roof of a bus, and watching in disbelief as his bike becomes ensnared in low-slung power wires on the hair-raising journey into the Parvati Valley. Hmm … not quite the Beginner Cyclist’s Epic Adventure I’m looking for.
My research is filling me with ideas and excitement. I’m looking for an epic cycling adventure, whilst also being very aware that I’m a relative cycling novice. Yes, I can replace the chain if it comes loose, and I can also adjust the seat height with one of my myriad Allen keys, but I know my limits. Google eventually leads me to a place where I finally settle: a specialist cycling adventure company who take care of all the other aspects of the trip, so I can focus on the most important bit: the cycling. I see a brochure with the striking image of a red-eyed tree frog with his soft, round belly and tiny orange feet sitting atop a rainforest leaf. The words underneath the evocative image read: ‘Pedal over 480km from the Pacific to the Caribbean!’ I’m sold.
‘Costa Rica. Do you fancy cycling across Costa Rica in November?’ I venture to my Other Half, who is hunting for a tape measure underneath the sink. I don’t think he’s heard me properly, but I take the ill-informed grunt to be a positive response. We w
ill deal with the aftermath later…
A few emails later, and it’s all sorted. Thankfully, I’m entirely naive about what lies ahead.
31
ANXIETY MANAGEMENT
I’ve really gone and done it this time, I think to myself as I sit cross-legged on my living-room floor and finally wade through the sizeable information pack we were sent some weeks ago relating to our forthcoming trip, mountain biking 480 kilometres across Costa Rica from the Pacific Ocean to the Caribbean. It still doesn’t seem real. The large A4 envelope has sat unopened on the sideboard, tucked in amongst my seven-year-old daughter’s scrawls purporting to be a Christmas list, and a printout of her school itinerary for the next sixteen weeks. I feel proud of myself for being ahead of the game until I notice on closer inspection that it dates from 2016.
Damn it.
How have I got here? It’s only a matter of months since I set myself the sizeable task of retrieving my old Trek mountain bike from the cellar and then subsequently concocted a series of incremental cycling challenges designed to prove to myself that (a) I could ride a bike; and (b) I could become braver and more proficient on two wheels within a relatively short space of time. It’s been a very interesting and – at times – quite frightening learning curve, but one which has enabled me to find some light in a sad, dark place. It has reminded me that there is more to my life – and more to my mental wellbeing – than just running. The discovery of this has been nothing short of colossal, and I have morphed into a stronger, braver and happier me.
But this latest cycling challenge is on a different scale. I read through the information pack we have been sent, and I’m terrified by what my slapdash ‘Hell, why not?’ attitude has gotten me into this time. It’s one thing to learn how to ride a bike again – if I ever truly learned in the first place – but it’s another thing entirely to commit to cycling 480 kilometres on a mountain bike across hilly terrain with a group of people who are bound to have infinitely more cycling proficiency, knowledge and experience than me. What’s worse is that I was so enthralled by the cute-looking Costa Rican tree frog sitting on his tropical leaf that I failed to consider that this cycling adventure has been graded. Rather like ski resorts grade their ski runs: green for novices, red for intermediates, and black for … complete nutters, so the cycling adventure company have graded their trips. This one – I discover at too late a date – is the equivalent of a black run, and at this stage I could probably just about eke my way safely through a green one. I read the small print and am horrified to discover that ‘… this cycle ride is regarded as one of our toughest overseas challenges …’ Gulp. My eyes are transfixed on reading more of the tiny words which are hidden far away from the image of the beautiful tree frog: ‘…Remember that you will be cycling 480km, over seven consecutive days, and in very hot temperatures …’ Shit. Shit, SHIT! What on earth have I done?
A Midlife Cyclist Page 16