You May Have Been Doing OCD Exposures Wrong This Whole Time
Written by our extern, Serena Bonomo, M.A.
Throughout my time as an OCD therapist, I have talked to several patients that have shared with me their regular practice of exposures and described them as unhelpful and unsuccessful. After some curious exploration, I have figured out a common mistake that people often make when trying to practice exposures on their own. It will go something like this:
“Serena, I do my exposures and I feel horrible after, it just makes me depressed and shut down.”
“Can you describe for me what these exposures entail for you?”
“So I imagine my worst fear, and I sit with that feeling of it being true.”
Ahhh, here we go. This is “The Mistake”. For my Relationship OCD patients, this mistake has involved them imagining how ending their relationship will ruin their and their partner’s lives, how everyone will be disappointed with them, and how they will be alone for the rest of their lives forever searching for what isn’t out there. For my fear-of-being-cancelled OCD patients, this mistake has looked like imagining them being fired from their job due to offensive comments, packing their desk with their belongings and proceeding to their walk of shame out of the office with their former coworkers scoffing and shaking their heads with disgust. They imagine this for five minutes and then feel sad, disconnected, or more fearful for the remainder of the day. Rinse and repeat. “A” for effort, but please, no more!
Why "The Mistake" Is Actually a Compulsion
While “The Mistake” is unhelpful, it is also a compulsion. The reason for this is because a compulsion is anything we do (or think) in order to erase distress or to gain certainty. If you think about it, imagining the worst case scenario is actually gaining certainty–it’s telling you that this is what will happen and you need to just accept it. Close, but yet so far.
What True Exposure Therapy Involves
An exposure is sitting with UNCERTAINTY, not with torturing yourself with the imagined worst case scenario and expecting yourself to eventually be OK with it. During exposures, we imagine that MAYBE this fear could be true, and –the most important part–we don’t do anything about it; we don’t ruminate, try to prove or disprove the likelihood of it happening or not, replay memories that either add or take away from its probability, or reassure ourselves that it is impossible. Most relevant to this article, an exposure also does not involve fantasizing and imagining the intricacies of what your fear would look like and all of its consequences.
The Real Goal of Exposure Therapy
The goal of an exposure is not to subject ourselves to bad feelings ‘til they no longer sting. Instead, we are training a muscle that can resist the pull of responding to uncertainty. In exposures, we are training our brains to sit with and eventually accept that absolute certainty in regards to any topic is impossible, and that trying to pretend we are certain about what will happen only ends up creating more distress.
You can absolutely achieve relief from OCD if you engage in ERP with the goal of tolerating and accepting uncertainty. Even though it is difficult, over time it gets easier if you commit to it. Even if you’ve made “The Mistake” so far, here’s your sign to tweak it and see results!