Dealing With Real-Event OCD (part 2)

Challenge Your Assumptions and Feared Stories for Real-Life OCD

Cognitive Behavioral Therapy (CBT) teaches that our thoughts influence our actions. When we can think differently about our experiences, our character, or the rules that govern life, then we can likely act differently too.

While thinking and over thinking can be the problem when it comes to OCD, taking a moment to reconsider the importance placed on feelings, certainty, and the likelihood of catastrophic outcomes can be helpful. This exercise can help build confidence to let go of compulsive behaviors and provide a firm ground from which to step into exposure treatment. But, the exercise is only helpful if it leads to a forward moving action, not a return to rumination and misguided certainty-seeking.

When trying to use your most logical and rational mind, or when you are in the presence of a therapist or trusted friend, asking yourself a few questions can be helpful:

• What are all the things that would need to happen or line up for my fear to be true? How likely is it that all those things would line up just like that?
• Do I have a history of making decisions based on feelings, and do I tend to over-value the role my emotions have in my life?
• While I’m having trouble accepting uncertainty with this, are there other areas of life where I am able make decisions or move forward while accept uncertainty and letting go of the need for perfect assurance?
• If I were to give up on seeking the answer or fully understanding this obsession, what would I risk? How likely is that outcome?

The unfortunate reality is that this exercise will never give you certainty that the catastrophe you dread will not happen. Nothing will. However, this exercise can help you gain the confidence that the feared event is highly unlikely, and that continued rumination and other compulsive behavior has not gotten you any closer to certainty.  

Making a Real-Event OCD Compulsion Inventory

Compulsions are done in an attempt to do two things.

1. Eliminate the awful feeling brought on by the obsession to feel OK again.
2. Ensure that the feared story does not happen.

No matter what you hoped or may have experienced, compulsions do not help in the long run. They are a temporary relief, but only make the obsession worse. Therefore, eliminating compulsive behaviors and thoughts is a necessity.

One of the first things to do in treatment is to make a list of all your compulsions. Remember, this can be both external things, like asking friends whether the relationship is still in good standing or reading police reports, or internal compulsions, like mentally replaying the event or evaluating your loved ones’ faces for anything indicating a change in their feelings toward you.

Once this inventory is completed, you, along with your therapist if you have one, will progressively work to minimize and eliminate these from your life. In doing so, you are putting your trust in your rational acknowledgement that these behaviors only provide a temporary sense of relief, and more often than not, lead to more anxiety, uncertainty, and doubt.

Furthermore, when you stop compulsions, you will finally be able to see that you can deal with the memory of the event and presence of the guilt without doing compulsions. Over time, you send the message to your brain that the associated anxious, fight-or-flight feeling is unnecessary because those terrible unwanted outcomes of getting caught, rejected, or arrested, didn’t happen and the compulsions were not the things that kept you safe.

Exposure Therapy for Real-Event OCD

Exposure and Response Prevention, sometimes called “Exposure and Ritual Prevention,” or ERP for short, is a treatment method used to help anxiety sufferers face their fears directly and overcome their anxiety. For many people, ERP is where the bulk of the recovery happens.

ERP is not about getting certainty that the event didn’t happen, nor certainty that everything about that event is ok, nor that you’re off the hook from responsibility or consequence in the future. Instead, ERP for Real-Event OCD is about learning that the feared outcome is unlikely to happen and that you can deal with the pain of uncertainty and the periodic remembrance of event without compulsive thoughts and action.

As you work toward developing a new relationship with the thoughts through the adopting a stance of tolerance, acceptance, and non-response, you progressively show our brain that the fight-or-flight response and “danger” is unnecessary. “Stand down, brain; nothing to see here.” As a side effect of your effort to disengage from rumination and compulsive behavior, you very often, but not always, experience “habituation” to the obsession. Habituation means that the emotional response, usually anxiety and fear, lessens and you feel more at peace with the thought when it is in mind.

Exposures can be done in a variety of ways. At its core, ERP is allowing a triggering thought or experience while resisting the corresponding compulsion. Two of the most common ways Exposure therapy is done are Natural Exposures and In-Vivo Exposures.

Natural exposures are the moments of anxiety and fear that we feel just in the course of living life. Seeing something on the subway, seeing a picture of someone from high school as you scroll on Instagram, or even randomly getting the memory while at work are all examples of natural exposures. For these, your job is to allow for the awareness of the thought while resisting any of those compulsive things you’d typically do while allowing for the thought to go away in its own time.

In-Vivo Exposures are intentional exercises where you decide to seek out and endure anxiety while resisting compulsive behaviors. These are usually done after building a trigger and compulsion hierarchy. Once completed, you would start with the easiest ones and progressively face the fear until you can effectively face it without compulsions, then move onto the next one.

Examples of ERP for Real-Event OCD can include:

• Looking at images of people or saying their names while resisting negative self-comments or inappropriate affirmation
• Listening to music that makes you think of the time
• Write a story about getting caught
• Write the feared story to the tune of a favorite song
• Draw a picture of the location, or draw a series of pictures of the event
• Visit locations of the triggering event and tolerate the thoughts and feelings that arise
• Watch movies, read books, go to websites, or listen to music you have been avoiding because they trigger the thoughts.

To read more about Real-Event OCD:

Click here to read part 1

Click here to read Part 3

Click here to read Part 4