How to Do Exposures for OCD
Obsessive Compulsive Disorder
The three structured practices we’ve just discussed are based on a single principle: to overcome a fear, you must approach the fear.
The fourth practice carries this same principle to actual situations you typically avoid because of your obsessions. Facing those situations directly for an extended period of time will be the only way for you to overcome all of your fears. If you avoid situations in order to feel safer, then you will need to practice this option.
Find every opportunity you can to face situations that cause you discomfort. What activities do you avoid in order to keep yourself or others safe? When do you hesitate to act, for fear that you will make a mistake? What events or places do you steer away from so that you won’t begin to have distressing thoughts? These are the times when you need to be alert, for these times give you the opportunity to practice facing your fears. If you are a washer, go ahead and touch those doorknobs or wear those clothes after they have been “contaminated.” If you are a checker, lock the doors of your home without having someone else check them. If you are a repeater, be willing to do things the “wrong” way. Orderers can let someone else straighten up the house, and hoarders can let someone else rearrange their “collections” or throw things out.
Often when you are in distressing situations your initial response will be to hesitate; you feel uncertain about whether you can handle the task. In such moments remind yourself of your long-term goals. You are not only seeking to get rid of your obsessions; there are tasks you want to accomplish, pleasures you want to enjoy, relationships you want to pursue. Focus on these positive goals. Your obsessions stand in the way of a meaningful, fulfilling future. Don’t just fight against your symptoms, fight for your life goals. Facing situations you have been avoiding is a step toward a new future.
Remember that when you first face distressing situations you will probably feel anxious. In fact, to expect that you will feel anxious is probably a good plan. You won’t be surprised by your distress. Use the skills I discussed to reduce your tension. Take a Calming Breath or practice the Calming Counts, that you learned on the breathing tape, and remind yourself that anxiety decreases over time. Remember, you don’t have to be alone in your struggle. Call a friend or a relative and tell him or her what you are trying to accomplish. Seek that person’s understanding and support.
Once you have practiced facing one of your feared situations, don’t just wait quietly for your worries to start again. Get busy! Focus your attention away from your obsessions by being active. Take a long walk, exercise, go to the movies, get involved with projects at work, or talk to a friend on the phone.
When you want to change your obsessional patterns, the single most important thing to remember is: Don’t fight your obsession. If you are having difficulty making headway with these techniques, ask yourself, “Am I still struggling to get rid of my obsessions?” If you are, stop! You already know struggling doesn’t work; that’s what you’ve been doing prior to picking up our book and listening to these tapes. The success of the skills we’ve described here depends on your willingness to give up the struggle. When you stop the struggle you will be able to notice a significant difference. You actually can have control over your symptoms.
Some of you will notice immediate positive results from applying these skills. Others will progress steadily for several weeks, reducing their worries by half… then spend another two or three months working to gradually worry less and less. So don’t get discouraged. If you are moderately or highly successful during the first weeks but find you’re still obsessing somewhat, continue practicing for several more weeks. You should notice improvement over time, even if it’s not apparent every week. Don’t give up. You must have faith.
If you practice daily for a few weeks and do not experience at least moderate relief, seek help from a mental-health professional who is familiar with OCD treatment. This specialist can assist you in solving problems you might be having with applying the self-help program and may be able to adapt these techniques so that they work better for you.