Exposure and Response Prevention In A Pandemic: What’s Changed?

FAQs Regarding ERP During a Pandemic

My clients want to do the right thing. They beat their contamination fears before the pandemic and they don’t want to revive their OCD by following the CDC Guidelines.

The following is a list of questions often asked:

Q: Prior to the pandemic, for exposure, I skipped handwashing after leaving the grocery store. I’d say something like, “I’d rather catch a cold than be worried sick about catching a cold.” Since the pandemic, I don’t skip handwashing after going to the grocery store. Should I sanitize after the grocery store or is that feeding my OCD?

A: Skipping handwashing presents a real safety concern. So yeah, follow the Public Health guidelines and wash your hands after shopping at the grocery store. You can still do an exposure though. While washing your hands say, “I’d rather get COVID than worry sick about getting it.” 

The exposure is the grocery store and the response prevention is resisting the urge to follow any OCD-made up super-duper rules. Stick to the guidelines and don’t go overboard.

No guideline is telling you to hold your breath when you wash your hands, scrub your forearms, or wash for 20 minutes 50 times a day. All of those safety behaviors are rules according to OCD (aka your imagination.)

Resisting compulsions cannot be emphasized enough! You will get plenty of exposure opportunities just living your life in a pandemic. You won’t have any trouble hunting down triggers. They’re everywhere.

Your most important job is to resist the safety behaviors that go above and beyond the Public Health guidelines.

Q: It’s odd. I’m the one with OCD, but I seem to have fewer fears about COIVID than other people. Should I be more concerned? Is there something wrong with me? Should I be taking more precautions?

A: Well, you’ve trained for a moment like this. You’ve rehearsed a pandemic in your mind over and over. So it’s no wonder you’re doing better than the average person. Do your best to follow the guidelines but stay in touch with reality. Remember, you can be super-duper cautious and it will never be enough.  

Don’t lose sight of the truth. Hold fast to this truth: You can’t ensure the virus doesn’t find you. You can’t control everything. Imagine doing all the right things for months: distancing, wearing a mask, washing hands and then someone you haven’t seen in a while (who is visiting from Florida) approaches you from behind (wearing no mask) and gives you a big bear hug.

You can only fake perfection so it’s fair to predict that you and everyone else will be less than 100% compliant with the guidelines. For example, “don’t touch your face.” Yeah. Right. Every time I put a mask on, my nose is suddenly terribly itchy. CDC guidelines recommend washing hands after petting a dog. I have three dogs and that’s definitely not going to happen.

Q: I’m having the urge to wash my hands more often. I know I’m supposed to resist going above and beyond the CDC guidelines but that’s easier said than done.

A: Really? C’mon, are you telling me that it’s easier to feed OCD? Performing compulsions is an easy way to live? OCD has you doing backflips on dental floss and you find that to be easy? 

Maybe it’s easier to perform rather than resist compulsions because you live in a bubble? Perhaps you’ve practiced compulsions to the point of habituation and you’re settling for less.

Yes, it’s hard to resist compulsions. Good news! You can handle hard work. You can handle anxiety. It’s unpleasant but you can handle it.

Sort yourself out! You’re being pranked by OCD into thinking you can’t handle hard work and anxiety. Resisting compulsions and performing compulsions are both hard. Choose a remedy or a poison.

Q: My daughter overcame the need to constantly wash her hands. If she goes back to school the teachers are going to make her sanitize and disinfect all the time. She doesn’t want to do it because she thinks it will make her become compulsive again. What should she do?

A: She used to be compulsive and wash her hands excessively because she was trying to gain certainty. She wanted to know for sure that she was safe. As long as she doesn’t fall into that trap again it won’t matter how often the teacher makes her wash her hands.

She must not go over and above what the teacher tells her to do. If she thinks the teacher is over the top anxious and asking her to do more than what other teachers are asking, your daughter should tell you so that you can speak to the teacher or administration.

Most importantly your daughter, who has done a good job at this, must stay in touch with reality and continue to surrender to the possibility that anything can happen. “Whatever happens, happens.”

Q: I have OCD. So I know my common sense isn’t always intact. You used to say that the way to tell what made common sense was to observe what the majority of people are doing. What most people are doing reflects common sense.

Nowadays following the majority is hard to do. It’s not clear who is the majority. How can I know that I am using common sense in my decision-making?

A: You’re right! It’s hard to know what makes common sense by watching people right now. Depending on what state or county you live in, what news channel you watch, the majority of people are either wearing masks or not. The majority are keeping 6 feet apart or not. The majority calls the virus a political hoax or the majority believes in medical and scientific information. 

Before the pandemic, you might have planned an exposure to touch doorknobs and shake people’s hands to “spread” whatever residue was on the doorknob.

The reason that was a safe and effective use of ERP is that’s what the majority of people did! Out of 100 people, the majority would touch doorknobs and shake hands without a second thought. Now out of 100 people, the majority do or don’t shake hands depending on the town or neighborhood you live in.

When I walk my puppy in my neighborhood, everybody keeps their distance. On the contrary, three hours away, I pull into my parent’s driveway to find a handyman and several neighbors hanging out on the front porch, sitting close to my elderly parents with no masks. Does my mask on my face show common sense or is it the majority of people on the porch with no mask who have common sense?

It seems like a no-brainer to me that at times like this, common sense is rooted in science and not based on what the majority of people are doing on the porch. Two out of three people trust science so that is the majority I ‘m following.

Common sense is in the eye of the beholder who is either influenced by a physician, Dr. Fauci, who has served as the Director of the National Institute of Allergy and Infectious Diseases since 1984 or a man who brags about sexually assaulting women, sidelines Dr. Fauci but praises a doctor who claims medication is made with alien DNA, and can barely recall the words, “person, woman, man, camera, TV.”

Ahh, I digress. The point is it’s hard to find common sense right now by watching other people. I vote for science, no matter how fluid it is. Dr. Fauci does not have a track record of lying. He has a track record of successfully fighting HIV/AIDS, Malaria, Ebola, and Zeka.

There is no way I trust a messenger with magical thinking (ahem), who claims COVID will disappear and is so jealous of Dr. Fauci, that he outright lies he too was invited to throw the first pitch at a major league baseball game. Good thing that wasn’t true. His bone spurs might have bothered him while winding up for the pitch. 

Ahh, I digress again. It’s hard not to these days.

Q: Before the pandemic, you would say the content of your obsession is irrelevant. We don’t need to focus on whether there is some kind of residue on the doorknob. We need to focus on the inability to ever know if that residue is there. Maybe it is. Maybe it isn’t. We can never know for sure.

Except now I feel like COVID is on the doorknob. For real. I look around and see people wearing gloves and masks and feel vindicated, “I was right to be super safe! I was ahead of the game. Welcome to my world. My fear was real!”

A: Okay, but wasn’t the last pandemic in 1918? You could live a lifetime in a bubble and never see another pandemic. I ask, “Who do you want to be and how do you want to spend your time?”

Besides, I highly doubt we’d (the United States) have this many COVID cases if we had had smarter political leadership and national response instead of a piecemeal one. So maybe the only reason “you were right” is because of a failed national response to containing the virus.

It’s difficult to do but it’s crucial, even in a pandemic, to shift your focus away from the theme of your obsessions, and instead focus on the relationship you are cultivating with your anxiety.

Are you wrestling with anxiety, trying to squirm your way out of it? OR, on the contrary, are you figuring out a way to live with anxiety?

What does anxiety make possible for you? In what way is OCD a strangely wrapped gift? Imagine what life would be like if you wanted to feel anxious? Are you willing to feel the fear and do it anyway? 

If you have a question I haven’t addressed please feel free to post one in the comment section.

One thought on “Exposure and Response Prevention In A Pandemic: What’s Changed?”

  1. Good practice pays off! I went to my nephews out side graduation party 3 weeks ago. I discussed with my wife before hand the guidelines we were following. Pretty much what the CDC says. So we go, and maintain our 6 ft and stay outside. The food was buffet style with people going up one at a time and using throw away utensils. we all sat in circles spread apart in chairs we brought. If any of these circumstance were not followed I was going to politely excuse myself and quietly leave.
    I thought it was a success and left after 2 hours. A week latter I get a call that another nephew that was at the party had tested positive for COVID! Well everyone had to be tested and thankfully all came back negative. I believe because we followed good practices and the CDC.
    Looking back on this we have decided to not go to any gatherings again till this COVID is over. Lesson learned!
    But following the CDC sure paid off for us this time. Next time I will not gather in a group as per the CDC.
    Follow the suggestions of the Doctor and CDC and you will probably be okay! Don’t worry, be happy!

    Miss you all and am proud of you, Tom!

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