Category Archives: Exposure & Response Prevention

Do You Want to Defy OCD or Do You Need To?

Defying OCD takes focus. You have to be focused on your needs, skills and wants. One without the other is of no value. 160_F_69325513_kjUZc2oxEDA2PThOUDQUBt6kdGE8okMP

Need: What you have to do
Skill:   What you can do
Want: What you desire to do—based on purpose, and all your hopes and dreams

Need Without Want
I’m thinking of a young woman who has a contamination fear. There is very, very little that she can touch or use in her home. Her OCD has convinced her that if she touches anything inside the house she will contract an unpleasant, long-lasting virus. She is particularly aversive to anything her sister touches and maintains a 3 foot distance from her at all times.

Yet, she uses the same toilet her sister uses. She allows her skin to come in to contact with the same surface her sister’s skin touches. When asked how she manages this she answers, “Well, I don’t have a choice. I need to be able to use a toilet. But, I don’t have to use anything else in the house.”

This woman is focused only on meeting a basic need. It‘s a good example of how you can only get so far by doing what you need or have to do. If you’re not focused on your wants then your actions are based on needs not wants. Doing only what you need to do is not going to take you very far.

Skill Without Want
A lot of times when a person with OCD is stuck they’ll be reminded to use their skills. They’ve spent time in therapy and know how to defy OCD. But, they stopped paying attention, went on automatic pilot and got tricked by OCD. They’ve regressed and are neglecting important needs. A worried, but frustrated loved one says, “C’mon, Boss it Back! Use your skills!” And the person who’s stuck responds, “I don’t care about my skills. Nothing works. I don’t want to fight this fight anymore. OCD is too strong.”

Want Without Skill
It’s not enough to have the desire to Boss it Back. Just the other day a woman said to me, “I want to Boss it Back. I really want to. I don’t want to live like this. I want to be free. I want all my hopes and dreams to come true. I want it so bad. But, I just can’t do Exposure Therapy. I can’t do it. I want to do it. But, it’s too scary to even think about.”

Wanting, Needing and Having the Skills will take you all the way. All three work in harmony 160_F_61978411_WH1ljyTm5Au9EccRXTLYhIq7AU278gmUand need your attention. One without the other isn’t enough.

This is day 27 of a 30 day challenge. It’s important to focus on all three areas: Want, Need and Skill. Conduct an assessment of where you stand in all three areas. Does one area need more of your attention? Are you focusing on all three areas?

Compulsions: Maybe You’re Not Doing Them Out of Fear

160_F_68916283_YWEclzyepzuVzgZ6TSAjzexKQugucuw0After years of being a slave to OCD it’s hard to stop. A lot of compulsions are done out of habit and not fear. I noticed a 42 year old tapping the left knee twice and then the right knee twice. This is what our session sounded like:

Q- Why are you doing that?
A- Hmmmmm. I don’t know anymore. It’s just something I’ve been doing for a long time.
Q- Are you aware of any particular thought before the urge to tap?
A- No not really.
Q- Well what would happen if you resisted tapping?
A- I don’t even know. I don’t remember why I started doing this.
Q- Does it make you nervous to think about resisting?
A- Yeah, but I don’t know why.
Q- Do you have other things you do that you don’t know why?
A- Oh probably but I’m not really aware. I didn’t even know I was tapping until you mentioned it.

That’s a great example of performing a compulsion out of habit. It’s very common!

During an exposure exercise in my office a young woman touched an object that she thought was contaminated. She’d been doing some exposure exercises on her own, but not really building any momentum. So this particular exercise was a bit more challenging than what she’d been working on. She hesitantly touched the “contaminated” object and this is what our session sounded like:

Q- What’s your anxiety?
A- I don’t know. I can’t tell. But I wish I hadn’t done this.
Q- How come?
A- I think I’m going to go home and spend hours washing.
Q- That’s what you used to do all the time, right?
A- Yeah, I don’t think I’ve touched anything like this in a long time.
Q- Maybe your brain has updated and you don’t need to wash anymore.
A- I don’t know. I’m really regretting this.
Q- How anxious are you?
A- I don’t know. I can’t tell.
Q- Well, you can go wash right now. It’s your choice, not mine. It’s up to you.

She went and washed her hands, but she wasn’t gone for more than a couple minutes. In the past washing hands would take a good 10-20 minutes.

Q- Now that you’ve washed how do you feel?
A- I don’t know.
Q- Do you think you might leave here today feeling disappointed in yourself?
A- I don’t really know why I just washed. I actually didn’t feel a strong urge. I just did it.
Q- Because that’s what you used to do?
A- Yeah maybe? I don’t think I really needed to do that.
Q- Do you want to try this exposure again right now?
A- Yeah. Let’s do it.

She did the exposure exercise and felt no need to wash her hands.

This is day 19 of a 30 day challenge. Consider the possibility that you are performing some compulsions out of sheer habit. These compulsions may be rituals or mental acts. Try to detect what it could be and then challenge yourself. There’s a strong possibility your brain has updated and you just don’t know it. Let us know if you have success!

10 Ideas for Adding Variety to Exposure Exercises

facefearIf your using Exposure & Response Prevention here are some creative ideas for your exposure hierarchy:

Loop Tapes
Record your unwanted intrusive thoughts and listen to it in excess.

Sing
For she’s a jolly good _________. Fill in the blank with the thing you fear that you are or will become.

Different Language
Use Google translate or Babblefish and type out your worst thought and then translate it in several different languages. Read it out loud in a foreign language.

Magnets and Bracelets
Get a roll of magnets, cut it into pieces and then write words on them. Make sentences on your fridge using trigger words. You can do the same thing by making a bracelet using letters, formed into trigger words.

Chromatic Drawings
With stick figures draw out your fear.  IMG_1316-1

Role Play
Sitting back to back (not facing each other) have someone play the role of OCD saying all the terrible thoughts that are in your mind over and over and over. Practice saying to OCD, “OK Whatever.” Then reverse roles.

Newspapers/Magazines
Find images and make a collage of your worst fears.

Bookstore
Go to the bookstore or library and ask to be shown to the section you would usually do everything in your power to avoid.

Ink
Buy or make a T-shirt with trigger words or images and then wear it, even if only under another shirt. Using a marker write the letters of a trigger word on each finger, even if you jumble up the letters. Write trigger words on post-it notes and drop them in a mall parking lot.

Movie
Find a movie that has the content of your obsession. When you get to a triggering part of the movie, rewind and replay it in excess.

Exposure & Response Prevention: 5 (More) Mistakes Commonly Made

Over the years I’ve seen many brave people confront OCD with ERP. It’s one of the scariest things a person can do. In their entire life, there will probably be nothing harder or scarier than the day they start to climb their hierarchy of fear—their Worry Hill.

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Going up the Worry Hill takes determination. You don’t feel like doing it but you do it anyway. It takes courage because it’s doing everything OCD has told you not to do. How can something that feels so wrong be so right?

Go up the Worry Hill because you’ve got a fight in you. You don’t have a lot of energy, but you’ve got just enough. Get your life back. You’re tired of being a slave to OCD and watching your life pass by.

But, as you’re climbing the Worry Hill, it’s not getting easier. The chatter in your mind is getting louder and more frequent. What’s going on?

Here are 5 mistakes commonly made when climbing up the Worry Hill:

Mistake #1 Trying to Get Rid of Anxiety
WANT the anxiety. You want it to be intense and you want it to last. It’s a mistake to do ERP in hopes of getting rid of anxiety. When doing ERP the goal is to purposefully make yourself anxious. As you climb the hierarchy the anxiety should intensify. This way you’ll begin to tolerate anxiety. You’ll become more and more confident in your ability to handle anxiety. As you climb the hierarchy don’t do anything to neutralize the anxiety. Sit with the anxiety. Want it. Say, “Good there’s my anxiety.”

Mistake #2 Looking Ahead
When you climb the Worry Hill it’s going to feel “just wrong” and you might be scared out of your mind. Take it one step at a time. 160_F_64095349_CJnntlYqxXtld1uBZD7bCxWc9hSMabjcDon’t look up the hill. Focus on the step you’re taking right here, right now. It’s a mistake to look ahead. Keep your nose to the grindstone.

Mistake #3 No Momentum
When climbing the Worry Hill, don’t stop ’til you get to the top. The mistake people make is to lose momentum. Presidential candidates work fiercely to build momentum. They say they won’t stop ’til they reach the top. They hold rallies, town hall meetings, and debates.They’re on TV 24 hours a day. This is an example of building momentum. If a presidential candidate disappears for even a day, they lose momentum. Stay in the game every single day. In fact, do at least 5 exposures every single day of your life.

Mistake #4 Trying to Get Rid of a Thought
WANT the thought. It’s a mistake to do ERP in hopes of getting rid of unwanted intrusive thoughts. ERP teaches you to allow the thoughts or obsession to be there. Do nothing to get rid of them. In fact, use them in ERP so that you learn to live with them. As you climb the hierarchy invite the thoughts. Want the thoughts. Say, “Good there’s my scary thought, my obsession. Welcome.”

Mistake #5 Climbing the Wrong Worry Hill
Make sure your hierarchy involves the actual core fear. It’s a mistake to not walk your fear through to the worst possible scenario.

Confront OCD with ERP

As you build the hierarchy keep asking: “If this happens, then what happens next? And then what? And then what?” Keep asking until you reach your worst fear. Your worst fear has to be what you’re climbing up towards.

What mistake do you think you’ve made or are making? Is it one of these five or something else? Will you choose to tackle this mistake?

If you’re just getting started with Exposure & Response Prevention you want to ease your way into it.  Check out this book to ease your way into facing your fears.

Exposure & Response Prevention (ERP): The #1 Mistake People Make

How do you know when ERP is successful?

Boss_It_1Now that you’ve built your hierarchy of fears it’s time to climb it. Starting with the easiest triggers to the hardest you’re determined to begin. You don’t feel like you’re ready but you start anyway.

It’s not helping. You feel overwhelmed. You feel worse. More afraid than ever. Why isn’t ERP working????

How do you know it’s not working? What’s your end goal?

I’ll know ERP is working when…

I’m not anxious anymore.
I stop thinking these thoughts.
The urges are gone.
I feel at peace.
I know for certain…

#1 Mistake
None of the above is the correct way to measure success. You’ll know ERP is working when you ARE anxious and not doing anything to fix it.

In fact you’re asking for more anxiety. You’re saying to OCD, “Bring it.” “Give me your worst.”

You’ll know ERP is working when you’re tolerating anxiety and living your life even though you’re anxious and having thoughts.

Wanting the thoughts, sensations, urges and anxiety to stop is your #1 mistake. This is only going to make you continue to suffer.

This is the first hierarchy to climb. It’s a mental Kung Fu hierarchy. It’s called “I Want Anxiety and A Lot of It.” or the “I Want to Feel Uncomfortable Forever” hierarchy. 

Make a hierarchy that has nothing to do with your obsessions. The list contains things that you know will make you anxious but not necessarily trigger your OCD.

Watch a scary movie and don’t cover your eyes.
Give the incorrect change to the cashier and don’t apologize.
Ask for a slice of pizza at McDonalds.
Start singing in the middle of the mall.
Call a department store and ask if they have a non existent DVD.
Ask for a job at the Apple store.
Say hello to someone who’s waiting with you in the check out line.

Your list will be unique to whatever makes you anxious and nervous but doesn’t trigger your OCD. Number the items on your hierarchy from easiest to hardest. Then climb this hierarchy hoping with all your might it causes you to be anxious.

You want to be anxious and you want it to last.

Go be anxious. Do it gladly.

11 Ways to Resist Compulsions

OCD is a trickster. That’s why every day with OCD is April Fool’s Day. Even if you conduct exposure exercises every single day of your life (which I highly recommend) you still can be fooled by OCD. It’s sneaky and will try everything up its sleeve to trick you into a compulsion or ritual.

OCD is scheming and manipulative—just like a drug pusher. All it needs to do is get you to buy one compulsion and you’re on your way to becoming a junkie. 160_F_78158575_49KcyvYHDAccjysVb1Lexz48ZSRh8V52The life of a junkie is a life of emptiness. All hopes and dreams vanish and the only thing you care about is your next fix. Your next compulsion.

Here’s how to tell the scheming manipulative trickster-drug pusher “NO THANKS”

  1. Recognize what OCD looks like. It’s the drug pusher offering you relief at no cost. “Just this one time. You’ll feel better.” In a room full of 100 people how many of them are worrying about what you’re worrying about? If the answer is not many then it’s OCD! Would you tell your friend to do what you’re doing? Would you take the piece of candy from the clown in the dark van? You’ve got to say, “I know you OCD. I see you. I know what you’re doing.”
  2. Make sure you’re doing exposures every day of your life. This isn’t optional. If the drug pusher sees you facing your fears you’ve got no weakness to be exploited. You have no problem that needs solving.
  3. You can’t talk your way out of buying a compulsion. As long as you’re talking to the drug pusher, you’re showing an interest in becoming a buyer. Don’t explain anything to OCD. Don’t answer any questions. Shrug at whatever OCD is selling. Would you really stop to explain to a drug pusher why you don’t think you need drugs?
  4. Practice focusing your attention for 10 minutes every day. Juggle or focus on something that is quite boring. You want your mind to wander. When your mind wanders, notice it and bring your focus back. Every time you bring your focus back you’re improving your mindfulness. The more mindful and aware you become the less likely you go on automatic pilot and act out of habit.
  5. Know what you’re fighting for. If you can’t figure that out because it’s been so long since you fought for anything, let your values drive your behavior. Write a script that basically says, “I’d rather take the risks (name them) than live like this (describe).”
  6. If you get a strong urge to do a compulsion—delay. Act like someone else for 15 seconds. Read your script. Think about what you have to lose if you give in. If you create enough space between the urge and the act, you can win.
  7. Give yourself permission to be anxious and uncomfortable. “This is unpleasant but I can handle it. I don’t need to fix this.”
  8. If you’re worried about something happening, remind yourself of the 100 people in the room. If they don’t have to do this compulsion, why should you? You might be unique but you’re not special! You don’t have some kind of special power! Stay in touch with reality! 
  9. Play mental Kung Fu. “Okay if that terrible thing happens so be it. I will gladly pay the consequence if it ever happens.”
  10. If you do get tricked, “recontaminate.” In other words, undo the compulsion by triggering yourself again and sitting with the discomfort.
  11. Make sure you’re eating enough protein, exercising and drinking plenty of water. This helps your brain to be a lean mean fighting machine.

This is day 15 of a 30 day challenge. Which of the above 11 ways to say “NO” will you work on? Choose and commit!