May 19

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​Practicing Exposure


When fears are faced, they get erased.

Intentionally facing irrational fears ultimately reduces them. Rational fears usually are associated with specific dangers. Irrational fears mushroom in size and generalize to the most harmless acts or objects. Most people proofread a letter once before mailing it. When you fear making mistakes (and being “incompetent”), you might find yourself proofreading 5, 10, or even 20 times. Then your checking ritual could generalize to reading your shopping lists over and over for mistakes.

Exposure —> —> Anxiety —> —> Anxiety —> —> Rituals/obsessions

To “decondition” anxiety reactions, you need to face the things you fear. When you intentionally provoke anxiety but imagined consequences do not happen, the association between your fear and the trigger event is broken.

You can learn that no harm will come by deliberately:

  • Making mistakes
  • Holding sharp objects
  • Touching “germs
  • Petting a black cat
  • Putting something out of place
  • Leaving an iron plugged in for 15 minutes
  • Throwing out a useless item
  • Going out without all your makeup on

PRACTICING EXPOSURE

Taking the following steps will help you learn that putting yourself “in harm’s way” can be healing:

  • Make a list of all the things you avoid. Generally, people with OCD fear being harmed, harming others, or being negligent/unacceptable. Examine your rituals to find out which of these you are trying to prevent or undo and list the specifics.
  • Rate how completely you avoid each item on your list (0 = never, 10 = always).
  • Arrange your list in order of the degree to which you avoid—Leaving the front door unlocked without checking for a 15-minute walk vs. leaving it unlocked all day.
  • Choose a situation that you avoid somewhat (level 5)—Leaving a dining room chair out of place or throwing out your collection of tin cans. Expose yourself to it.
  • Focus on the physical sensations of fear rather than your thoughts during exposure.
  • Confront the situation until you notice a marked decrease in distress. Continue to practice facing a situation until you experience minimal or no distress.
  • Practice 45–90 minutes daily for one to three weeks to achieve the best results.
  • Pick a situation that causes more distress from your list. Repeat steps (5) and (7) until you have eliminated distress in a level 10 situation. Use a partner or therapist to help you if your discomfort does not decrease during a practice session, or work on the same situation the next day for a longer period of time.
  • Practice highly distressing situations with imagery before actual exposure.
  • Be sure to identify all the ways you avoid so that you can expose yourself to and eliminate obsessions and compulsions. If you do not ultimately face all situations that cause you distress, you can lose gains you’ve made on easier items.

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