So yesterday the topic was avoidance, and I briefly mentioned and described “exposures.” I’ve probably briefly mentioned and described exposures many a time on the blog (and described the difference between lifestyle and purposeful exposures), but I thought I would delve in a little deeper today with some examples.
Basically, exposures involve forcing yourself to be in a situation that makes you and your OCD uncomfortable. Sometimes this involves doing something and other times it means not doing something.
Here are some examples (most of which I have heard of friends or other people doing or have had to do myself):
For contamination OCD: Touch a toilet bowl or the floor or something that triggers your “germ” obsession. DON’T wash your hands. Touch things: your clothes, your face, the couch, etc. Maybe eat some nuts or candy or something else you have to touch with your “dirty” hands.
For emetophobia (fear of vomiting): get a can of minestrone soup and fake vomit it up into the toilet. Watch videos on youtube of people puking. Get some fake vomit and put it somewhere in your house for you to “find” unexpectedly.
For checking: go to bed and don’t allow yourself to check and make sure the front door is locked. Tell yourself, “Maybe it’s unlocked. Maybe something bad will happen. But maybe not.”
For body dysmorphia: Wear the first outfit you try on, even if you think it makes you look fat or “bad.” Don’t change it for the rest of the day. Also: cover your mirror with a piece of fabric or take the mirror down— don’t look at yourself.
You might be thinking some of these are extreme or ridiculous (and frankly these aren’t very extreme examples). But the thing is, doing exposures and seeing that the world doesn’t end (or your obsession doesn’t come true) is what helps you recover. It’s the key to overcome the OCD and preventing or treating future “outbreaks.” My doctor has told me when I start going back over into obsessive and compulsive territory, I should immediately do some focused exposures. Exposures are like the vitamin c/zinc for OCD.
Exposures in action
My doctor has even advised me to counter “accidental” compulsions (ie when I slip up and do something I know I’m not supposed to do out of habit) with exposures. For example, let’s say I wash my hands an extra time when I shouldn’t, or I wash them when they aren’t actually dirty. Then I am supposed to go and touch something I consider “contaminated” (or whatever it was that made me wash them in the first place, maybe the kids’ dishes or a door knob or whatever) and NOT rewash them. In other words, my exposure is to recontaminate my hands and then prevent the compulsion of washing. When I don’t die or get sick, I’m supposed to learn that OCD doesn’t pay. Or something like that.
How exposures feel
While to someone without OCD, this might seem like a nice concept and even somewhat easy, let me tell you that it is NOT. Your brain may be telling you that something is dangerous or will get you or someone else sick or even killed. And then the doctor tells you to do it! And feel uncomfortable! Feel agonized! And do NOT do what your brain tells you will stop that agony!
Like, let’s say your best friend was dying in the hospital and all you had to do was take off your shoes to save their life (or so you whole heartedly believed) but the hospital security guard told you before you go visit that you could not, under any circumstance, take off your shoes. So you believe that your friend will die because of you. This is what doing exposures can feel like: incredibly painful and gut wrenching.
All of the “what ifs” and “maybe this will or won’t happen” crowd out logic. Sometimes it feel likes you are walking off a cliff blindfolded and just hoping that an invisible bridge is under you. But the thing is, at least for me, that the anticipation of doing the exposure is the worst part of it all. You think all of these things and how truly awful it will be and then you force yourself to take that step, to do that exposures, and you know what? It’s done. It happened, and now you can’t go back and undo it. You just have to wait and see if anything happens. And usually it doesn’t. Which is kind of the whole point of exposures. But still. It’s not easy.
5 thoughts on “Exposures”
Why can’t an exposure be purely mental? Why does having it be physical allow it to work?
Matt check out this:
Matt, imaginary exposures are used to counteract mental rituals when it’s not possible to actually do true exposure “in vivo”, meaning in actuality. This would apply to fears such as loved ones doing in car crashes, getting fired, etc.
I’m quite sure we met at the Seattle OCD support group and possibly at Dr Kosins’ group as well. I’ve really been enjoying your posts. Well done!
I am a moderately well-functioning person with OCD; it is no longer debilitating. Still, I find the whole idea of intentional “exposure” to be utterly terrifying. And a doctor telling a person to intentionally “re-contaminate” for washing her hands once too often sounds sadistic to me. I apologize if you find my opinion unpleasant.
Yes, I get it that a person with OCD knows rationally that his compulsions are irrational. I do. So yes, exposure should teach us that not acting on a compulsion is possible.
But isn’t there a better way to treat OCD? This method seems punitive and cruel to me.
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