Something that Dr. Grayson said at the OCD Conference during the scrupulosity panel a few weeks ago resonated with me. Basically, he said that exposures are never done to prove that the “bad thing” won’t happen.
The “bad thing”—the feared outcome—may very well happen. So why should we risk doing exposures? To prove to ourselves that we can handle that feared outcome. It won’t be the end of the world. We can live with that outcome.
This idea relates to something I’ve been learning about in an online course I’m taking through the Beck Institute on Cognitive Behavior Therapy for Anxiety. Basically, the idea is that those with anxiety have an exagerated view of risk and an underestimated view of their capabilities to handle that risk.
The anxiety or OCD gets us not only because we think that something terrible will happen but ALSO that we will not be able to handle that terrible something. Cognitive behavior therapy and exposure response prevention are tools that help us face those ideas and prove to ourselves that either: our ideas about the risk were incorrect OR that if our ideas were somewhat founded, our ideas that we couldn’t survive the effects of the risk were incorrect—and this is one of the places that the behavior part of CBT and the cognitive part (changing our thinking) intersect.
Theory vs. Practice
It’s very well to think about in theory. It sounds great, in fact. My thoughts might be wrong! I am stronger than I imagined! But in practice, actually dealing with the feared outcome can be really difficult.
For some exposures or events, the “feared outcome” might not be so awful. But for others, it can be really hard. If my daughter gets poop in her underwear and I’m the only adult home to deal with it, I’m not exactly nonchalant in the moment. Internally, I’m likely freaking out. But the point is, my brain is working, and I have the choice to let the OCD scream at me or to logically and rationally take care of the problem, step by step.
Maybe I still employ some avoidance or “safety behaviors” (another CBT term from my course), like throwing out her underwear instead of washing it, but hopefully I am making a bit of progress. Maybe I can work on getting better and cutting out those behaviors in the future, should the need arise.
We can’t always expect ourselves to go from our extreme anxiety/OCD behaviors to completely “normal” in one exposure. But we can attempt to minimize our outbursts of frustration or desperation if a “feared outcome” arises and try to stay in the anxiety as much as possible.
“Not an option”
My psychologist commented once that the compulsion should not be an option. This is also one of those “sounds great in theory but is super difficult in practice” statements. But the point is that when the feared outcome happens, OCD tends to get really excited. It’s like he’s saying “Oh! See! I was right! You didn’t listen to me and now the bad thing is happening! Do the following compulsions right now to fix it! Hurry up!”
It’s at this moment that the statement “don’t let the compulsions be an option” comes into play—when the feared outcome happens, solve it without any or with as few compulsions as possible. How would a friend, your spouse, or your mom handle the situation (assuming they don’t have OCD)? Would they even notice what had happened? What would they do? Try to do that.
It’s really difficult. It will likely feel uncomfortable and you may be super frustrated with your life for a bit. But I think Dr. Grayson’s idea here is valuable to remember in these circumstances—you didn’t do the exposure to prove the “bad thing” wouldn’t happen. You did it to prove that even if it did, you could handle it. Because really, you are stronger than your OCD and anxiety. You are a survivor.