You Want Me to do What!!

Hello Everyone,

Exposure Therapy

If you have been reading my blog posts up to this point you should be aware that doing exposure therapy is a crucial part of overcoming almost any anxiety disorder and especially overcoming OCD. Exposure therapy has many aspects to it, and I have included Guidelines for Doing Exposure Therapy listing what I believe are some of the most important aspects to consider when doing exposures. But one of the more important ones, I think, is that you must go to the very end of your hierarchy. You must do the things that you think you could never do. 

Go to the End of Your Hierarchy

If you don’t go all the way to the end of your hierarchy then you leave some unfinished business which is like leaving a burning ember after you put out the campfire and that burning ember could later on erupt and begin a new forest fire. Another metaphor that I’ve used is if your cancer surgeon, after operating on your tumor, informs you that she took out most of the tumor but left part of it still there, I’m guessing that you would not be happy to hear that. Dealing with OCD is much like this. It’s a better policy to get all of the “tumor” and not leave part of it still there to bother you in the future. This means, however, as I said above, doing some things that may seem a bit extreme.

M&Ms and Almonds

I co-led a weekly OCD group for about 11 years and here are some of the things that I would routinely do as part of the exposure work during the group. I would bring food such as M&Ms or almonds to the group and at some point scatter some on the floor and invite everyone in the group to pick up an M&M or almond or two and eat them. And while this may seem a bit extreme, it proved to be very effective in helping people address some of their contamination fears. Many clients with contamination fears found using public bathrooms was an especially difficult exposure and so I would routinely ask those clients to use the public restroom just down the hall from our group room. They were to go in and use the toilet, wash their hands in the sink without overdoing it and return to the group. While this may sound pretty straightforward, for my clients with fears of public bathrooms this proved to be a very challenging exposure for them. If they were feeling particularly brave, then I might suggest they use the bathroom and not wash their hands or perhaps just rinse and their hands. 

Band Aids and Dumpsters

The particular exposures we did on any given group night would vary based upon what appeared to be my clients most challenging exposures and what was available for the exposures that evening. I recall a particular group where several of my clients had both contamination issues and fears of catching blood-borne diseases. As it turns out just that day I had a physical and had some blood drawn and there was a Band-Aid covering the site where the blood had been drawn. When I removed this Band-Aid there was a speck of blood on the Band-Aid. As part of the group exposure I asked people to pass this used Band-Aid around the room and asked everyone to touch it.  As you might imagine, my clients with the blood-borne disease issues found this to be particularly challenging. Another routine exposure I often did was pass around a garbage can and ask people to put their hands inside the garbage can and then not wash their hands until the next normal time they would wash their hands. My final example is having clients go out to the parking lot of the building where the group was held and touch the outside of the large building dumpster.  If my clients were reluctant to follow through with this exposure, I would tell them a story from a British TV show called The OCD Project where a client with contamination OCD was asked to not just touch the outside of a dumpster,  but was asked to get inside the dumpster!

Yes…This Does Work!

In most people’s everyday life we rarely eat M&Ms off the floor, neglect to wash our hands after using the bathroom, touch a used Band-Aid, deliberately put our hands in a garbage can and go out of our way to touch a dumpster, but if you truly understand how exposure therapy is supposed to work you might see the value in doing these types of exercises. And these types of exposures did prove to be helpful in assisting my clients to learn how to better manage their OCD. Of course, I would not recommend that you tackle doing these exposures without the guidance of a qualified therapist to help you. My goal here is just to let you know that sometimes it’s necessary to go to these extremes to really overcome and learn to manage OCD.

As always, I hope you find these posts helpful and let me know if you have any questions. I’m always happy to help. This post isn’t meant as a substitute for therapy and so if you’re struggling with anxiety/OCD please consult a qualified therapist. If you know someone who might benefit from this post, please forward it to them and if someone was kind enough to forward this post to you and you’re interested in subscribing you can go here.

Stay safe,

Dr Bob