APTC Blog

The issue of (hyper-)responsibility and the accompanying guilt shows up everywhere in OCD and across all forms of OCD. For many clients it is the core of their struggle with OCD. It can show up in a variety of ways. When experiencing an intrusive thought or image (“I could hit someone in that intersection!” Or ”What if there is asbestos or lead in my home!”) most of us would take reasonable precautions and then would drive through the intersection or continue to replace the old flooring in our homes, but when we have OCD we take this “threat” more seriously and are more likely to engage in excessive avoidance or safety behaviors to be absolutely sure that nothing bad can happen. If the avoidant and safety behaviors are not engaged in, the result is usually very strong feelings of guilt and shame.

It is often recommended that when doing exposure therapy that a hierarchy be constructed. By “hierarchy” we mean that you identify situations that make you uncomfortable or scare you, give them a ranking between 0 and 100 (this is usually called a SUDS rating, which stands for Subjective Units of Disturbance Scale) and then to list the items from the most difficult at the top to least difficult at the bottom. This list usually consists of between 10 and 15 different potential exposures and can form the framework for the exposure therapy work to come.

1. Uncertainty is at the core of all types of OCD. To move forward you must accept the uncertainty and act anyway.

2. As hard as it is to believe, the contents of your obsessions are irrelevant. The issue is uncertainty.

In this week’s blog post I thought that I would continue with my theme of expanding upon the suggestions in the recent PDF I wrote on ways to do exposure therapy most effectively. If you haven’t already read my two previous posts on this topic you might want to check them out here and here. A point that’s worth mentioning again is the idea that though exposure therapy comes under the general heading of “psychotherapy”, it is not what most people think of as traditional therapy.

To better manage your anxiety you have to accept that you must do exposures regularly, you must face whatever you’ve been avoiding and you must do the above willingly (points 1,2 and 3 from the PDF).