People with obsessive-compulsive disorder (OCD) have obsessions mostly related to the fear of being harmed or harming others. To neutralize such fears, people with OCD perform compulsions (i.e. repetitive actions, like checking or cleaning). In my previous two posts, I talked about the following: The need for control in OCD, why compulsions appear to work, and possible reasons individuals with OCD are motivated to believe compulsions work.
As previously promised, today I begin discussing the basics of an effective treatment for OCD called exposure and response prevention; this treatment requires confronting one’s fears, without performing compulsions during or after the intervention.¹
A treatment, not a new compulsion
I will describe this intervention in more detail in my next two posts, but for now let us look at what the treatment is really asking you to do: Facing your fears.
When explaining exposure and response prevention to a poster online, I was asked (I paraphrase):“What if next time when I refrain from compulsively cleaning my kitchen, I catch a rare disease and die? What if I survive but have to undergo many painful and invasive medical procedures? If I do this treatment for OCD, will you promise me that terrible things won’t happen?”
I explained that exposure and response prevention is not another compulsive ritual (aiming to reassure you that bad things will not happen); it is a behavioral intervention which teaches that you have the power to face your fears without the help of rituals.
What you learn from exposing yourself to the feared situation repeatedly (while carefully noting everything that occurs) is that while bad things do happen, you have been exaggerating their probability or consequences.
Someone else’s OCD
If facing your fears without the help of your ritual still makes little sense or sounds too scary, try this strategy: Think of another person’s obsessions and compulsions. Have you ever wondered why someone else’s obsessions (be they fear of causing fires, getting ill, accidentally poisoning one’s partner, going to Hell) do not cause you the same distress? There are many dangers out there in the world., so why do you obsess about some dangers but not others?
Let me use a hypothetical example based on a real case, which I have modified for this post. Assume one of your friends fears getting into a fatal accident because of tire problems. The few times he has given you a ride to work, you have witnessed his compulsions. Whenever he feels something does not feel quite right, he pulls over to inspect the tires. Once this occurs over 20 times during a 30-mile drive!
When you ask if all this checking is necessary, he shows you statistics about tire-related car accidents.
Your friend’s brother who is also present, reacts to these statistics by saying that although tire problems are inevitable and can be dangerous, they do not occur every single day; furthermore, attempts to detect problems earlier—by quickly pulling over each time one senses something is wrong—can be costly in terms of lost time, added anxiety, and ironically, greater risk of accidents!
Nevertheless, your friend is not convinced. Statistics and probabilities are no comfort to him. He could have a car accident because of something he failed to do. That is the reality, he says.
While your friend’s obsessions and compulsions may appear strange, you can probably identify with the feelings and thoughts behind his actions. Like many people with OCD, your friend is exaggerating the likelihood of a threat and severity of its consequences, assuming what is possible is probable. He also holds himself responsible for rare events. Lastly, he has great difficulty tolerating uncertainty.
As this example illustrates, our own obsessions and compulsions seem rational and necessary to us, while other people’s do not. Yet it is helpful to examine other people’s obsessions and compulsions to remind ourselves that life can be dangerous in too many ways for anyone to be able to prevent all bad things from happening. The compulsive attempt to exert perfect control over one issue may give us the illusion of control but will not make us safer overall.
Of course, this is not to say we should give up trying to prevent bad things. Prevention is not a black-or-white issue. Following safety precautions is important (they do work), but so is trying to accept that absolute certainty and absolute safety is impossible.
That is the reality of limitations of human beings. Remember, even our heroes and fictional superheroes have vulnerabilities.
At best, our compulsions are time-consuming activities that lower our quality of life and make us suffer. At worst, they bring life to a halt and put us at risk for other negative consequences. For instance, even the seemingly harmless act of washing one’s hands compulsively may cause painful skin lesions and infections.
If the arguments or examples I have presented today have piqued your interest in exposure and response prevention, then have a look at my next two posts because there I will explain this intervention in greater detail. Research suggests that it is one of the most effective treatments for OCD.¹ It may be worth your time.
1. Strauss, C., Rosten, C., Hayward, M., Lea, L., Forrester, E., Jones, A. M. (2015). Mindfulness-based exposure and response prevention for obsessive compulsive disorder: study protocol for a pilot randomised controlled trial. Trials, 16, 167.