12 Tips for Doing Exposure (for OCD)

In this blog, I have summarized 12 tips for doing exposure treatment from Jonathan Abramowitz's book (2018), Getting Over OCD: A 10 Step Workbook for Taking Back Your Life.

First, for exposure to work, it has to be:

Intentional: Exposure won’t work if it’s just accidental or incidental.  For it to be effective, it needs to be planned and deliberate.

Prolonged: Exposure that it too quick won’t give you a chance to learn what you need to.  Think of exposure as a way to test predictions like ‘If I leave the lights on I’ll start a fire’ or ‘If I eat off the floor I’ll become very sick.’

Repeated: Exposure (usually) only works when it is done many, many times. It is similar to what happens if you watch a horror film 100 times. The first time you see it, you don’t know what to expect and it’s very frightening. But after a few more times watching it you get used to it and even start to become bored with it.

12 Tips for Effective Exposure 

1.     Practice with situations that closely mirror your obsessional fears.

2.     Use exposure to test negative predictions. Approach exposure as if you’re a scientist conducting an experiment: Will you get sick? Will you lose control and act violently? Will something about you change (such as your sexual preference or your personality)?

3.     Continue each exposure until you’ve learned something. While habituation (getting used to something), is good, learning is even better! So continue doing exposure until you’ve really discovered that what you’re afraid of is unlikely to happen AND that you can handle the feelings of anxiety and uncertainty about your obsessions.

4.     Expect to feel uncomfortable. Don’t judge your success by whether your anxiety subsides but rather your ability to stay in the situation despite feeling anxious.

5.     Use exposure to practice openness to anxiety and fear. Side note: Anti-anxiety medications (such as Valium, Xanax, Ativan and Klonopin) will largely prevent your exposure from being effective because they prevent you learning that you can sit with anxiety.

6.     Don’t fight your obsessions. Let yourself worry about them. Let them ‘hang out’ in your mind. OCD wants you to be afraid of your obsessions and when you try to resist them you only reinforce their power.  But you can have them be there and still get on with your day. Fighting obsessional thoughts is like trying not to think about a red-faced monkey. The harder you try not to think about it the more you’re thinking about it.

7.     Use response prevention – don’t ritualize! This step is vital (therapeutic exposure doesn’t occur without it) and may take all your effort but give it everything you have! Stop all compulsive behaviour, mental rituals, mini-rituals, even attempts to get reassurance. Substitute new ways to respond.

8.     Don’t distract yourself. Try to stay ‘in contact’ with the distressing thoughts and feelings instead of distracting yourself. If you distract yourself, you’re not actually doing exposure.

9.     Surprise yourself. The more you’re surprised at what happens in exposure, the better because it ‘jolts’ your brain and the learning (see tip3) is much more powerful.

10.  Practice exposure everyday: Typically, we’d suggest 45 mins per day of intentional exposure (plus whatever incidental exposure that may happen throughout the day). Once a week is better than once a month, but once a day is better than once a week. The more you practice, the better.

11.  Vary your exposure practices. The traditional approach to exposure is to use a hierarchy and work your way up the hierarchy (from easiest to hardest), but new research suggests a better way is to vary it. One reason for this is that it resembles real life a lot more which doesn’t come at us in a neat or hierarchical way. But also, it helps you learn that you can manage high levels of anxiety and you don’t necessarily have to ‘build up’ to them.

12.  Face your fears in different settings. This helps the learning to generalize across different settings/places.

To learn more about OCD and ERP, here is a list of great resources:

Podcasts

-       The OCD Stories – many episodes with interviews of people who have or are still suffering from OCD.

-       Breaking The Rules Podcast – our very own Podcast hosted by Melbourne Wellbeing Groups’ Dr. Celine Gelgec and Dr. Tori Miller.

Books

-       Freedom From OCD by Jonathan Grayson. A fantastic book that guides you through treatment of OCD so you can (almost) become your own therapist.

-       The Family Guide to Getting Over OCD: Reclaim Your Life and Help Your Loved One by Jonathan Abramowitz.  This book is essential reading for family members seeking to support someone with OCD. OCD often effects family members and family members often play a vital role in helping the OCD sufferer with their treatment.

-       The Joy Thief by Penny Moodie. Weaving her personal experience with the stories of other OCD sufferers, as well as the expertise of some of the world's leading OCD doctors, psychologists and psychiatrists, Penny explores OCD's symptoms, stigmas and treatments with raw honesty and zero judgement.

You Tube Channels

-       International OCD Foundation: The IOCDF uses its platform to fight stigma, increase access to treatment, and foster a supportive community. One of the ways they do that is through their YouTube channel, which features town halls, live streams, and helpful information for those with OCD or assisting loved ones with OCD.

-       Katie d’Ath. Nice short videos that get straight to the point.