In this final section, we shall be getting into the thick of things. We shall learn how to do some exposures, and we shall also talk about a few ways to handle our compulsions. Since there is truly no end to the number of compulsions one can engage in, in any form of OCD including Harm OCD, and since the manifestation of each compulsion is different for different people, it is impossible to cover everything one can do. So, I am going to pick up the compulsions outlined in this book and provide as many ways to deal with them as I can.
These procedures are not set in stone, though. Also, core fears are different for different people. Hence, the procedure outlined in one compulsion may be used for other compulsions as well, if it works better. There is no one way to handle each compulsion. You should use whatever works best for you, provided you are using it well and not making mistakes in the implementation.
Before we handle the compulsions though, I want to explain how the exposure is to be recorded. First, the exposures are to be deliberate. Which means whatever your triggers are, instead of avoiding them, face them. Working with tools such as hammers and saws, swimming with your friends, using knives and forks around your loved ones may all be triggers. When you are doing your exposures, you will need to pick out any one of these activities to trigger yourself.
Second, keep part B of the Anxiety Hierarchy Worksheet (Worksheet 3.18) open when you start the exposures. Remember to NOT take the most difficult triggers immediately, even though you may want to get rid of them first. Also, remember that you cannot afford to take too many exposures together. If you take the difficult ones first, or if you take too many together, you may fail more often and that may dissuade you from following it through. So, start with something small. Like say, something that has a SUDS score of 5.
Write down the date against the appropriate exposure in the Date column and start the exposure. When you trigger yourself, you will have obsessive thoughts about causing harm. Note the anxiety that you are experiencing right then in the Beginning column. Use the response prevention script formulated earlier to not do the compulsions. When you try to resist the compulsions, your anxiety will go up as it should.
Observe your level of anxiety as per the SUDS and make a note of it every ten minutes (or twenty minutes, if you find that more comfortable) in the appropriate columns. If you do the exposure right, after sitting with the anxiety for a sufficient amount of time, the level of anxiety will start dropping. Continue the exposure until it falls to half of what you started with. In the examples, you can see that the exposure was started at an anxiety level of 8 and terminated when the anxiety level dropped to 4.
Repeat this exposure over and over for a few days until you are desensitized to the thought and the associated anxiety is extinct. Move on to the other exposures in the worksheet systematically and keep eliminating your fears one by one until all the fears in the worksheet are ticked off.