Sometimes in the midst of our exposures, we end up doing some sneaky compulsions without realizing that we have done the compulsions. Since it is impossible to provide all scenarios given the complexity of the disorder, I shall provide two examples to offer some clarity.
Example One: You are watching an action movie with lots of violence with friends as an exposure and trying to trigger yourself. You feel triggered during fight scenes and you get the urge to compare if you feel the same level of rage and violent urges as the antagonist does in the movie. You know you are not supposed to compare, because comparison is your compulsion. So, you respond to the thought by saying, ‘I don’t care if I am similar to the villain in the movie, I will continue to watch it.’
So far, so good. But, while you do not compare yourself to the antagonist, you may end up providing reassurance to yourself by saying, ‘I don’t get the same level of urges as the villain and hence, I am not a bad person’. You did not compare, (which is healthy), but you ended up offering yourself reassurance, (which is unhealthy). Your exposure was not effective enough because you did not resist doing all your compulsions. You merely replaced one compulsion for another.
Example Two: You are driving back home from work and feel a bump on the road. Jay tells you that you have probably run someone over and you have the strong urge to check. But you know that would be a compulsion and you decide that despite the difficulty, you will not do it. So, with tremendous control, you keep driving past.
But, while you are not stopping or going back to check, you distract yourself by saying, ‘I don’t want to think about it because it makes me anxious’ and listen to loud music instead. Sure, in this case you did not check, but you substituted that compulsion with another compulsion such as distraction thereby reducing the effect of your exposure.
Whether it is self-reassurance in the first example or distraction in the second, your Harm OCD would have succeeded in making you do some compulsion, without your knowledge. Through some way or the other you are staying engaged with the obsession and hence the exposure is not entirely effective. If you start to mindfully recognize the other compulsions that you may end up doing inadvertently, you can learn to deal with them when they strike. Or, mindfully, you may choose to do them to take the edge off of a bigger response prevention. Agreed, that you may fail in the beginning and end up giving in, a greater number of times than you succeed. But it is fine to give in and start again, rather than to give up altogether. With practice, you will learn to reduce the instances of giving in and increase your resistance.