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 ROCD, 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 hard cast 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, since this is ERP and not just RP, as mentioned you need to set out some time maybe an hour for yourself every day to do your ERP. The ideal recommended time is two hours every day. But you can decide the duration that works for you. And you can also decide on what time is good for you. Do you want to do it in the morning when you are fresh? Or do you want to do it in the evening when the day’s tasks are over?
There are different schools of thought on this though. Some people think doing your exposures in the morning is the right approach because you may be too tired at the end of the day and may have neither the willingness nor the energy to do your exposures. The argument against morning exposures is that you experience anxiety first thing in the morning and your OCD may threaten to ruin the rest of your day.
Strictly from a textbook perspective, this may be the right thing to do for two reasons. One, you get the most difficult task of the day out of the way right in the morning and leave yourself with no excuses to not do the exposures. Two, the thought that the rest of your day will be ruined is Kay’s thought to stop you from doing your exposures when you are fresh and mindful. Under ideal circumstances, you should choose mornings to do your exposures.
The other school of thought is to do your exposures at the end of the day. You are already tired and stressed. Doing your exposures at that time may only raise your tiredness and stress by a few notches. It is like returning home from work and finishing a household task that may make you sweat further before going for a shower. Since you are already sweaty, doing that additional task may not be too much more to take on.
However, the flip side is that Kay may convince you that you are too tired to take up anything extra and ‘how about picking it up tomorrow?’ The temptation to not add more stress can be high and you may not do your exposures at all. Hence, you need to decide what works best for you without letting Kay make excuses for you. Whatever you decide, you need to incorporate ERP into your lifestyle and hence, make it a permanent fixture of your to-do list, at least until you recover.
Next, the exposures are to be deliberate. Which means whatever your triggers are, instead of avoiding them, face them. Watching a romantic movie, looking at happy couples on Instagram, reading about happy relationships may all be triggers. When you are doing your exposures, you will need to pick out a movie and start watching it to trigger yourself.
Keep the Anxiety Hierarchy Worksheet 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 your partner. Note the anxiety that you are experiencing right in the beginning and note it 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.
In the Anxiety Hierarchy Worksheet, 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.
The next chapter will be about starting small to recover faster.
Fill WS15 – the anxiety hierarchy