How can I do exposure therapy if my compulsions are all in my head. The only thing I do is I just think about my obsession over and over and over until I am so wrecked with guilt and panic I can’t move or breath.

Myself I allow the thought to be there, and I do a lot of the SOS activity that says my obsession may happen however things aren't all in my control. I was wrecked with guilt yesterday and so far this is what works for me, any other suggestions because this is a good question. It's like pocd.

Well I think meditation would help with this...like having the thoughts and being stressed out about them but not letting it ruin your day? I mean maybe...have you talked to a therapist yet?

It depends on your theme, but exposing yourself to your triggers without following it with rumination, compulsions, checking, avoiding, etc. is the idea.. and it can be scary but the more you do it the less power the thoughts have over you

ruminating for me is definitely a compulsion, because I find that i’m still looking for an answer.. instead, I try and let the thoughts flow without latching on to them, and try and redirect my focus elsewhere

Your thoughts are unreal that is what you have to know. So when the thoughts appears, accept them. That doesn't mean you are some thoughts you don't like. Unreal thoughts doesn't mean a shit. But If you keep obsessing about: what you have to think about them: you lose. This is a cycle. Break the wheel, "okay I have this thoughts. I don't like these thoughts. This thoughts make me suffer all the time. But they are in my head so okay. Okay head, okay anxiety, I accept they are here now. I know who I am. Im okay. They are not important. I am. I'll get through this." You don't have to accept what your thoughts mean. Just accept they are thoughts. Disturbing ones yes, but they have no power over you. You are the only one who is giving them the control. And you can regain it too. Nothing bad is going to happen if you do that.

I think ERP and mindfulness and accepting uncertainty are what decrease the thoughts (/the meaning we give to them) in the long run, but i’ve found that not giving in to the compulsions (and not blocking the thought but letting it be there) brings me to a place where I can function and start to feel like ME again (and makes me feel stronger for ERP!)

Something called imaginable exposure is a form of ERP for Pure O. It involves writing out your fears in a story then reading it back over and over to trigger the anxiety that erp would do for someone with say a contamination theme. Eventually after doing this a lot you sort of desensitize to the fear and the anxiety will come down. Here’s a really good description of it with some tips https://ocdla.com/imaginal-exposure-ocd-anxiety-4847 One thing my therapist told me when I brought this up was to include as many details as you can about physical sensations (like sweating and other things), to really put yourself in the story and make you feel what you would if it were really happening.

Yeah.... on and off... no one really has a good answer for me. SSRIS worked really well in the past but now I am having a lot of breakthrough aneixty and when the SSRI increased I had almost delusional paranoria and obsessions

Maybe you try not to think about it? Or do what tnb81 said, sit with the knowledge it might happen. I had a therapist once have me draw a picture of what I thought was going to happen over and over again until I wasn’t anxious about it. The problem is I can’t just bust out a notebook and draw horrific pictures at work, or in public.

I think the issue for me m.a.d is how do I not ruminate? Is ruminating the compulsion?

Does that help decrease the obsessive thoughts in the long run? I’m worried by distracting myself I won’t be truly exposing myself to the aneixty of the obsession and it won’t help me in the long run.

I have the exact same thing

Yeah and so a few weeks ago I had exposure to a contamination trigger...and what I did was just not reassure myself, like I’d say “well that bad thing may happen, there’s definitely a chance”....and whenever I started thinking “nah that’ll never happen”...I’d remind myself that it could and I’d think of how I’d cope with it...it was SUPER tough to do, and it made the anxiety last longer but I think there’s less of a chance of it coming back as strong, it’s like a trade-off...instead of no anxiety now with the threat of sever anxiety later...you just have mild anxiety about the situation all the time, that way it can’t sneak up on you