Can ERP effectively treat existential thought OCD through exposure techniques?

Take a page out of a philosopher’s book. Or a Buddhist book. Or someone tripping on shrooms or acid. Am I real? Is this life real? Am I real or am I a Sim in a game? Maybe, maybe not. It’s a thought experiment people engage in all the time, so it’s not abnormal to ponder. But since you have this particular OCD, you can’t get into it like, let’s say, a philosophy student can.

Hello there, Back in April I had a completely meltdown due to my existential and fear of death OCD. I have been in ocd therapy ever since with a really good psychologist (thankfully!!!), and the exposure therapy is very similar to contaimination erp, etc. It’s the same idea of exposure and response prevention, but it’s a bit… tougher in some ways. You literally have to let yourself think the scary thoughts, and then allow your body to feel that anxiety without doing anything to “cope” or lessen it. Now, if you have a good therapist, they will help you start with your least bothersome thoughts and work up from there, so you aren’t starting with the thoughts that send you into panic attacks! (All the therapy is coupled with regulated medication too, btw). Basically, our bodies have taught themselves to have a flight-or-fight response to specific thought topics, and so we have to teach our bodies out of that adrenalized muscle memory. When you let your body panic without avoiding the anxiety, eventually the anxiety will crest and then recede. And eventually you won’t even have the panic response anymore to that thought stimuli! Truly, I never thought it was possible to have some relief from my ocd, and though I am still in the beginning of the journey, I have more hope than I ever had before. Good luck, and know you’re not alone!!

Thanks heaps for your advice 🙏🙏🙏 at least it now makes sense how a therapist can help with existential OCD but therapy is so expensive so might have to speak to a different psychologist to see if they specialise in OCD 😊

Thank you so much for weighing in 🙏🙏. Did you ever feel depersonalised or disconnected from reality and those around you ? I often don’t know whether it’s my ocd or just my depersonalisation, sometimes I feel like I’ve disappeared out of my own body or just not in life anymore , I look at my kids and try to feel their existential, I talk to them and do everything but without ‘feelings’ it’s sooooo difficult to deal with and I’m back on Lexapro after using it for 13 years then stopping it but while it works to lessen the anxiety the constant feeling of depersonalisation/ derealisation is still there ! Also I don’t feel happy but I don’t feel sad so the doctor is going to switch me to fluoxetine ( after I taper off lexapro) have you taken fluoxetine before ?

I don't have that specific theme, but a lot of my obsessions and compulsions are mental in nature so it's hard to do an in person ERP like touching a doorknob like you've mentioned. I'm not sure if this will conflict with depersonalization, as I don't know what's suggested to help manage it. I haven't gotten to this point yet, but I know for harm ocd (one I deal with) a suggested ERP is writing out a scenario where you did the violent thing and all the consequences and the worst case scenario as a way to conjure the anxiety in order to practice sitting with it, if that makes sense. It's a common way to practice ERP I think, for themes and fears that are impractical, dangerous, or immoral to actually act out. I hope the meds change will help out too!