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@Erin P Meant for Anon - sorry.

@Erin P Yes, I’ve worked with 3 different ones. With the bug phobia for example, I don’t have compulsions other than I do avoid walking by discarded furniture, and avoid keeping cardboard inside the house. I don’t like staying in hotels for this reason and when I do I am careful where I set my suitcase. I occasionally will have false alarms and become very very distressed. And it’s in those instances that OCD shows up. The only guidance was to not avoid things such as the cardboard inside the house.

@Erin P With the virus phobias, it’s both feeling disgust/dirty and fear of infection. So there is a lot of avoidance and uncertainty after normal cleaning which can lead to repeating cleaning. When engaging without compulsions the feeling dirty/gross is the main feeling I’m fighting or at least that feels front and center. It doesn’t peak and go down, it sticks in my memory. I recently read more about different types of contamination ocd and it explained that often it’s keeping tabs of what’s contaminated that keeps the cycle going for when fear of contamination is what is feared vs fear or getting sick. And I see that…but how to begin to break that down into doable parts? B/c the alarm and feeling is strong it gets well recorded in memory. It feels that I need to accept the reality of life but how to get one to want to. Sometimes the longer I don’t give in to the compulsion the sticker it gets…that if I do later give into the compulsion than it doesn’t work anymore b/c mind was not able to forget. And I’ll want to clean it again! Perfectionism/just right plays out here. I have applied ERP in these cases and with these it’s doable, but you see, it’s after cleaning it. I just spent 4 days feeling contaminated I can endure it but the feeling persists until I need to change clothes or shower due to normal conduct. Is this how you have or currently experience it?

@Aanoymous Yes, I am extremely familiar with disgust/ dirty driven compulsions. Yes, I’ve experienced keeping track of what is contaminated. Yes, I’ve felt contaminated until I have gotten clean due to normal contact reasons for doing so. I’m not an ERP therapist but I know that if I just resist cleaning but don’t take the additional step of accepting the risk and uncertainty I stay on a state of dirty vs. clean and the anxiety is there and the memory of what’s dirty. What has helped me is going towards the dirty actively as an exposure. You asked about breaking down into doable parts. I’ll follow up on that part in a moment.

@Aanoymous I’m not a therapist but here’s my thoughts re: doable parts- let’s say you cleaned a table because you were afraid of germs and you just don’t feel like you cleaned it enough. You might start by looking at the table and saying it’s contaminated with viruses. If after say 10 minutes if this your anxiety is the same you could say to yourself maybe it’s clean enough maybe it’s not and feel the anxiety and accept that there is a risk that it’s not clean enough. Whether or not that decreases your anxiety you would then put both hands on the least scary part of the table and accept the risk that you could be getting contaminated and that you aren’t going to clean your hands. Your anxiety should go down if you don’t let your brain switch to reassurance (you can counteract it with “but maybe it is really contaminated”). Once your anxiety goes down, eating something with your bare hands may be a good exposure. Or maybe you touch food to your contaminated clothes or touch your nose and lips to your clothes as an exposure. Basically actually accepting and taking the risk instead of mentally waiting it out until you change your clothes. It sucks but it works.

@Erin P Thank you Erin for taking the time with these last two comments - I feel heard, and it is helpful to hear the process based on your experience as a sufferer - there is some weight/trust to that. The 1st and 2nd steps are really triggering for me, if I say it’s contaminated I immediately feel intolerance and that I have to take action. And I can’t get to the 3rd step. If I skip those steps I can return to normal use…but it seems those steps are necessary in many instances - I’ll need to try it out with more variety of instances to observe what happens.

@Aanoymous Does you current therapist do exposures with you - as in touching the contaminated item as well? That can make the difference between being able to do the first steps without compulsions.

@Erin P We did once, and it didn’t go well. I’m not sure I was doing it right. I was asked to touch it and keep my hand there and observe the thoughts, of course the longer I did that the more thoughts came up and eventually one that was really sticky and the concern rose up from level 3 to level 8. And I wasn’t able to not give into compulsions, and additionally felt I needed to clean the surface which I hadn’t felt the need to prior. I really don’t know how this works for others.

@Aanoymous You weren’t doing it wrong. But it sounds like observing the thoughts was not the right method for you. I’m not an ERP therapist but it seems like there could have been a better way for them to help you through this - like when you needed to clean the surface they should have touched it and maybe had you touch their hands after yours were clean. Or they could have had you try going back to that surface another time and not observing the thoughts. I would suggest a different therapist but since you’ve been through 3 I’m not sure what to suggest.

@Erin P Erin you’re a gem, you give me hope. I also think observing the thoughts was too much…but was feeling like I’m going to set myself up for failure if I try to circumvent that. But the ideas you’ve shared give me hope that there is a way to further adjust and maybe it won’t be the most direct way to build tolerance to uncertainty but will be a way for me to start moving forward.

@Aanoymous It makes sense to concentrate in the priorities. Not all ERP therapists use a hierarchy, but NOCD and higher level treatment does. Sorry pictures don’t help - for me it’s varied based on the fear.

@Erin P I see, good to know. Thanks again for sharing your experience. ❤️

@Aanoymous Any time 😀

@Erin P For you feelslikeionlygobackwards