Ideas for exposure therapy

My NOCD therapist (who has been awesome) and I are both struggling to identify ways in which I can practice exposure therapy while in-session, because the vast majority of my OCD symptoms are mental compulsions. For example: indecision and inability to commit to a choice; seeking reassurance on decisions from friends and family; mental review of things that have just happened / social situations; over-thinking and catastrophizing. I also have some other hallmark symptoms (contamination fears, moral scrupulosity, etc) but those tend to be inconsistent too. It’s hard to really practice these during my sessions because so many are in the moment and fleeting. By the time I join my session they are no longer active. How can we establish exposure responses during my sessions, if most of my OCD involves mental rumination and overthinking patterns/thought loops that only occur “in the moments - rather than specific or consistent compulsions (such as hand washing)?

This is my first time posting - I have a fear of throw up and I’ve been told it is cause from my OCD (repetitive thoughts) which makes sense because if someone gets sick it replays over and over again and I can’t get it out of my head. It’s gotten a lot worse in the past maybe two years. I’m always on edge that someone is going to get sick around me. I’ve heard the “best or most common” way to help with this is exposure therapy and OBVIOUSLY I don’t want to do that. Anyone have any tips or anything for this (or maybe have done the exposure therapy)?

I realize this may not work for everyone, particularly those who are struggling with moral or existential forms of OCD, but as someone struggling with relationship OCD, here’s my proposition and what’s worked- 1. ERP and resisting compulsions involves intentionally exposing yourself to distress and not trying to do anything about it, but just sit with it. It is a fundamentally ascetic and meditative practice. 2. Resisting compulsions also means overcoming your bodily desire (because more than anything OCD is a nervous system response, not a rational one) for relief from distress, and instead aligning yourself with a higher principle that overcomes your temporal state. 3. OCD also operates similarly to addiction, and recovery outcomes for addicts are significantly improved through belief in a higher power. Higher power is actually one of the core elements of AA programs because it makes self discipline a lot easier. 4. ERP/CBD is effective, in part, because it already fits within the psychology of someone with OCD. What I mean by this is that it involves homework, specific procedures done at regular intervals, intense self discipline, and is overall pretty formulaic/ritualistic/somatic in nature. And we know that it works, and this method of addressing OCD tends to really excite and appeal to those who suffer with it. We act like the totality of OCD psychology is bad, but it also seems to be the key to reversing OCD, and may be a kind of superpower when properly utilized. 5. We have countless religious traditions that are thousands and thousands of years old which have developed techniques and rituals precisely for what OCD recovery needs- Getting out of a reactive state, getting into a state of gratitude and meditation, developing ascetic skills to overcome temptation (compulsions), being okay with uncertainty, creating a place of inner peace and compassion, having a system of accountability and reminders which keep you from slipping back into compulsive patterns, and doing all of this in community with people who experience the same struggle. So far, religion has been *the most* helpful thing I’ve done for my OCD. Here’s how this has played out in my own life: -Hesychastic prayer. This is an Eastern Orthodox tradition where you project the Jesus prayer, in repetition, channeling it not just from the mind or mouth but from the heart. It is deeply psychosomatic, with the goal of creating ego death and achieving a state of seeing God in all things. It creates a calm, warm feeling in my chest that feels identical to a psychedelic afterglow. It takes me out of my head and into my body, and the first time I tried it, with a prayer candle lit beside me, I experienced very rapid relief and was able to sleep for the first time without having any nightmares. I now do this consistently, along with other kinds of prayer and hymn recitation, and gratitude before meals, and it’s something I genuinely enjoy and look forward to. Since doing it, my compulsions have gone done by like 70%. Every time I feel myself slipping into compulsions, instead of doing them, I pause and pray. Prayer fills me with warmth, gratitude, and comfort. I feel connected to something greater than myself, my body becomes calm, my heart stops racing, and afterwards, I no longer feel compelled to perform my compulsions, because I know that it is harmful to myself and those around me, and that God is watching over me guiding me to act in a more thoughtful and wise way. This has single-handedly brought me more long term relief than any other OCD technique or treatment has. Not only has it relieved my OCD, but I have so much more energy, motivation, and self discipline in other areas of my life. It’s like I can feel my neurochemistry balance itself in real time. I’m eating healthier, my relationships are richer, I’m a better student, I feel more creatively inspired, and I have so much more self discipline to resist habits that are bad for me. I hope this may be helpful to anyone else who might be struggling. I’ve searched online and there’s really no information out there that I could find on religious ritual being an effective OCD treatment, but it’s been completely revolutionary in my life.