Existential OCD Trigger Warning: What is the best ERP for the “What if I’m not real?” thoughts? I’d been doing better-ish, and today I’ve been freaking out. Okay, so truthfully, every day has been a form of a living hell on earth, it’s just some days aren’t quite as tormenting as others. I hate DP/DR, which came right along after I saw a post about a year and a half ago, from someone who acted like we can’t prove our existence. I know there isn’t any evidence to think I might not exist, but this is torturing me. Help! I need to do self-help because of finances at the moment.

I used to get caught in a loop with existential thoughts very frequently. Every question made my stomach drop: (TW: existential questions) … … ... "Why does anything exist at all? What will death be like? Is anything even real? Is there any meaning to this? Is the universe infinitely big, and if not, what's beyond it? Are there multiverses? Has the universe been around forever? Will the universe end for good, or will it keep going forever? What is forever like? What even IS reality?" It would get so overwhelming that I remember lying on the floor in a fetal position for hours because I felt like there was no escape. I spent most of my days reading articles and watching videos about theoretical astrophysics and philosophy in a desperate attempt to "figure it all out." Of course that only made me more anxious, raised more questions, and kept me trapped in the cycle. Things started to improve once I learned to turn TOWARD reality, rather than away from it, and ERP really helped me do that. I learned that these questions weren't the problem. I learned that I can actually handle the anxiety that arises when exposed to these ideas and concepts. I don't have to figure anything out to make the anxiety go away; it arises and passes away on its own. Ironically, bringing myself into the present moment and becoming more aware of reality helped me escape the cycle of existential dread. Because of that, this topic no longer takes over my life. If I'm triggered by something I see, hear, or think, I may still feel a little twang of anxiety, but then it just goes away. "Maybe, maybe not" has been the single most useful phrase of my life. Do you ever get trapped in a cycle of existential questions? Are you worried that the ERP approach would be too scary to handle? If so, I'm happy to give my advice.

I recently posted about my experience with Existential OCD (https://app.treatmyocd.com/community/posts/2184668), and one of the most common questions I got was how to deal with DPDR (depersonalization and derealization), as it often goes hand-in-hand with existential obsessions. I wanted to create this post to summarize my thoughts and understanding of DPDR, so I have something to point people towards. For context, I'm not a trained mental health professional, doctor, or neuroscientist. I'm just someone who has been through the gambit with OCD, and has learned about the mind through conversations with several therapists, reading books, and watching videos. I also regularly consult with a few Buddhist teachers, and have been practicing meditation for several years. Please keep all of this in mind, and take everything I say with a grain of salt. First, some quick terminology: Depersonalization = a feeling of "detachment" from your own body, almost as if you're living life as an autonomous robot. Derealization = a feeling of "detachment" from the outside world, where people, places, and things feel distant or alien. They often go hand-in-hand, and mainly differ in terms of what feels "unreal" (yourself, or the outside world). It's easy to see how this can coincide with obsessive existential thoughts. After all, when things feel unreal, how can you help but think about the big questions of existence? So these feelings often make those with OCD extremely uncomfortable, and the desire to make it "go away" inevitably arises. But, just like with anxiety, most attempts to "get rid" of it generally make it worse. Even grounding exercises can become problematic if the goal of those exercises is to get rid of DPDR, just like any other compulsion. That's why my first piece of advice is always to acknowledge and accept the feeling. One way to get comfortable accepting any feeling is to understand where it comes from. As of today, the exact neurobiological workings of DPDR aren't fully understood, but one thing seems to be pretty clear: DPDR is the result of the brain momentarily shifting gears to protect itself from overwhelm. It's something that happens when you are stressed, and/or burnt out. It's the brain protecting itself from overstimulation, similar to a circuit breaker closing down parts of an electrical circuit to prevent overloading. It's important not to take this information as reassurance against the existential intrusive thoughts that arise during DPDR, rather simply as an explanation as to what is happening in the present moment. I'm a big proponent of using "maybe, maybe not" responses to intrusive thoughts. So in the case of DPDR, you may considering responding to the existential thoughts with: "Maybe that's true, maybe it isn't. Right now, this brain is overwhelmed, and it is protecting itself." (Side note: the use of "this brain" instead of "my brain" is a habit I've picked up from Buddhist philosophy. It's a way of practicing non-attachment to the self. If that doesn't work for you then feel free to phrase it in whatever way makes sense. I also recognize the beautiful irony of bringing up non-attachment in a post about DPDR 😂) Basically, you want to acknowledge the existential thoughts, acknowledge the feeling of DPDR, acknowledge that the DPDR is coming from a place of stress, and then refocus your attention to the present moment. The key is to not refocus your attention in hopes to GET RID of the thoughts or feelings, but to do it DESPITE those things. You need to teach yourself first-hand that none of those things are dangerous, and that you can continue to live life while scary thoughts exist in the mind, and while you feel uncomfortable things. The more you try to push the DPDR away, or logically dig yourself out of a hole, the more stressed you will become. And since DPDR is a stress response, this will only cause it to stick around longer. It's the same ironic cycle that fuels the intrusive thought / compulsion loop. Sometimes it can last for a few minutes, a few hours, days, weeks, or even months. While DPDR disorder exists, in many cases (especially with OCD), DPDR tends to persist because of our resistance to it. If you find that it just won't go away, try not to get discouraged. Instead, look for the resistance, and consider how you may be able to open up to the experience in a lighter way. If you find yourself resisting, gently remind yourself: "I don’t need to figure this out right now. I can let the brain do its thing and focus on living life." It can also help to recontextualize the DPDR. I like to think of it like a warm blanket or sweater, or the brain taking a nap. You wouldn't want to wake someone up from a nap, would you? Let 'em rest! I hope there is something helpful here for those struggling with this issue. Trust me, I've been there.

Been struggling with existential OCD lately. Very hard to describe the thoughts/feelings, but it is a constant feeling of being stuck in my head. Like what is consciousness and where do I think from? Like I think it’s OCD, maybe it is maybe it isn’t. But if it is, what would be good ERP exercises? Just existing (lol)? And what would be my response prevention? I’m not even sure what mental compulsions I may be doing.