i had a theme i obsessed over for a while but now it feels like a new theme is being completely taken over. how do people do ERP for thoughts of “what if i dont love my partner?” when i clearly do but the thoughts are just giving me discomfort? not sure how to do ERP for this one.

You basically start to deal with the discomfort caused by the thoughts without doing any obsessing. You turn your attention to something else despite the urge to analyse and the anxiety which is trying to tell you that this topic needs your attention. You treat it as if it doesn't deserve your thinking time anyway. Any time you notice your thoughts have drifted to it and started to try to respond to the question, you redirect your attention to something else. There's no need to come up with an elaborate exposure protocol. The more consistently you avoid mental compulsions when you feel triggered, the less often the thought will appear, and the less threatening it will seem.

@Scoggy i thought like “avoidance” is something that is a compulsion? is “avoidance” a good thing when it comes to mental compulsions then?

@🌱 Avoidance compulsion = avoidance of triggers, adapting your life to avoid the issue. Not performing mental compulsions is not close to being the same thing as avoidance.

@🌱 Otherwise you could just as easily call "avoiding" obsessively checking the windows and doors are locked and the stove is switched off and dealing with the discomfort of not checking, avoidance. You treat mental compulsions the same as any performative ones- you resist doing them, despite the urges.

@Scoggy ah I see. so when i have the thought of “what if i dont love my significant other?” and “what if that intrusive thought means something/means that i dont love my partner?” the most effective thing to do is to NOT respond to these thoughts by trying to solve them or reassurance myself and go carry on with my day like enjoying a hobby? what im AVOIDING is my mental compulsions by carrying on with my day, correct? im not sure if asking this is a reassurance seeker, but how would I tell the difference between my true feelings and the intrusive thoughts?

@🌱 Yep that's exactly what to do. You can't reliably tell the difference, but that's the whole thing about OCD treatment. You have to take your best guess, resist compulsions and see what happens. Having OCD about something is never a guarantee that it isn't true/how you really feel/thoughts you want etc. To be honest, I prefer to not bother drawing any distinction between regular thoughts and intrusive thoughts. If I'm ruminating on something, and it's getting me nowhere, and I would like to stop, then I apply response prevention. Most worries are not worth worrying about- worrying doesn't get you closer to a resolution than not worrying about it. ERP can't take away the scary possibilities in the world, or even make them less likely, but it can prevent me from suffering over them. If I am experiencing habitual, compulsive thinking, which is doing me more objective harm than good, and I would prefer for the topic to pop up less often, then ERP works. It's still perfectly possible to consider and come up with actionable plans, where those are possible and useful, for questions and threats without compulsively mulling them over.

@🌱 Whether the idea "maybe I'm not in love with my partner" was a random, intrusive thought like everyone gets, or arose out of a genuine concern, obsessing over the possibility is not healthy or helpful. Where there are genuine relationship issues, you are perfectly well equipped to address them without the crutch of obsessive thinking. Where there aren't, or you're not sure, you can take no action, do response prevention consistently, and then see if there are any obvious problems. Another useful indicator is to weigh up whether this is something which seemed to come out of nowhere. I get OCD themes about stuff I've never even considered before, and threats and possibilities which didn't bother me in the past. Knowing that they didn't bother me previously, I can imagine a future where they once again don't bother me, and that's the future I aim for.

@Scoggy thats really great thinking. for me i notice im kind of like a “sponge” when it comes to obsessions. when i was obsessing over one theme and i watched a video about someones experince with breaking up after a long relationship/not being happy in it, my mind went “what if IM like that?” and my theme honestly felt like it switched from the old one to this one now ever since then when i never questioned it beforehand. so then it went to “what if im not happy? what if i just dont love them enough?” even though i enjoy my time with them greatly and i always want to talk to them. does this make sense? im not sure if others are like this with OCD. i notice that its done this with other things before, as in i’d see someone do something “bad” and i would think “what if I DID that?” but i think the reasoning as to why im obsessing over “what if i dont love them?” more intensely then anything else now is because my significant other is the most important person in my life right now.

@🌱 Honestly that's how it goes for a lot of us. Someone makes a suggestion, or we see or read something, or have a spontaneous idea, and we think "what if that's me/true/going to happen/has happened??". And it comes with a sickening anxiety which seems like immediate evidence for the truth of it, so we take it as a genuine threat and start trying to fight it, or analyse it, or even give in to it. A focal deficit in the OCD brain is that it weighs scary evidence more heavily than evidence against. That's how we can get false memories and sticky ideas- the thing we imagine feels much more emotionally 'real' than even the facts we know, and we go into doubting stuff we hadn't had any reason to doubt before. OCD brains also require more evidence and information gathering to feel confident about any decisions at all. Unfortunately, there isn't much evidence to suggest that this tendency can be reversed entirely through ERP, which more just teaches us to rely more on what we know/knew even if it feels wrong, and to not go too deep into investigation or imagination in search of confidence. There's only one specific drug I know about, a beta blocker called propranolol, which actually helps the brain to feel more confident in decisions and reduces time spent information gathering. In a larger dose timed with exposure, it can also treat phobias and PTSD, producing total fear extinction in one session, lasting at least 3 months. It prevents you from being physically able to get that negative physiological reaction (sinking feeling, racing heart, sweats, anxiety etc) which comes with perceiving a threat, including a threatening idea, making it way easier to not take it seriously and not do compulsions. It makes the OCD brain actually *able to learn* from the experience, and stop treating the thought as a threat. I wish there was more research and that more people knew about it.

@Scoggy that’s actually really interesting. i feel like i’d fear being on that type of medication because you said it prevents the brain from feeling that negative reaction, so i would think that i wouldnt be able to “tell right from wrong” since im not having anxiety

@🌱 Your moral compass comes from your values, not from anxiety or threat warning you away from bad choices...

@🌱 Relying on your anxiety to tell you what's right and what's true is kinda the fundamental issue of OCD.

@🌱 Hey in fact- the fear extinction studies explicitly said that while it removed the emotional response, it left knowledge perfectly intact. It used the specific example of, if a phobia bombs is resolved by extinction treatment which entirely removes the emotional response to bombs (say, ideas that every backpack might have a bomb in or that certain places are unsafe to go because there was a bombing there years ago or because bombings are done there, like trains and planes), that leaves all the knowledge about what to do if there is an actual bomb threat completely unchanged. They'll still run away from bombs, they'll still know what to do, and do it, because that knowledge comes from someplace else besides their emotional response. The studies indicate its benefit for PTSD (including avoidance behaviours) and OCD, but afaik hasn't actually been trialed for them using that protocol. One could imagine that exposure to things which trigger anxiety and obsesive thoughts, subjected to fear extinction, would still preserve your awareness of genuine threats and your ability to ask questions, but might make it easier to live with having an open question which doesn't have certainty, without wasting your life ruminating over it, which could let you approach the question in the same way that anyone without OCD would. I don't not rob a bank because it makes me anxious to think about it, or even about the consequences. If I couldn't feel anxious about it, I wouldn't just rob a bank because I would still know about all the negative consequences of doing it, and could still weigh them up. I'm definitely not even saying that we would be super rational if we didn't have emotions. Emotions are sometimes really useful- they tell us what we want, what we like, what we hate etc. But OCD brains are super duper emotional, and getting rid of the intense negative emotional reactions to reminders of an obsession seems like a really useful tool. For example, in POCD if people no longer had the intense negative response to being around children or seeing images or mentions of them, then the obsession would be triggered much less often, it'd be easier to choose not to give it extra thinking time, and that would be a big boost for response prevention. Taking away the anxiety can't actually change what you think about something unless you were basing your judgment on the fact of feeling anxious, you would still know that molesting a child is a harmful thing to do, and that's what can guide your choices. It does take away an individual's ability to use their anxiety as an attempt at evidence against the fear ("if you were really a pedophile then it wouldn't make you anxious"), but that's a habit which already makes OCD worse in the first place. OCD likes to make you think that you need it in order to make good decisions, but that's how it keeps you trapped, and it's a belief worth shedding. It doesn't bring any more insight and certainty to a situation, than 1 session of thorough thinking would (there are studies to this effect), and has the potential to make the feared idea simply seem less realistic and important to dwell on in the first place, by getting rid of the anxious response. OCD is driven by emotional reasoning, and we take ideas seriously which others could easily dismiss precisely because the fear presents itself with a strong emotional element which makes it seem.... *relevant*. Even when we can't figure out how it should be relevant. It has emotional weight, and that emotional weight is what keeps it on our minds.

@Scoggy so then what would happen when a person would take this medication or another ocd type medication and get off of it? im assuming that this medication shouldnt be taken forever right

@🌱 Depends how it's used really. It only needs to be taken once with the right protocol to cure a whole theme, theoretically. But it does work at a low maintainence dose to just lower that threshold at which we feel confident so we don't do so many mental compulsions, and at least reduce the physiological responses to fears. There are very few medications which work well for OCD in particular. Propranolol is a beta blocker, not an SSRI, is non addictive and doesn't have much in the way of side effects, it's prescribed a lot for anxiety (my doc is happy to). With SSRIs you start getting permanent alterations in the brain after around a year which make you more dependent on them in the long term, they aren't really designed to be used for longer than that. You can stay on beta blockers forever, and as the dose is low, you don't get negative effects from coming off them. I would assume that mentally, you'd probably go back to having an abnormally high OCD level threshold for feeling certainty, there's nothing much to indicate that the benefit of daily use would be permanent when you come off it, but you might have learned a different way to be and think, which could make you more resilient to slipping back.