Where I'm getting stuck is that there are two approaches in therapy. And the two contradict each other. 1. Experience the intrusive thought, don't do the compulsion. 2. Do an exposure. I don't believe I can move forward because the two contradict each other. I don't understand how people go through ERP and come out feeling better from OCD. I don't get it. I'm trying to do both #1 and #2, but the two just clash. What am I doing incorrectly?

Yes, I agree #2 would be more intense than #1, but it still confuses me. Leaving my car unlocked would not be safe to do in the area where I live. There's a lot of break-ins. This is so confusing. Leaving it unlocked is different than having a THOUGHT it's unlocked. Like sometimes I'll have the thought I've dropped my wallet while walking, so does that mean I need to actually lose my wallet as an exposure. Very confusing.

@OCD1994 Nononono. If you have an OBSESSION with the possibility that you've dropped your wallet, it's frequently on your mind, you constantly perform checking compulsions and reassure yourself that you haven't lost your wallet, always go to check that it's still where you left it etc, THEN it would be appropriate to do an exposure. We ABSOLUTELY NEVER EVER "do an exposure" because we have an occasional, normal thought that we might have dropped our wallet. VERIFIED OBSESSIONS ONLY. From what I've been able to tell from chatting, the only genuine obsession you currently have is with the idea that you need to do ERP for everyday things like this which aren't even obsessions.

@Scoggy If you had an obsession with the possibility of having dropped your wallet, you would check the place you left it every few minutes, all day, for weeks or months. You would be afraid to take your wallet out the house with you and leave it home whenever possible. You would obsess about possible solutions like keyrings with Bluetooth or physically attaching your wallet to yourself. You would be constantly consumed by anxiety that you might have lost your wallet and visions of what the consequences would be. You would be OBSESSED with preventing it from happening. Not occasionally thinking of it. Not a mild annoyance or a habit. Not a slight concern. An OBSESSION. THEN it might be appropriate to do any kind of ERP for it, ONLY if advised by your therapist to do so, and in a way which is safe and sensible. If you had an obsession with not having shampoo remaining on your body after a shower, it's not that you'd find the idea of being covered in shampoo uncomfortable and weird, you'd be TERRIFIED of it. You'd avoid showering for months to not have to go near the shampoo in case it gets on you and you fail to get it all off. You'd Google alternative ways to keep your hair clean without shampoo so that you don't have to use it and take that risk of failing to wash it all off. You'd feel sick any time you're near or see shampoo, you'd avoid shop aisles with shampoo in, you'd be utterly paranoid any time you're in the shower that you might have got some on you, you'd check your house all the time in case there's shampoo somewhere that you forgot about. That's what an obsession looks like. It's not a mild discomfort at the idea of having shampoo left on you, it's a goddamn overwhelming fear. If you actually had that obsession, then IF your therapist said you should, then you should do exposures, starting with not doing imagining and checking compulsions any time you're reminded about shampoo, and building up to actually letting some shampoo touch you, *eventually* deliberate leaving some on you despite the intense fear of doing so, without washing it off or doing other compulsions designed to get rid of the panic. That one is not dangerous or risky, so it's one nobody would think is a bad idea to build up to doing.

@Scoggy My point being, you're compulsively asking questions which are just furthering your VERIFIED obsession with doing ERP for every little normal idea and thing as a "treatment". You're doing the absolute opposite of what you should be doing to actually treat the real OCD that you have. What you need to be doing is NOT spending your thinking time ruminating on this or asking questions to calm your anxiety that you're not doing enough, which are both compulsions. You need to follow your therapist's guidance and not try to second guess them or work around what they say to do and not do.

@Scoggy That makes sense. But I also have read that thoughts are just thoughts. And just because I have an intrusive thought that I have lost my wallet wouldn't ever mean to do that as an exposure. I do have intrusive thoughts about losing my wallet some days.

@OCD1994 Intrusive thoughts are normal, they are not obsessions. We treat ingrained obsessions and their compulsions via ERP. We do not treat normal, occasional intrusive thoughts with ERP. Everybody in the world has weird and intrusive thoughts. They do not treat them with full ERP therapy, they dismiss the thoughts instead. In fact, the times that non-OCD people get intrusive thoughts that DO spike anxiety, they do response prevention without realising that's even what they're doing.... Because you know what response prevention is? It's thinking about something else. Instead of ruminating or doing self reassurance. They put their thoughts to something else because they know that's the healthy thing to do. They treat thoughts as if they're just thoughts. If we all treat our intrusive thoughts the way non OCD people treat theirs, we would no longer have OCD. OCD is a set of behaviours.

@Scoggy I agree with you. I want to treat my intrusive thoughts as just thoughts. But that would be go against ERP.

@Scoggy I want to treat them the way people without OCD would treat them

@Scoggy But then that would be going against ERP

@OCD1994 No, it wouldn't. It would be doing the level 1 type ERP. Listen to your therapist.

*is a

Yes, I'm trying to do #1 only, but I've been taught that we're supposed to do #2 as well, so very confused.

I'm trying to straightforwardness of it, I really am giving it my all, but I don't see it. It's very confusing.

@OCD1994 Well don’t you think that since everyone is explaining to you how they are not contradicting or confusing, makes it show that your ocd is attacking this?

@anxiousalways It's just keeping a car locked vs. keeping a car unlocked is different. I thought thoughts were just thoughts.

No, it would be something that you do 1 time, once you're good at response prevention (especially mental compulsions), and only if your therapist recommends it. It's not that complicated. If your therapist judges that actually leaving your car unlocked would run a realistic risk of something bad happening (i.e. because you live in a bad neighborhood or something), then she may recommend that you do response prevention for the thoughts about it rather than for the real thing. The idea is to get your obsession with your car being locked under control to where you can deal with not having total certainty 24/7 about whether it's locked. That's why response prevention is only useful for genuine obsessions with persistent compulsions. If obsessions can't be overcome by actually exposing yourself to the full fear (e.g. leaving it unlocked on purpose) and doing response prevention, because it's actually judged by outside observers to be a bad idea to do so (genuine, rational, significant risk), then just exposing yourself to your own thoughts as they come and doing response prevention instead of mental compulsions may take longer but will still work. Listen to your therapist. Imho you're definitely not ready to do any kind of #2 exposures because you don't have any grip on not doing mental compulsions yet.

@Scoggy It's still confusing. I'm trying to see it as straightforward, but how is it straightforward?

To prove to our brains that it isn't actually a big enough threat to be spending all day every day obsessing about. The only thing you spend all day obsessing about is whether you're treating all your thoughts 'correctly'. Follow your therapist's guidance on what to do about that.

@Scoggy I don't have a therapist at the moment.

@OCD1994 Oh! I thought she told you not to put soap on your TV, or was that someone else?

@Scoggy No, that was me. I'm not seeing her anymore because I wasn't able to put her advice to action.

@OCD1994 Do you get the basic principle of ERP though? If I am scared that I'll hit someone if I drive a car, and I'm so obsessed with that possibility that I avoid ever being in a car and spend all my time trying to remember every car journey I ever made in case I might have hit someone, I can be said to have OCD about the topic. My compulsions are memory-checking and avoidance. Because my OCD is interfering with my life by not letting me drive a car and taking up all my thinking-time and making me feel like a bad person all the time, I decide it's probably a good idea to do ERP. The principle for my ERP is to expose myself to my fear without performing compulsions. We do this so that our brains learn to be confronted with the fear, without needing the compulsions to get through it, BECAUSE those compulsions are the things that are making our lives worse. The goal of ERP is to learn to cope without the compulsions that damage our lives. So, I would start with the basic response prevention that whenever I am reminded of the topic of hit and run and I feel the desire to do my memory-checking compulsions, I have to instead meditate or distract/refocus myself. I need to do anything other than the memory checking. If I'm at work, I need to focus back onto my tasks. If I'm relaxing, I could either focus back on what was on my mind before I was triggered, or I could meditate. The goal is to allow the anxiety and urges to do compulsions which were caused by the obsession popping into my head, to fade away by themselves without giving into them. The next level of ERP would be to deliberately trigger the obsession by being around cars and being a passenger in a car. Again, it spikes major anxiety, and the goal is to get through the experience without running away from the situation and without doing compulsions such as asking for reassurance that nobody has been hit by the car, and even compulsions like reassuring myself that everything is fine. The goal is to allow the full anxiety to exist in me and LET it be there, doing nothing about it, until it slowly goes away all by itself. The final ERP step up from that would be to drive a car myself again, without checking my memory for whether I might've just hit someone, without reassuring myself that I haven't, etc. Just driving the car, having all horrible intrusive thoughts that I might have just hit someone or be about to hit someone, but refusing to follow those thoughts. No attempting to remember. No going back and checking. Just driving normally despite the upsetting thoughts. In this scenario, we do not do any extra steps of ERP like *actually doing a hit and run*. Because that would be stupid. We don't do ERPs which are dangerous, harmful or very risky. Doing the other things dilligently should still be enough. However, with some obsessions which are not about harmful or dangerous things, we CAN do an extra step in order to learn to not do compulsions during extreme anxiety. Often after just 1 successful time of doing this, an obsession will go away entirely, as the individual feels very empowered. For example, we had a boy on the app who has an obsessive fear of getting bugs on him. He controls his family members and checks them for bugs in case they come inside the house and get near him, and asks them to assure him that they haven't been near bugs. He refuses to go near grass. He checks his environment for bugs constantly. These compulsions are designed to calm his own anxiety down, but they are interfering with his life and relationships. So he needs to do ERP. He can do ERP by refusing to check for bugs even though he has the urge to. He can do ERP by not controlling his parents' behaviour nor checking their bodies for bugs. He can do ERP by not asking for reassurance that there are no bugs. This ERP will work gradually. He will learn that he can survive being very anxious about bugs without giving in to his urges to do compulsions. Learning to feel his anxiety until it goes away on its own, instead of doing compulsions to try to force the anxiety to go away, shows him that he can survive without his compulsions. The fact that he is no longer doing compulsions means that his life improves a lot, he no longer treats the anxiety associated with bugs as so much of a threat, and eventually his brain simply just moves on and the obsession disappears. Because bugs are not dangerous, the ERP process CAN be sped up by doing higher tier exposures, which would be things like going near to bugs on purpose and having bugs put on his skin. This would give his brain the opportunity to be in situations which cause extreme anxiety, and then to not do compulsions, instead allowing the anxiety to go away on its own. After 1 session of this he may take this experience of seeing that he can allow his anxiety to come and go on its own without compulsions, and suddenly find it much easier to not do compulsions. Facing your fear and discovering that you can cope with it without compulsions is very empowering. The boy may still have anxiety sometimes when he thinks about bugs, but through quitting his compulsions and surviving without them, he gets a normal life. And that is the goal. A life not ruled by damaging compulsions.

@OCD1994 I suspect that the reason you struggle to 'get it', is because you don't actually HAVE an obsession which has compulsions which damage your life like bugs or hit and run obsessions. All you have is an obsession with treating every thought you have as if it's a symptom in need of fixing, when actually OCD is a pattern of behaviours. It's a pattern of teaching your brain that an unimportant idea or a thought is important via spending all your time thinking about it. You don't seem to have the insight that your obsession is with 'Treating OCD Correctly' and your compulsions include rumination, analysis and reassurance seeking. Your compulsions are interfering with your life by taking up all your thinking time and stressing you out, isolating you etc. All your random, normal passing thoughts about soap and your wallet etc are not the problem. Your obsessive searching for a problem to fix and then researching how to fix it 'correctly', is the problem. I think it's a shame that you let your doubt get the best of you when it comes to your therapist. Her advice was not to do an unnecessary pseudo 'exposure' for a thought which was not an obsession and had no compulsions. That was good advice. You doing what she told you not to do, would have been a compulsion. I think you were perfectly capable of letting go of the reigns and doing what you were advised to do instead of what you wanted to do. You're not going to be able to overcome OCD until you're willing to listen to someone or something other than your OCD.

@Scoggy It is a shame and I should've stayed in therapy. I'm trying to understand the basic concept of ERP, but I still don't. Thank you for explaining though. I'm just trying to survive at this point in my life.

@OCD1994 The key is that it's not about the obsession, it's about the compulsions. ERP treatment is only needed if compulsions interfere with daily living. You can Google lists of mental and behavioural compulsions. The goal of ERP is to learn to live life with the fears still there but without doing harmful compulsions. It's about learning resilience. Again: it's not about the obsession. All OCD is the same thing. It doesn't matter whether your ERP treatment involves full exposure to your irrational fear, or lesser exposures. It's not about the exposure, it's about the response prevention. OCD is treated the same way as a phobia is: a paranoid fear of dogs which gets so strong that you're unable to leave the house, can be appropriately treated by being exposed to pictures of dogs, videos of dogs, being near dogs, touching a dog and eventually being around an unleashed dog. At each step of the way, the person does not do the compulsions like avoidance (running away) which have restricted and harmed their life. Dogs are not the problem, their fear of dogs is the problem. Being around dogs does indeed come with some small risk of being bitten or catching fleas, but those risks are less of a bad thing than being unable to leave your home due to fear. So yes, the intrusive thoughts and irrational fears are "just thoughts" and should be treated as just thoughts, via not giving them much attention and acting normal and thinking about other things. Being exposed to the irrational fear without doing compulsions is simply a fast-track way of overcoming an irrational fear by literally teaching your brain that the situation isn't as bad as it felt like and that it's survivable without the compulsions. Both ways of doing it will work if they're done correctly (meaning no compulsions). It's all about the compulsions. Not the exposures. If there aren't compulsions, or the compulsions do not cause a distress and restrict your life or monopolize your time, then it does not qualify as OCD. Only legitimate OCD with damaging compulsions is treated using ERP. The goal of ERP is to learn to live without compulsions. The only OCD you have is an obsession with doing 'correct treatment' via treating every passing thought using high level ERP instead of ignoring the thought like the rest of the world. Structured ERP is not needed unless there is a verified persistent obsession and life damaging compulsions. For random passing or intrusive thoughts, the correct behaviour is to ignore them and think about other things instead.

@Scoggy Thanks, this makes sense. It's just getting my brain to believe that it's not really about exposures, but response prevention. Looking back at past themes, I've always been able to beat my OCD using response prevention only to be honest. Planned exposures, especially "high end" exposures, are a huge target for my OCD.