This is an excellent article - really nuanced and helped me understand some things about OCD/ERP that I didn't understand before. "Mistaken Beliefs about Uncertainty Acceptance and OCD" by Jon Hershfield. https://www.madeofmillions.com/articles/mistaken-beliefs-uncertainty-acceptance-ocd

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.

As a 20+ year OCD vet and OCD conqueror. I wanted to share some tips and tricks that help me. 1. A thought is not the same as a belief. You can think something, and not believe it in the slightest. 2. Thoughts DO NOT represent ANYTHING. They are not indicators to who we are as people, they are pop up ads for the brains computer. 3. We DO NOT control our thoughts! The average person has about 60,000 ( yes, 4 zeros) a day! NONE of which are controlled. 4. We DO have control over which of those 60k thoughts are important. i.e. thought A. I could murder my entire household- survey says? not important ( because yea, sure, you could, but you probably don't really want to) thought B. i need to do my laundy-survey says? important... unfortunately, i hate laundry. which brings me to number 5. 5. Emotional reasoning ( where you let your feelings impact your decisions) is a COGNITIVE DISTORTION. It is a flawed thought process and should NEVER be used. "wanting to do something" does not mean you SHOULD do it, same and sometimes NOT wanting to do something doesn't mean you shouldn't do it ( picked what is important) my brain might tell me i WANT to break up with my husband, ( unimportant) and it might also say i don't want to get up and go to work in the morning ( important). 6. YOU-ARE-IN-CONTROL. Not to be confused with HAVING control. We don't control our thoughts, we control which ones are important, we don't control our feelings or emotions, but we control how to react (or not react) to them. We don't control our OCD, but we can control how it affects our lives, and that can mean that is has all the power, or none. 7. If the action you want to do ( confess, get reassurance, check, analyze, avoid, re-do) are to gain relief from anxiety, IT IS A COMPULSION. DO NOT DO IT. Sit with the anxiety and train your brain to realize its not dangerous or important with ERP ( this takes time, but practice makes perfect) 8. Know your enemy. NOCD has a HUGE amount of articles and information on ALL subtypes of OCD and how to respond and how to treat them. OCD is MUCH easier to combat when you understand how it works. 9. BE PATIENT. BE KIND to yourself. Prioritize healthy habits, a healthy body is better equipped to handle OCD. Good sleep, whole foods, sunlight, social interaction, exercise ( walking especially). When the mind feels weak, make the body strong. 10. You are not alone. OCD is classified by the World Health Organization as one of the top 10 most distressing disorders. Reach out to people, seek medical help. Medication is not evil, it can be life-saving, TALK to people. Bonus Tips * if the question is " What If" its OCD. * Total certainty does not exist, be content with 99%* *"But this feels different, this feels like its not OCD, that its real*- emotional reasoning... its OCD. Hang in there. You got this. Im here for any advice, questions, or support. Today is a great day to have a GREAT DAY.

I had just posted a summary of ERP for a group member, and I thought it might be useful for everybody. Here it is below (with a little extra added)…. ERP therapy is researched-based. Most other therapies don’t work. There have been people who have been literally stuck in their houses (from their OCD) who gained their lives back through ERP therapy. NOCD does ERP therapy exclusively. You can find it in other places too, but you have to ask around. There are two tenants of ERP therapy: The first one has to do with the repetitive thoughts inside our heads. These thoughts are actually defined as “obsessions”. You are not supposed to do anything with the obsessions. You are supposed to let them run through your head freely, without trying to fix them or stop them. Imagine a tree planted by a river. The leaves fall off and float down the river. You can see the leaves falling, but you don’t try to stop them or pick them up. You don’t try to fix them. You just let them float away. This is really important to do with your obsessive thoughts. The more you try to fight them off, the worse they get. I used to have blasphemous sentences running in my head 24/7. I felt like I had to put a “not” next to each sentence in order to “fix” it. But this just took hours of my time every day, and it was very scary, because I was worried that if I messed up, that I would go to hell. It was very freeing to learn later that I could just let those sentences run freely through my head without trying to fix them. The second part of ERP therapy is all about “denying your compulsions.” Every time OCD tells you that if you don’t do things a certain way that something really bad will happen, that is a compulsion. Once you recognize what your compulsions are, ERP therapy will have you practice stopping doing all of those things. For some people, that will mean stopping washing their hands or touching lights switches or, in my case, putting “fixing” words in their head. Compulsions are safety behaviors. During ERP therapy, you will practice stopping engaging with safety behaviors. All this is very hard to do and scary, so during therapy you will be given tools to help you deal with the fear. Often ERP therapy will take people from being non-functional to functional. I highly recommend it. ————————————————- PITFALL #1: After you have been doing ERP for a while and become somewhat successful, the OCD will try subtle little tricks to bring you down again. The first one is to tell you that your thoughts are REAL and not OCD, and therefore you can’t apply ERP therapy. Don’t fall for this trick! All thoughts are just thoughts. They are all meaningless. Don’t try to figure out what is real and what is OCD. Just treat all thoughts with ERP therapy. PITFALL #2: The second pitfall is that OCD will tell you that you can’t move forward unless you have absolute certainty that you will be safe. Hate to tell you this, folks, but there is no certainty in life. You will never know for SURE that you or your loved ones will be “safe” from the OCD rules. Therefore, you have to move forward in the uncertainty. It’s hard, but it gets easier with time and practice. We got this, guys !!!!!!