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Self-directed, better to come up with specific exposures or just sort of challenge OCD when it comes up?


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Should I set up specific exposures or just kind of challenge OCD when it comes up? The second one is a bit more loosey-goosey, less structured, free-flowing whereas the first one puts a lot of pressure on me to do things in a structured way. What do you guys think? I have a tendency to obsess about doing therapy in the exact right way, so maybe the second is a better option?

I can't go to therapy right now for insurance reasons so I'm on my own, but I believe i can make a lot of progress on my own.

 

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How much progress did you make with a trained therapist? You really think you can do well on your own?

Your problems are several fold. First, you second guess everything. Especially when the going gets tough. Second, you resist going the extra mile. You do safe things but that isn't going to get you down the road to recovery.

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I do think I can do okay on my own. I just got out of a hospital, so I know how to do exposures.

The reason I didn't make progress with a trained therapist was because I wasn't consistent in doing exposures because I was obsessing about the therapy. I'm going to try to not let that happen now.

Edited by Ryukil
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The CBT way is to set up structured exposure and response prevention, tacking individual triggers - usual upwards in a graded hierarchy of anxiety-inducement. 

You stay with a trigger, repeating short periods of exposure and response prevention until the anxiety fades away. 

Next time you practice this aspect of CBT you work on the next trigger in the hierarchy. 

This is the accepted way of doing it in order to get better. 

It is focused, and achieves since each trigger is faced and overcome. 

ERP won't work, however, unless the sufferer has grasped fully the cognitive side of CBT so knows why the trigger is a consequence of a false exaggerated or revulsive OCD core belief and accepts that. 

If you aren't fully understanding of that cognitive side then it is not likely that the ERP will be successful. 

Any attempt at exposure lesser than this necessary methodology would, in my opinion, likely prove unsuccessful - this structured method works, as I know in my own case. 

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So, for example, my whole thing is that the notes or actions I take can be "contaminated" by my thoughts. The cognitive distortion here would be magical thinking, I believe - like, thoughts can't actually contaminate things. However, if I say to myself that thoughts can't contaminate things, isn't that reassurance?

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3 minutes ago, Ryukil said:

However, if I say to myself that thoughts can't contaminate things, isn't that reassurance?

If you use it as a repeated habit to try and neutralize the intrusive thought then it would be a form of reassurance.
However if you use it sparingly as a way to help break the negative cycle its not compulsive.

For example, if you have the intrusive thought and then repeat in your head over and over "thoughts can't contaminate things" until you feel better than is a compulsive response.  You aren't challenging the distortion in a constructive, merely engaging in a repeated behavior.

On the other hand if you notice the intrusive thought, think to yourself once "No wait, thats just OCD.  Thoughts can't contaminate things" and then refocus on something else that would be reframing your thinking.  At first you may have to remind yourself a couple of times but the goal should be to reduce the use of whatever particular phrase you use as your guide until its once and then occasionally and eventually you don't even think about it.

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3 hours ago, Ryukil said:

Should I set up specific exposures or just kind of challenge OCD when it comes up?

It doesn't have to be either/or, you can do both.  Particularly at first it may be most beneficial to set up structured, pre-planned exposure sessions.  You yourself admit one of your troubles in the past has been follow through.  If your exposures are planned and on a regular schedule it will benefit you not only as exposures but also in terms of helping you commit to and maintain a treatment plan.  A structure would also help you measure progress by setting up measurable milestones and help you ramp up exposures over time, rather than mitigate via avoidance and complacency.

Meanwhile taking opportunities to engage in exposure as situations present themselves in your day to day life is also valuable as it is how you live your life, you can't pre-plan and prearrange it all.  If you truly want to reach the point where you can go about a "normal" day you'll need to be able to confront these situations in unexpected times and places.  

So rather than choosing one or the other I think the correct answer is to choose both.

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5 minutes ago, Ryukil said:

I see, there's a subtle difference there. Thanks.

Yes, its important to remember that the problem with compulsive behavior isn't the behavior itself, but the manner and frequency with which its used.  For example, its not only good, but important to remember to wash your hands in certain situations (before eating, after using the bathroom, before performing surgery, etc.) but hand washing goes from good/necessary when done at a correct time to dangerous and harmful when done in a compulsive fashion.

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5 minutes ago, dksea said:

It doesn't have to be either/or, you can do both.  Particularly at first it may be most beneficial to set up structured, pre-planned exposure sessions.  You yourself admit one of your troubles in the past has been follow through.  If your exposures are planned and on a regular schedule it will benefit you not only as exposures but also in terms of helping you commit to and maintain a treatment plan.  A structure would also help you measure progress by setting up measurable milestones and help you ramp up exposures over time, rather than mitigate via avoidance and complacency.

Meanwhile taking opportunities to engage in exposure as situations present themselves in your day to day life is also valuable as it is how you live your life, you can't pre-plan and prearrange it all.  If you truly want to reach the point where you can go about a "normal" day you'll need to be able to confront these situations in unexpected times and places.  

So rather than choosing one or the other I think the correct answer is to choose both.

Okay. Yeah, this is now an obsession. Time to nip it in the bud and just take action before I get bogged down. Someone on Reddit answered my question with: "a better question is, is it better to take action or to be certain that you are going to take action correctly and perfectly?"

Edited by Ryukil
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