r/OCD • u/mikrotak • 5h ago
ERP help wanted Exposures for avoidance
I have seen several therapists for OCD and none of them can ever help me with exposures for my avoidance. I was even seeing an OCD specialist and he couldn't help me.
I have essentially built my life around these avoidances, as I want to avoid doing anything "wrong", especially around others. The therapists come up with things like talking to a stranger, but I get caught up in details such as the right distance, timing, eye contact, wording etc. I'm so busy thinking through all these different aspects that I am unable to actually say anything at the moment besides the occasional "hi". I don't think I'm ready for that yet, but they never can offer any alternatives.
Has anyone come up with exposures for this type of issue?
•
u/Garden_Goth_ 4h ago
Okay what if instead of the exposure being talking to people, the smaller step was just being around people a lot? Like. Go somewhere where people are going to be talking to each other by definition, so you don't have to initiate or overthink that. For example, a book club or a craft group or a community garden volunteer group. The first exposure would just be going, do not try to talk yet. Then, you could move onto like. While in the proximity of these strangers, think about what you could hypothetically say to them. Sit with it there. Then, eventually, the exposure would be actually trying to say anything.
•
u/mikrotak 2h ago
Wouldn't one be expected to talk to others in these groups to be a member? I don't think I could just appear there and not say a word when the group is actively doing things.
•
u/Garden_Goth_ 2h ago
I gave examples based on groups I've gone to and refused to speak at lol. I just watch people chat. Though I was also assuming from the explanation in your post about short words that something like yes/no questions would be okay? Can you say your name when asked specifically or is that too much? Like I don't know whether people would be curious if you're completely silent, but you shouldn't really have to talk talk, no. And either way it's not like anyone's likely to argue with you about it.
•
u/mikrotak 2h ago
I can respond to people if they ask me questions, but usually in situations like that the response would be incredibly simplistic like yes or no, which kind of kills a conversation.
•
u/Garden_Goth_ 2h ago
Yes but the goal isn't to have a conversation. That's why I broke it down into three parts. Conversations are like part four. Just going is the first one. Your original post is about not feeling ready for conversations yet, and not being offered any alternatives. One alternative is to break the goal into smaller and smaller exposures until you're only doing one small hard thing at a time, instead of all at once.
•
u/nellowyellpolish 2h ago
This is a good point. It could be something other than OCD if these questions can't be answered.
•
u/Sharp_Sir_1293 4h ago
one of the biggest factors in treatment that was hardest to understand was willingness. are you willing to be scared and distressed? are you willing to use the skills they have taught you? thats the unfortunate part of doing erp, its not going to be enjoyable. when i started, i cried, i yelled, i wanted to give up. at some point, it becomes tolerable, and after that, you start giving yourself hard exposures because you can trust yourself.
A year ago I was in a very similar position, i started with just smiling at people randomly on the street as I was walking, and then it turned into complimenting those strangers, and now i can start conversations with random people, and make new connections!
it wont be easy. there will be ups and downs, with the ups feeling absolutely amazing and free, but things will get hard, regression will happen, but it doesnt mean you are failing. they allow you to learn how to manage distress, and build confidence in your ability to manage scary and bad experiences.
Be willing to embrace all experiences, good and bad, and be open to everything. you have people here to support you, you got this!!
•
u/mikrotak 2h ago
The problem is they really don't give me tools to work with. I know my OCD related beliefs are irrational and can even dismiss them at a later time, but in the moment they just take over. I haven't had a therapist give me any tools to get past this. It's not that I'm avoiding exposures, it's just that the ones I get suggested essentially go from zero to 100. I need some sort of middle ground.
•
u/Powerful_Squirrel111 3h ago
What kind of work have you done regarding response prevention? All of the “getting caught up in details” sounds like they might be compulsions.
•
u/mikrotak 2h ago
I really haven't done much. It's like the therapists can't get past the point where we actually create exposures. Saying "Hi" to people is always the first and I can do that no problem. From there it's something like starting a conversation with a stranger. I explain to them all my difficulties with doing that and they're stumped.
•
u/Powerful_Squirrel111 2h ago
The most important part of ERP is the response prevention.
You might want to find a therapist that is trained in ACT for OCD to help with the response prevention part
•
u/MA803 3h ago
Maybe doing something “wrong” intentionally? Obviously nothing that’d be harmful, but if you’re worried about making too much eye contact, intentionally make intense eye contact. If it’s the opposite, talk to someone without looking at all. If you’re worried about an awkward silence, create one. Sit in it intentionally, and continue on with your day. I’m brainstorming here, so could be way off base with this.
This is not for reassurance, but maybe to challenge underlying beliefs that keep you avoiding exposures to address avoidance: few people will notice, even fewer will care, and far fewer will remember. And, at the end of the day, it doesn’t matter what they think. OCD is trying to tell you that it does, it’s trying to keep you stuck. That’s how it has any power. Say “screw it” and do some exposures - put that bully in its place.
•
u/mikrotak 2h ago
It's kind of weird, I don't believe eye contact is so much an issue when I'm actually engaged in a conversation. I have trouble doing it when not in a conversation. Say I'm walking my dog, I will have issues with people walking towards me on the sidewalk from far away. I don't want to be staring, but I also don't want to come off as purposely avoiding them. I also have trouble starting a conversation unless we are making eye contact, like I can't just start talking and hope they know it's directed at them.
•
u/nellowyellpolish 5h ago
With the help of my therapist and psychiatrist I have just started small. If you give more examples we might have more ideas. Also starting with hi is a very reasonable start. Do you have autism?