ERP Part 2: Identifying Values and Accepting Uncertainty
Part 2: Identifying Values and Accepting Uncertainty
ERP helps us overcome OCD by helping us develop new skills and learn from new experiences (if you haven’t already, you might want to check out part 1 here).
But before we can develop new skills and learn from new experiences, we have to establish the foundation on which all our later ERP-related work will rest.
That foundation is understanding what values we care about that would motivate us to be willing to taking calculated risks and accept living with uncertainty without completing our safety behaviors.
Here’s the disturbing truth those of us with OCD come into close contact with: Practically nothing in our lives is 100% certain.
This stinks because we want to be sure that the things we value – us, and the people we care about – are 100% safe. But the idea of 100% safety is an illusion. Because 100% safety is an illusion (I discuss this more here), the first step in ERP treatment is reviewing the advantages and disadvantages of trying to be 100% sure that we and the people we care about are 100% safe.
When considering some of the advantages of completing their compulsions and trying to be 100% certain and 100% safe, my clients typically report thoughts such as:
I really do care about being safe and keeping the things I love safe and I feel like I make things safer when I complete my compulsions
Even if I can’t ever be 100% certain of keeping myself and the people and things I care about 100% safe, at least I did everything I could to be certain and safe and so I can’t be blamed
If I don’t do my compulsions, I’ll be so distracted and anxious that I won’t be able to function well throughout the day. So I may as well do my compulsions so that I can at least have some semblance of a life
I don’t know if ERP will actually work for me. And, even though I don’t like completing my compulsions, my compulsions really do help me feel better in the short-term. So, I’d rather go with what I know than take the big risk of really doing ERP and resisting my compulsions
When considering some of the disadvantages of completing their compulsions and trying to be 100% certain and 100% safe, my clients typically report thoughts such as:
I barely get to live my life because I’m either obsessing, anxious, or completing my compulsions most of the day
My relationships have become so strained because of my constant obsessions, anxiety, avoidance, and compulsions
My whole life (or a good portion of my life) is controlled by OCD and going on this way is surviving, not living
I’ve lost things that are very important to me because of my OCD, whether that’s experiences, relationships, or just the ability to enjoy myself or have peace of mind
Amy’s Willingness:
Let’s explore an example of willingness by looking at Amy’s experience with OCD.
Amy came to see me because she had a history of OCD and was having a “flare up”. She was noticing near constant obsessions, tremendous anxiety that was making it difficult to function, and participating in hours of compulsions every day. As usual, one of the first processes Amy and I stepped into was an exploration of her obsessions.
“I keep trying to figure out if I really love my husband. One part of me knows I love my husband. He’s great to me and our daughter. We have such a good time together…at least before my OCD came back again. But over the past four months, literally every time I’m around him I have the thought ‘Do I really love Kevin?’ and then my mind just explodes with other doubts. I wonder:
Do I love Kevin?
Do I feel attraction for Kevin?
Does having doubts about Kevin mean he’s really not the right match for me?
Am I going to miss out on the right relationship if I ignore these doubts?
Am I a bad person for having these kinds of doubts?
“These doubts make me so, so anxious. So I check my body to see how I feel about Kevin and try and figure out if this is what love feels like. And I scrutinize all aspects of Kevin’s appearance to see if I’m attracted to him. I scrutinize the appearance of others too, and try to compare what I feel for them compared to what I feel for Kevin. I try to figure out why I’m having these doubts and what it might mean, so I analyze again and again. I frequently have thoughts that maybe a perfect partner for me is just waiting for me to get out of my marriage…and then I have thoughts that maybe I’m a terrible wife and person for having these thoughts. I don’t want to mislead or deceive Kevin, so I confess to him the thoughts and feelings I’m having all the time. He tries to be understanding but I know he gets confused and frustrated with me.”
Amy and I reviewed her history of OCD, including her report that, in college, she ended a relationship she very much valued because of OCD-related doubts and she’s scared the same thing will happen within her marriage. We connected how Amy’s current obsessions, anxiety, and compulsions are related to important features of OCD, such as:
After reviewing these foundational components, Amy and I were in a position to more fully explore her values. Amy identified that she valued “commitment” and “loyalty” within her relationship as well as valuing “freedom” and “peace of mind” for herself. Amy and I agreed that she had OCD and her values were being challenged and undercut by her OCD-related symptoms.
Like most of those I work with, one of the toughest parts of Amy’s healing process was her being willing to practice her OCD-related skills in response to her OCD-related experiences.
For example, consider a very common experience for Amy during which she reported the following thoughts: “What if I’m not attracted to Kevin’s stomach? What if this means that I’m missing out on the type of attraction that would really make my life relationship and my life great. I might get to the end of my life and realize that I spent my life with the wrong partner and now I’ll never get a chance to experience real attraction within a relationship.”
These thoughts made Amy very anxious. In the past, she would scrutinize Kevin’s stomach and analyze her own thoughts and feelings (frequently for hours). She simultaneously had other thoughts about what it might say about her that she spent so much time thinking about Kevin’s appearance. “Am I a shallow person because I’m so fixated on appearance?” As a result of these thoughts and feelings, Amy found herself avoiding Kevin more and more in order to avoid thoughts and feelings like this.
As part of Amy’s healing, she and I reviewed our assessment that her thoughts about Kevin’s stomach, and what these thoughts and feelings might mean about Amy, were probably just OCD-related intrusive thoughts. But, and this is where willingness to tolerate uncertainty comes in: These thoughts might not be OCD. These thoughts might be real, important areas of concern that should be taken seriously and attended to.
In this situation, Amy had to confront the inevitability of taking a calculated risk: Should she participate in the doubts and try to “figure out” her emotions and thoughts about her relationship and herself? Or should she apply her OCD-related skills and abstain from her compulsions and avoidance behavior? If she uses her OCD-related skills, she might be making a big mistake by remaining in a relationship she should leave or by not correcting “shallow” and “wrong” traits about herself. If she doesn’t use her OCD-related skills, she may end up sabotaging her current relationship by getting pulled deeper and deeper into her OCD. Either way, neither Amy or I could be 100% sure what the certain, perfect decision was.
At this point, Amy and I were able to connect to her values and how these values motivated willingness to take calculated risks. Her report sounded something like, “I don’t like having these doubts and related anxious and guilty feelings. I believe that these obsessions and feelings are probably OCD. But I can’t be 100% sure. But I believe can handle these thoughts and feelings. And I choose to take the risk of not participating in these doubts and letting these anxious feelings be here – of practicing my OCD-related skills. I choose to practice my OCD-related skills because this is the process involved in healing from OCD and it’s related to my values of commitment, loyalty, and finding freedom and peace of mind from my OCD. If it ends up that it was a mistake to use my OCD-related skills, I won’t like that and I’ll have to find some way to live with it…but I’ll understand why I made that decision. I made that decision to fight to get my life back from OCD.”
Amy very bravely and persistently used her OCD-related skills and achieved remission from her OCD after about three months of consistent practice.
My Experience With OCD and Willingness
My experience with OCD is a great example of stepping into willingness being a process that can take a long time. My OCD began in 2007. I didn’t realize it was OCD until many years later. And I didn’t learn I needed to be doing ERP until 2014. And it was three years after that, in 2017, before I finally was willing to begin ERP treatment.
In my case, my biggest OCD theme area (although I had many) was that I might die from rabies. My most common intrusive thought was “What if I was bit by a rabid animal and didn’t realize it?” As a result, I was constantly checking (and re-checking and re-checking) places and things (whether at home or outside of home).
A typical example of my OCD: When walking from my car to a building, I would see an object on the ground. Then I’d have my intrusive thought. Then I’d feel very anxious and feel compelled to closely examine the item on the ground (frequently taking many pictures). These thoughts popped up all the time, no matter where I was (at home, at work, at the movie theater, etc.)
By 2014, I finally “knew” I had OCD (I’d been experiencing symptoms since 2007) and knew the most well researched treatment for OCD was ERP. However, whenever I tried to abstain from my compulsions, I’d have new intrusive thoughts such as:
“What if this is the one time that I actually need to check? Wouldn’t it be absolutely terrible if this was actually the one time that I really was in danger from rabies? After all, it’s not impossible that this might be the one time I need to check. And think about how long I’ve spent keeping myself from rabies. If I don’t check and this is the one time I actually needed to check, all the years I’ve spent being very careful will now all be for nothing because I’m going to die of rabies.”
For years, these types of thoughts made me very afraid and acted as obstacles to completing ERP treatment. These sorts of evolving intrusive thoughts are very common when individuals begin considering taking steps to challenge their OCD.
At this point, a key step for those of us with OCD is determining why we might be willing to take the calculated risk in challenging our OCD by abstaining from our compulsions. And the willingness to take calculated risks requires that we know what we truly, deep down, value.
What someone truly, deep down, values, and how this might lead to someone being willing to take calculated risks, can be different for everyone. In my case, the turning point came about when I realized that my top value was no longer staying alive and not dying of rabies. Of course, I didn’t want to die of rabies. But, I realized that if not dying of rabies was my top value, I’d spend the rest of my life having intrusive thoughts, feeling anxious, and completing my compulsions.
So, my shift occurred when I realized my top value was bravely challenging my OCD. I “knew” if I abstained from my compulsions I’d probably be fine (the chances of my dying of rabies are, after all, very, very small). But, as my OCD correctly pointed out: Maybe I wouldn’t be fine. Maybe I would die of rabies if I don’t complete my checking compulsions.
I didn’t want this to happen. But something I wanted to happen even less was to get to the end of my life, fifty years later, still having OCD. I didn’t want to get to this point and look back on my life and realize that I never got a chance to actually live because each of my days was controlled by OCD.
I realized my top value was not missing my chance to be brave. And this meant that I’d rather die bravely than let OCD steal my life away one day at a time.
I realized that if dying bravely challenging my OCD is the way I end up exiting this world, I wouldn’t be happy that I died. But I would be proud that I courageously faced my fear and, at the very end of the day, was not ruled by my OCD.
And, so, in July of 2017 I finally participated in ERP…and, within a few months it worked exactly like the scientific research supporting it says it would and I achieved remission.
What I want to reinforce with this portion of my OCD story is that the willingness to take calculated risks (which is necessary in overcoming OCD) requires us to have a very clear idea of what we value the most and why we are willing to take the risks involved in fighting for and protecting those values. It’s only after these values have been identified that we can be on a solid foundation to accept uncertainty and then develop the skills and learning from new experiences that are involved in ERP (you can learn more about the skills developed in ERP treatment for OCD by reading the next post in my ERP series, here).