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Strategic Exposure Therapy for OCD & Anxiety

Strategic Exposure Therapy for OCD & Anxiety

Strategic exposure therapy is an incidental exposure technique. I first learned about strategic exposures from Dr. Reid Wilson. He's been in the field of treating anxiety and OCD and training therapists and doing workshops for many years. And, as many of us in the field, he has changed and evolved his treatment techniques over the course of his career. And that's because we learn more and transition to what works best. I think it's a wonderful method.

The first step in strategic exposure therapy is externalizing your OCD voice from your voice. If you were to see a video that I did on Pure O obsessive thoughts, in that video, I externalized OCD as a purple, little monster, Gus. I visualized oneself as a stick figure next to Gus. And in the video, it shows that at first Gus was large and our little stick figure was small. And then we developed a stronger, louder voice. We became larger and stronger, and OCD became smaller and had a smaller voice. And became a little tiny monster, Gus. I like that visualization of OCD. Externalizing is very important. Step two is shifting your relationship with OCD and anxiety. If you have OCD and anxiety right now, you probably don't want to have it. Right? You're thinking that you have to get rid of it. Tell me what to do to get rid of this. And instead I want you to change your relationship with OCD and anxiety. And instead, I want you to say, I want more of this. In fact, I want more anxiety. I want more uncertainty and doubt. I want more. I can tolerate this anxiety. I can tolerate this doubt. I can learn to handle this. Now what we're doing in this method is we're actually pairing an obsessive thought with a cognitive thought of, “I want more and I can tolerate it. I can handle it, bring it on. I want more.” And so every single time that we have an obsessive thought, at the same time, we're going to right away think, bring it on. I want more, I can handle it. I can tolerate it. And we're going to repeat that process over and over every single time that we have an obsessive thought or that we have anxiety. Now what Dr. Wilson explains is that our particular theme of obsessive thoughts and OCD is not important. He is saying whatever your theme is, whether it's contamination or safety or responsibility for harm or fear of losing control, violence, sexual thoughts, harming thoughts, relationship thoughts, superstitious thoughts, and numbers, and repeating and thinking rituals. All of those themes don't matter. In fact, he just says, he wants you to concentrate on the feeling of anxiety and the feeling of uncertainty. The treatment method is all about handling and tolerating the uncertainty and the anxiety. It's not about the theme. Step three is that we are going to do the opposite of what our OCD wants. Our OCD wants us to try not to have it and to try to resist it. And then to do compulsive behaviors, trying to get rid of this anxiety. But instead, we're going to do the opposite. We are going to feel that anxiety, and we're going to say, bring it on. We want more, we can take it. We're going to, we're going to take it. He describes it as take the hit of the anxiety. Bring it on, take the hit, and we're going to do nothing. We're just going to ask. All we're going to do is ask for more. Then, we're going to repeat it over and over, as many times as we possibly can in a day, hundreds, if possible. In OCD, what's really happening is our prefrontal cortex is talking to our amygdala. And we are scaring ourself with OCD. We just continually try to scare ourselves. And so this is a paradoxical technique where we are actually not going to do what OCD wants, and we are going to do the opposite. We are going to ask for more, more uncertainty, more anxiety. And then the last step, step four is just going through our day, looking for as many opportunities as possible to ask for more anxiety. Anytime you're feeling anxiety, anytime you have an obsessive thought and you're feeling that anxiety, you ask for more, and then you do nothing. If you don't want to work on it on a particular time of your day, then you simply say to yourself, “I'm choosing to not work on it right now”. But every time that you can ask for more. ask for more. This is an exposure exercise. You might want to know why would it be considered an exposure exercise? In planned exposures, you set a determined time that you are going to practice the exposures. And many times people don't have that time during the day to do that. And they're not practicing their exposures every day. This is called a strategic method because we are continually practicing our exposures. Every time we have an obsessive thought, we're saying, there it is. There's that anxiety. There's that feeling of uncertainty, and I'm going to tolerate it. I want more. Every time we're going to do that. And so we're getting a lot of exposure experience through the day. There's a reason why Dr. Wilson changed to this method in his practice. Like every type of exposure. I just want to say that the same rules apply. There is no reassurance seeking behavior. There's no safety behaviors of having other people with you or avoidance behaviors. And there's also no secondary gain. Secondary gain is when we have some kind of benefit from having OCD. Maybe we can't work, or we can't be in a relationship or we can't leave the house. Perhaps we cannot be without this person by our side. Those are all secondary gains. And we don't want any of those behaviors with OCD.

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