In this video, I am going to describe OCD Core Fears and why knowing your fear triggers and your core fear is important in creating an effective ERP, Exposure and Response Prevention plan to treat your OCD.

What is Your Core Fear and why is this so crucial to know when you are treating OCD with ERP? People with OCD and anxiety disorders have a core fear and different stimuli, like thoughts, images, sensations, situations, activities, objects and events can trigger that core fear. If you have OCD, you will likely do anything to avoid triggering and feeling your core fear. (We call these avoidance behaviors) and you do extra things to protect yourself and others from your core fear (we call these compulsions, rituals, or safety behaviors).

ERP, Exposure and Response Prevention, is one of the most effective, evidenced-based treatments for OCD. Sometimes people may add other therapies to ERP like medication, ACT, Motivation Interviewing and/or Mindfulness based therapies. In ERP treatment for OCD, you expose yourselves to something that triggers your CORE fear, and then practice what we call, Response Prevention, and refrain from rituals, compulsions, or avoidance behaviors. By not responding to your fear, discomfort, and anxiety by doing your compulsions avoidance behaviors, you are allowing your brain to learn that you can tolerate or endure the discomfort and what you thought would happen, doesn’t happen. It’s called safety learning. Understanding your core, underlying fear is important and sometimes is not so obvious, even for OCD specialists. For example, a person that washes and cleans excessively may appear to have a fear of contamination, and that they may get sick or make someone else sick. However, this is not always the case. It is also possible that they have a fear of not feeling “just right”. No matter how much they wash, they have difficulty feeling like they have done it right or feel right. Their core fear is that they are never going to feel “just right” or clean or again and that the “not just right” feeling they are experiencing will get worse. To do ERP treatment effectively, you need to identify your Core fear, and come up with ways to trigger and face that fear, while refraining from doing your mental or physical compulsions. According to Dr. Elna Yadin, the most common core fears are causing irreversible damage, suffering, or being bad in some way, and death. Dr. Michael Greenberg suggests that your core fear is a form of emotional suffering, and you are afraid of having to live permanently in that state of emotional suffering. For example, living with feeling shamed, judged, rejected, hopeless, trapped, contaminated, not good enough, etc. I agree with Greenberg’s view that core fears do seem to have this element of fearfulness of emotional suffering that may be there forever. I look at Core Fears having primarily 3 broad categories, is like Dr. Alec Pollard’s view with a slightly different perspective: First, there is category of people that have difficulty sitting with or tolerating distressful, uncomfortable feeling that we call “not just right” OCD. This is not exactly uncertainty, this is a feeling of being off, uncomfortable, distressed or even disgusted as described by some people. People describe this feeling when exiting and entering places, washing, dressing, driving, any number of activities. They want to feel “just right” and often find themselves compulsively redoing activities to get that “just right” feeling. Second, there are others who can accurately describe a particular catastrophic event that they fear and want to avoid. For example, I am afraid the bridge is going to collapse, and I will die if I go over that bridge. (This is called thought/action fusion, if I think it, it will happen.) And third, and possibly the most common is an undefined overall fear that “something bad will happen”. It is related to having difficulty trusting oneself and tolerating uncertainty in certain areas or themes in their life. What if this happens, what if I do that, what if I didn’t do that, what if I do this wrong, what if I cause this or that. How will I ever live with myself knowing I did that? It is related to what Michael Greenberg is getting at when he describes the fear of making some irrevocable mistake that causes them to live in a state of emotional suffering forever. But it is also related not trusting yourself and uncertainty. Wanting certainty in a world that something will or will not happen is impossible, even when knowing that none of us have certainty. I call this a fear of uncertainty about making a mistake, resulting in something bad happening that causes emotional suffering forever. Those are all heavy burden to bear. I want you to think of what is central, or at the core of your OCD? Are you afraid of feeling “not just right” and that it will just haunt you and get worse if you can’t get that “just right” feeling? Are you afraid of one catastrophic event happening? Or is uncertainty or mistrust in yourself about making an uncorrectable, devasting mistake that results in guilt, shame, regret, loss and emotional suffering forever the basis of your core fear? I have clients that try as I might, I cannot fit into one category, they seem to have a combination of these core fears. We just make sure we target their exposures to cover whatever core fears we have identified. A helpful way to identify your core fear, if you are having difficulty with this, is to ask yourself, what would be the consequence is I did not do my rituals and compulsions? This usually makes it clear. If you look at the Worksheet from Step 1 again, you can now complete the third column. What are your feared Consequences if I do not do my ritual? And then, at the bottom, you can complete the section that states, “based on my feared consequences my core fears are:” Once you have identified your core fear, and the fear triggers, those internal or external events that trigger your core fear, you are ready for Step 2 of creating your personal ERP plan. Step 2 is identifying what you do after you are triggered in your attempt to stop, avoid, or neutralize your anxiety and discomfort. Step 2 is Identifying your mental and physical compulsions and rituals, avoidance behaviors and accommodations. Before you can do ERP, you will need to come up with creative ways that you can trigger your core fear, these will be your exposures. And your Response Prevention, the RP of ERP will be resisting the urge to do your identified rituals, compulsions, or avoidance behaviors. We will go further in the next lesson, Step 2 of my 3-Step-Process to treat your OCD. If you would like more information about whether you have OCD or Pure O, I am leaving a link to a self-quiz in the description of this video. And I am also leaving a link for my PDF on The Top 10 Things You Need to Know to Practice ERP for OCD and Anxiety Disorders. And if you need more help for OCD, please contact me at PaigePradko.com Until next time, I will see you in session.