Note: All parts of the guide have been updated as of Sep 2022 after much discussion from those suffering from SOCD and my own experience. In particular I have considerably adjusted the ERP approach, as I now believe that is better to simply avoid doing any explicit rituals, rather than trying to literally do nothing, which seems to have been causing some issues for people.
This unit is part of a guide. To see all units in the guide, click here.
What happens next?
If you are doing the exposures and NOT doing any rituals, you anxiety will soon diminish.
The graph below illustrates how it might go. You actually may experience an increase in anxiety when you begin these exposures; that’s unfortunate, but it’s one of those things where it might have to get worse before it can get better (you also might find you are ‘remembering’ the obsession all the time). However, soon your anxiety will diminish, but not necessarily in a linear fashion. There will be ups and downs, and days where you felt worse than the day before. However, just keep doing the exposures, and over time the anxiety will reduce. You can measure how you are going by comparing how you have felt on average in the last 7 days to the 7 days before that; it should generally be better (use the anxiety log below to track this). If not, it means something is not right.
The exact timeline will vary to vary from person to person. Generally, I’d expect extreme anxiety to reduce quite rapidly in the first two weeks or so, when you should be doing all the exposures mentioned every day. If you were to say your anxiety was at 100/100 when you began, hopefully it is now at 25-30 and life is much more bearable. You might be tempted to stop some of the exposures if there’s been a big decrease in anxiety, but my strong advice is to not stop until the anxiety is at 0. This can take quite some time.
Don’t lose hope if you are feeling extreme anxiety or pain on a given day. Those days may happen, and it might seem like things are not working. But what matters is the long term trajectory.
Exercise 2.3: Begin an anxiety log. For each day, give yourself a score from 0-100 based on the anxiety you felt during the day, with 100 being the worst anxiety or pain you’ve felt. In another column, you can write down anything of note during the day; for example if you felt anxiety at a certain time, or after a certain situation, how how it fluctuated during the day. This will really help you increase your awareness of how you are feeling throughout the day. What you should notice is that there are ups and downs, but it is going down over time. You’ll be able to see the progress which will hopefully make you feel much better.
Expect new obsessions
The vast majority of people will find once you begin to eliminate anxiety for a certain obsession, your OCD will jump to something else. For example it might have been swallowing, and then it jumps to blinking. And then to eye floaters. And then back to swallowing. You have to keep eliminating anxiety for ALL types of obsessions you have. Don’t leave a single one lingering there. Expect this to happen, and engage in the exercises in this guide again for any new type of obsession. This means you’ll have to change up your exposures as required (and challenge thoughts if needed as well).
After this, it usually takes a few months to pretty much eliminate anxiety for all obsessions, and by that I mean to get anxiety down to 0. At this point, you can remove the other all kinds of exposures. However be careful not to do this too early. Don’t leave anxiety at 2/10 or 3/10; if so, it can remain something that annoys you from time to time or even come back. You want to get to the stage where you are COMPLETELY okay with it.
You are not your OCD; it is the enemy
Your OCD is something you have, but it isn’t who you are. This thing external to yourself, OCD, is what’s making you anxious. OCD is the enemy is, and it’s what you want to beat.
You can thus conceive of your OCD as an external entity, and engage in a ‘conversation’ with OCD when you get obsessions or thoughts. This can sound a bit strange, but it does work. You can say things in your head like “Thanks OCD for giving me an opportunity to get stronger” or “Great, thanks OCD for reminding me, I almost forgot about the obsession!”.
You can also be sarcastic based on fears you might have had. For example you might get an obsession and say “Oh no I’ve just remembered about being conscious of my lip. Guess that means I’ll remember this forever and my life will be ruined”. You can use the unrealistic thoughts you wrote down earlier from 1.2 for this. Of course, you don’t believe it when you are being sarcastic. There’s no need to be too systemic about this, it’s just something that you can do whenever you get reminded of obsessions.
Embrace SOCD obsessions
I’ve touched on this earlier, but I can’t emphasis how important it is to have an attitude of welcoming your SOCD obsessions, rather than running away from them. Remember, each time you are exposed and don’t do a compulsion, you brain learns there’s nothing to be scared of. You are getting stronger. So each time you are exposed, it’s actually an opportunity for growth. It’s an opportunity to get better, so embrace it.
I like to think of it as being like Neo in the Matrix (apologies if you haven’t seen it). It’s a ‘come at me’ kind of mentality. You’ve got no fear, but rather want to face those fears head on. Look for every opportunity to expose yourself to your obsessions. This is the exact opposite of running away from the obsessions, which is what your SOCD feeds on. It’s an attitude of strength, instead of weakness.
If you feel any anxiety at all, the only way to get through them is exposure. So any time you feel any anxiety, try exposure as much and as intensely as possible; that’s the fastest way for you to be anxiety free. Create as many reminders as you can of the obsessions, make it as uncomfortable as possible, do extra exposures and so on.
With that kind of mindset and continuous exposure, your SOCD will hopefully be a thing of the past. Post your thoughts below.