In this episode, Kelley and Lauren discuss Imaginal Exposures: What they are, how to write them, the importance of response prevention in doing Imaginal Exposures and even how to ease your way into them. As always they answer questions at the end.
In order to understand Imaginal Exposures, it’s helpful to understand the difference between Imaginal and In Vivo exposures.
In vivo exposures are direct exposures to external triggers. A concrete example of this is driving when you have hit and run OCD
Imaginal exposure are exposures to thoughts themselves. When we do imaginal exposures, we basically create a story
Lauren: Basically, we create a story.
Kelley: A really good story.
Lauren: Oof. It’s a really rough story, I’m not going to lie. It’s a sad story.
Kelley: Yeah, it usually doesn’t end happy.
Lauren: Never, never. It’s basically what the worst case scenario is.
Kelley: For you.
Lauren: For you- personally. And, to be clear, this is a pretty advanced exposure for a lot of people so I think writing the whole script and reading it back can be really intense. And sometimes we piecemeal that…
Words and phrases that are triggering for people are a short form imaginal exposures.
These might include words and phrases like:
Kelley offers that the word “pop” might be triggering. Lauren notes that Snap, Crackle and Pop are, apparently, the Rice Krispies of imaginal exposure.
Somebody’s gotta put their foot down with OCD from time to time. Like “No!” For me too. You’ve been there and done that for me too. Like “Nope, unhunh, let’s not do that. Let’s… no.”Lauren Rosen, LMFT
Whether you’re using words, phrases or longer form imaginal exposures, response prevention is key!
In terms of writing the Imaginal Exposure or Script you can write them in first person present tense – like “I walk down the hallway and have a strong sense of deja vu.” You can also use language that highlights the uncertainty. For instance: “I might be living in the Matrix.”
It’s important to take core fears into account when writing imaginals.
According to Elna Yadin, there are four categories of core fears
- Being Bad
(This is per a blog article by Dr. Michael Greenberg where he cites a personal communication with Dr. Yadin).
Per Dr. Michael Greenburg suggests that the core fear is always of a perpetual emotional suffering. (read more here: https://drmichaeljgreenberg.com/the-core-fear/_)
People often fear different concrete outcomes.
For example, someone with POCD might fear:
- Going to jail
- Being hated by their families
- God forsaking them
- Being disgusted with themselves
- Having life experiences ruined by the presence of unwanted thoughts
- Some other worst case scenario
Understanding the feared outcome can also be helpful in writing an imaginal.
Many people ask “But I’m already thinking about it all the time, so why would I do an imaginal?”
What these people are talking about is having intrusive thoughts (which we’re trying to bring up with an imaginal exposure) and also engaging in rumination (what we’re trying to disengage from as part of response prevention).
Lauren and Kelley talk about the fact that Inhibitory Learning Theory suggests that combining imaginal and in vivo exposures can be more powerful than either alone.
For example, if you have hit and run OCD, you might drive around while listening to recorded audio of an imaginal about hitting someone. You can learn more about Inhibitory Learning Theory here.
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Disclaimer: This information is meant to be general information not unique to any individual. Before following any guidance or advice found on this site or in the Purely OCD Podcast a visitor or listener should always consult with their own licensed healthcare practitioner. The Purely OCD Podcast and Website are not therapy or intended as a replacement for therapy. They are for educational purposes only.