Welcome to this week’s episode of Purely OCD.

This week, our hosts, Lauren Rosen, LMFT, and Kelley Franke, LMFT, continue the conversation on Harm OCD with a focus on harm befalling you or a loved one and exposure response prevention.

Let’s dive in!

Harm obsessions: Harm befalling you or a loved one

(1.50)

Lauren: Let’s talk about the fear that harm will before you or a loved one.

Kelley: …we often see that a lot with younger kids with separation anxiety. It might look like a fear that your parents are going to die and you won’t see them again, that’s the core of separation anxiety. But you certainly see it in adults as well. For some reason, it sometimes switches for some people and they fear that they are the ones who are going to commit harm. 

Then the exposures vary. 

When we go through these exposures, I want to be really clear that everybody’s treatment looks different. So the examples we give are just guidelines of what typical exposures would look like, the run-of-the-mill stuff. If you are seeing a treatment provider, follow their treatment plan for you.

Exposure and response prevention

(3.48)

Lauren: Okay, so say you have the obsession, what if somebody breaks into my house and murders me and my family?

That thought comes up and you want to do these compulsions that which we’ve talked about in the past episodes. And so when we’re doing exposure and response prevention, we’re trying to bring up the trigger on purpose so that you do have these thoughts. 

So that you can you can respond differently to the presence of those thoughts, and the feelings that they tend to bring up as well. So if you’re somebody with this fear that somebody’s going to break into your house, how might you go about suggesting somebody try triggering themselves so they experience those thoughts and feelings more?

What might exposure and response prevention look like?

(5.00)

Kelley: We would certainly at some point remove the husband or wife, or whoever is accommodating in the family.

We may even lock the window. We might lock the window with our eyes closed, and walk away. We might talk as we lock the window because sometimes clients want to hear it lock. 

And to resist, of course, the mental rumination and reassurance seeking that go on around that. 

Lauren: …it’s interesting. I have seen some clients who won’t be as triggered during the winter months because they aren’t opening windows. So we open windows them!

Exposure Vs. Response prevention

(6.55)

Kelley: …the exposure part is actively going towards the anxiety to bring it on intentionally. The point is to actually try to evoke whatever feeling is associated with that. 

And then response prevention is about trying to resist those compulsive behaviors. 

Lauren: …I think that working on a hierarchy first – so really starting to go through the ways in which you’re relying on other people to check for you – can be a good place to start.

Kelley: It’s all challenging. And one of the most important things about ERP is that we’re doing things gradually, we’re doing it one small step at a time. We’re not taking on the biggest thing first. We don’t want to not torture you, we want to give you a win so let’s do tiny bites at first to get that confidence going. 

Navigating uncertainty

(9.05)

Lauren: …so we’ve talked about this instance in which somebody is afraid that they’re gonna get hurt. I also see this coming up with natural disasters. The fear that there’s going to be an earthquake or there’s going to be a fire, those kinds of things.

Kelley: Absolutely, we can sit here and fixate whether or not there’ll be a fire or tornado, but the reality is, a tornado could happen. Earthquakes can certainly happen at any time, with sinkholes, mudslides, and all sorts of things. There’s so much uncertainty that exists in this realm. The reality is that your loved ones and you will be hurt at some point physically, and emotionally, That is almost a guarantee, right? 

Lauren: That has to be one of the acceptable possibilities or outcomes in life. Yeah, of course, we’re going to take steps to mitigate that potential. We’re going to try and make sure that doesn’t happen. But at what point is it becoming excessive? When the attempt to try and resolve that uncertainty stops you from living your life, that’s when it’s a problem. 

Harm obsessions: Hurting others

(12.00)

Kelley: So with harm obsessions, they typically relate to violent intrusive thoughts like raping or stabbing, for example. So we want to lean into that. If you’re avoiding cutting the carrots for the soup for fear of using the knife to stab someone, you want to use the knife to cut the carrots and then maybe leave it out on the side.

Lauren: From a values perspective, let’s say that you have been pushing off all cutting responsibilities and cooking to a loved one. Maybe you’re a teenager and you’re not helping your parents at all, even though you want to be the kind of person that would help. Kindness or thoughtfulness are important values to you. 

Try to remember what kind of person you want to be.

And if you want to be seen as a helpful person, prioritize that and pick up the knife and chop.

Kelley: That’s right. Spot on. Values-informed exposure is great. It’s one of my favorites definitely gets you motivated too. Oftentimes going into values will really help you. You might feel resistance, and wonder why would you risk stabbing someone you love. Well, what’s going on in your head is increasing the distance between you and your loved ones and stopping you from living your life.

Fun exposures

(16.33)

Lauren:  …there are some sort of fun ones, too.

You could watch docu-series’ on serial killers.

TV shows about murderers, you could watch Law and Order or the series about Ted Bundy, for example. And these can be great exposures because there’s be so many opportunities to resist the urge to do compulsions when thoughts come up that challenge whether or not you’re like these people.

Common exposures for ham obsessions about hurting others

(17.48)

Kelley: You could read stories about mass shootings.

If there’s the fear of rape, you might avoid public restrooms just in case there’s someone in there and you might do something. That’s the time to go to those places you’re avoiding.

Many people keep their hands in their pockets, so you might try to keep your hands out of your pocket.

Lauren: You might find a good podcast, right? On a topic that triggers you. We do want to incorporate those things as much as possible into your life as well, right? Because the goal of treatment is to get you back into living your life. So if you want to be walking on a daily basis, and you know that listening to the podcast is going to be highly triggering for you, then just throw your earbuds in and go for a walk. You’re going to have plenty of opportunities to disengage from the desire to figure it out every single time that you hear something that’s triggering. 

Kelley: Also, if we’re just going to like basics, you might write down kill, kill, rape, rape. Murder stab, blood, I’m violent, I’m a murderer. All those things. 

Using images for exposures

(20.45)

Lauren:  I like using images. This is going to be difficult if you’re in a public space a lot with your phone or with your computer. But if you can, make the backdrop of your computer a picture of a knife.

Kelley: Also, you could have a picture of a specific person who may evoke this fear more than others. For example, you may be a mother who is fearful of harming her child, so pop a picture of your son or daughter on there.

Lauren: Yeah. And that goes back to value-based exposures. If there are certain loved ones that trigger those fears, we want you to be able to feel comfortable being with them. So don’t avoid them, lean in. See them more often. Expose yourself to them.

Using Humour in your recovery

(23.28)

Kelley: I had a thought randomly right before a podcast about microwaving my cat. So I might use humor by holding my cat and telling her I love her so much, but I’m gonna microwave you later.

Walking by the microwave and telling her she’s going to get nuked.

You’ll be done in one minute on the cat setting.

We are using humor because the reality is, scientifically, it helps you. You’re actually sending responses back to your brain that you’re okay. We’re smiling. We’re laughing. So we’re okay. Let’s keep moving through. You might not be able to access that right away. Some people never access that. But by all means, if you can, do it. Even if it’s a half smile. It’s biofeedback to your brain – we’re all good.

Lauren: It’s not like we’re trying to get rid of the anxiety. But why not add a little bit of levity to a really heavy experience, not to get rid of the heavy, but so that you’re having both?