This is a guest post by Jackie Shapin, a licensed therapist in the areas of life transitions, anxiety, and OCD, at Jackie Shapin Therapy.
Response prevention is often believed to be the most important part of exposure and response prevention (ERP) therapy, a research-based treatment for obsessive-compulsive disorder (OCD) recovery. However, exposures are also a helpful component of beating OCD at its own game. To get the most out of exposures so that you don’t face your fears for nothing, it’s important to focus on “leaning in.”
Leaning into exposures rather than tensing your way through them, also known as “white knuckling,” isn’t a new concept in OCD treatment. I have been working with people struggling with OCD since 2017 and have both read and heard about the distinction. But it wasn’t until I attended IOCDF’s OCD conference this year that I was able to experience it for myself – the value of leaning in really hit me.
What is an Exposure?
An exposure can be anything you do or experience that triggers your anxiety, fear, or disgust. The aim of exposure in ERP is to practice purposely having obsessions, feeling physical sensations, noticing emotions rising, and experiencing the urges that come with them. Successful exposures include response prevention: tolerating the discomfort or disgust and reducing or eliminating compulsions.
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Exposures can be in-vitro (typically done in a therapy session), in-vivo (facing fears in real life), and imaginal (triggering obsessions by writing or recording stories about a fear coming true). Imaginal exposures can be helpful for facing fears that can’t always be practiced in real life or feel too difficult to start in-vivo. They are also useful when it feels like there’s no time to work on your fears. Once you write and record an imaginal exposure, you can play it in your car on a drive or listen to it throughout the day when you’re doing tasks that don’t take a lot of thinking.
White Knuckling vs. Leaning in
If you are bracing yourself the entire time you are exposing yourself to your fears—tensing up, holding your breath, and just waiting for it to be over—you’re “white knuckling.” White knuckling is an understandable response to discomfort, but it unfortunately limits what you’ll get out of ERP.
Instead—as hard as it may be—lean into the fear. Get to know it, notice it, and name it. Describe how you physically feel when you have the discomfort, disgust, or feelings you usually try to cover up. I promise, it’s worth it in the end. Leaning into fear helps show us that we can handle hard things. We are teaching our brain and body that even though something feels scary or gross, it might not be true. And even if it is true, we’re learning that it isn’t as dangerous or detrimental as the OCD brain wants us to think it is.
Leaning into fear doesn’t mean ignoring it. Similar to “fake it ‘til you make it,” I want you to “act as if.” Act as if you like the exposure; even put a smile on your face. Widen your stance, shoulders, and arms. Show your brain and body that this thing you are doing that is indeed scary, or even disgusting to you, is also okay and safe. Afterwards, reflect on the difference in how you feel when you lean in versus when you tense, shrink, squint, and lead from a place of fear.
While leaning in, utilize self-compassion. This means practicing self-kindness over harsh criticism, recognizing your own humanity or the fact that each of us is imperfect and experiences pain, and maintaining a sense of mindfulness or unbiased awareness of experiences – even if they are painful. One of my favorite tools for increasing self-compassion is focusing on curiosity over judgment. Allow yourself grace when things don’t happen as quickly or easily as you’d like.
Remember, you cannot get rid of obsessions, just like we cannot get rid of feelings or thoughts. Focusing your attention on getting rid of obsessions often just makes them stronger. Trying to eliminate them altogether can also result in white knuckling.
The more you can allow discomfort and anxiety to exist, the more you are teaching your brain that you can handle anything without compulsions. And if you can lean in, relax your body, even smile a little, you can manage your OCD that much better.
Put it into Practice: Experiential Exercise
Our minds are extremely powerful. I want to lead you through an exercise that is very similar to what Kimberly Rockwell-Evans led us through at the IOCDF conference. Read through the directions first so you can try the exercise without pausing to read.
Sit in a chair and let your back rest against the back of the chair. I want you to close your eyes, and notice your breath without judgment for just a few moments. Now imagine you have terrible aches, knots, and pains in your back. No matter how you move in your chair, your back just won’t relax. It feels tight and uncomfortable. Notice any sensations that come up as you notice the discomfort in your back. How is your heart rate? Are you warmer or cooler than when you first closed your eyes? How are you feeling emotionally?
Open your eyes and take note of how that experience felt, both emotionally and physically.
Now I want you to close your eyes again. Notice your breath again. Notice your back against the chair. You’re sitting in your chair and this time, imagine you feel relaxed, comfortable, and loose. You feel so comfortable you could almost fall asleep. Your shoulders are dropped and as you breathe, you notice calm throughout your body. With each moment you feel heavier and calmer, like you’re in a lounge chair at a beautiful resort. Notice how you feel emotionally and physically. After a few moments, open your eyes.
How was that experience? How did it differ from the first experience?
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Experiencing the power of thought through this exercise was a “wow” moment for me, and I hope it reaches you the same way. If you’re interested in learning more about leaning in, I encourage you to explore the Acceptance and Commitment Therapy (ACT) “drop the rope” metaphor, DBT’s willingness/willfulness, Robyn Walser’s ACT demonstrations, and Tara Brach’s “The Power of Yes”, a guided meditation in her book “Radical Acceptance.”
At NOCD, our licensed therapists truly understand OCD and are specialty-trained in ERP, the most effective treatment. They’ll create a custom treatment plan and equip you with the tools and knowledge to manage your OCD symptoms and maintain your progress long-term. You can book a free 15-minute call to get matched with one and get started with OCD treatment.