This might be controversial, but I don’t think exposure is always the answer to OCD. I know we preach it as the gold-standard treatment for OCD, and I’m not denying that. Research supports that OCD gets much more manageable with ERP (exposure and response prevention) treatment. I just don’t think when stuck in an anxiety spiral, turning to exposure is the answer 100% of the time.
Let me give an example. A few weeks ago, I started a new dance teaching job with my local Parks and Rec. Doing anything new is incredibly stressful for me. It takes weeks, sometimes months, to feel adjusted and reasonably comfortable. Then, I found out since this position is also through town employment, and I work at the public library, they go to the same hour cap. I would likely have to lessen my library hours to continue the dance teaching. Which raised the question: Was it worth pushing through the stress of doing something new?
I looked at the pros and cons. I likely wouldn’t continue teaching dance through the town in the fall, to avoid this hour cap problem. So, right when I would just be starting to get comfortable, it would end. I examined my values. While I enjoy teaching dance eventually, once I get past the stress of meeting a new class, it isn’t a long-term career goal. I weighed my motivation for doing the exposures of continuing to teach through the summer. My motivation was low, and the SUDS the exposure would bring was high. Exposures don’t work well without motivation. I ended up deciding no, it wasn’t worth pushing through the stress of doing something new. (I will still be teaching at a local dance studio though.)
I tend to view exposures as short-term suffering vs. the long-term suffering of OCD. We put ourselves in short-term pain, for (as cheesy as it may sound) long-term gain. But in this case, it would be short-term suffering with no real long-term benefit. Yes, some of my decision was driven by anxiety, but another large part of it was also driven by internal wisdom and reason (called wise mind in DBT).
Sometimes pros/cons, values, and motivation don’t lead to exposure as the answer. Sure, I could white-knuckle my way through it and finish out teaching the summer, but at what cost? It would be incredibly stressful and take up time that could be spent elsewhere. That energy and time could be spent moving towards other goals and values that better align with how I want my life to look. I’m willing to accept that I have severe anxiety, and I can often push through my anxiety, but I don’t always have to.
I’m not saying I will never do exposures again. Far from it. Though I don’t do targeted exposures anymore with where I am in recovery, I will need to continue living the “exposure lifestyle” to keep OCD in check. Otherwise, my world would shrink to be very small. What I’m saying though is it’s more nuanced than always leaning into the exposure. There are other therapies, like ACT and DBT, that can complement ERP. Yes, ERP is a valuable tool, but it is not the only tool. Humans and OCD are complicated, and so is how we should treat OCD.