Welcome back, everybody. Today, we’re diving into a question I get all the time—how do I do exposures for intrusive thoughts? If you haven’t asked this question yourself, you’ve probably wondered about it or Googled it at some point. It’s a common question, especially for those beginning their recovery journey with OCD. But here’s the thing: it’s not a simple question to answer when it comes to understanding and treating intrusive thoughts.

Here’s a little preview of what we’ll cover:

• Why treating intrusive thoughts is so complex
• What you should be asking instead
• Examples of tailored exposures

The Complexity of Intrusive Thoughts

When people ask about exposures for intrusive thoughts, they often assume that there’s a straightforward answer. This question typically arises when someone is new to the concepts of treating intrusive thoughts and exposure therapy. These terms might be new and intriguing, but they can also be overwhelming.

The issue is that asking “How do I do exposures for intrusive thoughts?” assumes that it’s a question with a simple answer. It’s not. Especially when asked on social media or through email, where the response can’t be personalized or therapeutic, the answer just doesn’t capture the full picture.

Why Exposures Aren’t One-Size-Fits-All

When it comes to exposures for intrusive thoughts, my brain immediately goes to hierarchy development. Hierarchy development is the process of creating exposures in a hierarchical fashion. These exposures are anxiety-provoking situations that someone with OCD needs to purposefully face, with the goal of not performing safety behaviors, compulsions, or rituals.

This process isn’t about just picking any exposure. It’s about collaboration between the therapist and the client to create a hierarchy that works for that individual. Sometimes, we use a 0 to 10 scale (or 0 to 100) to gauge difficulty. But even this process isn’t always concrete—sometimes, it’s just about throwing ideas out there and seeing how difficult they would be for you.

Four Key Pieces of Information

To properly develop exposures for intrusive thoughts, you need four critical pieces of information:

1. Your Subtype: Before anything else, I need to know your subtype. Even though I’m not a huge fan of focusing too much on subtypes, they do provide some direction. However, OCD isn’t really about the specific subtype—it’s about doubt and the intolerance of uncertainty. That’s why people often have more than one subtype, and why OCD can shift from one focus to another.
2. Specific Fears: Beyond knowing your subtype, I need to know what you’re specifically afraid of. For example, within the contamination subtype, are you afraid of getting sick, getting others sick, bodily fluids, or chemicals? Just saying you have intrusive thoughts isn’t enough—I need to know the details.
3. Core Fears: Next, I need to understand your core fears. This is where the downward arrow technique comes in. This technique involves asking yourself repeatedly, “What would be so bad about that?” to uncover the deeper fear driving your anxiety. For instance, if you’re afraid of getting sick, you might discover that the core fear is actually about being alone or being judged. These core fears are often what ties different subtypes together.
4. Triggers and Goals: Finally, I need to know your specific triggers and goals. What are the things that you’re no longer able to do because of OCD? What do you want to be able to do? Understanding how OCD impacts your daily life helps to create exposures that are relevant and meaningful to you.

The Importance of Personalized Treatment

Even with these four pieces of information, creating a treatment plan is not just about following a generic list of exposures. Each person’s experience with OCD is unique, and so their exposure hierarchy should be as well. For example, two people with the same subtype, like pedophilic OCD, might have completely different core fears and triggers. One might fear being ostracized from society, while another fears being punished or disappointing their family. These differences mean that their exposure exercises will be different too.

Make sure to head here to learn more about my OCD and Anxiety Recovery Blueprint if you are ready to take your mental health into your own hands and become the bad ass I know you are!

Examples of Tailored Exposures

I’m a big believer that we need to actually address and work on the core fear or core fears because there are probably so many other areas where these things are coming up for them.

Let’s say someone has pedophilic OCD and their core fear is being punished and going to jail. For them, an effective exposure might be something like driving by a police station or even touring a jail. However, if another person with the same subtype doesn’t share that core fear, these exposures wouldn’t be helpful. Their treatment needs to be tailored to their specific fears and life impacts.

Or take someone with relationship OCD, whose core fear is living in regret forever. For them, exposures might involve talking about their future with their partner or making decisions without being 100% sure. The goal is to lean into these fears and address them directly in ways that resonate with their specific experience.

Treating Intrusive Thoughts With Exposure Therapy

The question, “How do I do exposures for treating intrusive thoughts?” is much more complicated than it seems. It requires digging deeper into your subtype, specific fears, core fears, and how OCD impacts your life. This process allows for a truly customized treatment plan, which is essential for effective exposure and response prevention (ERP).

If you’re a therapist, your clients deserve this level of customization. And if you’re dealing with OCD, you owe it to yourself to get curious and dig deeper into your fears. The more you understand about your OCD, the better you can tackle it head-on.

I hope this helps you start brainstorming how to approach your intrusive experiences. Remember, understanding your subtype, specific fears, core fears, and how OCD affects your daily life are the keys to creating effective exposures.

That’s a wrap for today. If you found this helpful, please leave a review or comment. Don’t forget to subscribe for more insights on conquering OCD and anxiety. Keep doing all the hard things—you’ve got this!

Keep doing all the hard things. Bye for now.

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