Comprehensive Treatment for Primarily Obsessional OCD
By Dr. Christian R. Komor
OCD Recovery Center
Appendix I: Special Instructions for Massed Exposure Exercise
Congratulations on choosing to participate in a "Massed Exposure" (ME) exercise. ME is a powerful form of exposure and response prevention therapy and is useful for treating many forms of obsessive-compulsive (OC) behavior. ME is particularly helpful for OC problems where obsessions are predominant or where there is no identifiable compulsion.
Following the reminders below will ensure that your ME exercise is optimally successful. Please make sure to ask any questions you may have as you go along with the exercise.
- Make sure before beginning ME that you are committed to doing the exercise on an ongoing basis for several weeks or even months. Doing ME for a day or two and then quitting is likely to actually increase the OC problem somewhat, so it is better not to begin at all than to begin and stop abortively.
- Do as much of the exercise as often as you can. The "gold standard" is to do 20 minutes of audio tape listening + 20 minutes of reading your script + 20 minutes of reading your script out loud and to do this once per day. If your time is limited taking a couple of days per week off, or shortening the times to 10 minutes, or only doing the audio tape listening are acceptable compromises.
- At the same time as you are exposing yourself to the script you have prepared through the methods in #2 above it is important to also give yourself some visual and or olfactory (smell) input. To accomplish this you may place samples of or pictures of a feared object or situation in front of you while you are listening to and reading the script.
- As you go along with the exercise you are likely to think of additional things you can add to either the script or the visual objects you are using. Make notes of these on the script as you go along. They can be included later in order to "re-energize" the ME exercise.
- Most importantly, always resist the urge to "undo" or "neutralize" the exposure. Some people will even hold out for weeks or months and then finally give in to washing, repeating, checking or otherwise "undoing" the anxiety created by the ME exercise. Remember, there are two routes of getting through the anxiety created by an exposure. The first is the do a compulsion or ritual. This reduces the anxiety, but strengthens and prolongs the obsession. The second way is to simply feel and anxiety, let it flow through and know that it will dissipate eventually over time. Taking this later route gradually frees us from the clutches of the obsessive compulsive cycle.
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