Wednesday, September 7, 2011

Paradox of Exposure and Acceptance

Psychologist Reid Wilson states that Obsessive Compulsive Disorder (OCD) and other anxiety "Wins," i.e. maintains and gets stronger, by making the rules of the "game." By making the rules, it always wins. He sees the rules as:

1. Be careful or you might cause a horrible problem OR you have already harmed
2. If a fearful thought ("content") occurs, take it seiously.
3. You MUST feel ABSOLUTELY certain.
4. Use your anxiety as a gauge. If you feel uncomfortable, then there IS danger.
5. ALWAYS act defensively. Avoid, worry, escape, and do rituals.

In order to stop the anxiety from continuing to win, he suggests the following NEW RULES:

1. Don't pay attention to the "Content," i.e., the specific obsessions and
2. Accept the obsession when it pops up - "It's fine that I just had that
3. Tell yourself "I WANT to be anxious and STAY anxious. It's NOT about the
content." It's purposefully choosing to feel the generic sense of
uncertainty and anxiety.
4. If necessary, make rules and follow them, i.e., "Here is how I am going to
wash my hands, check doors, etc." This means what procedures and limits will
be used, as opposed to doing those things until they "feel right."

On first take, this is counter-intuitive - and sounds impossible to anyone struggling with significant anxiety. The natural response to this type of anxiety is to avoid and try to escape. Avoidance and escape is how anxiety maintains itself and gets stronger.

By this logic, if you have your fingers in a Chinese finger trap, you pull your fingers apart. The result is the finger trap becoming tighter on your fingers, making escape impossible. The only escape is pushing your fingers together, just as Dr. Wilson suggests accepting and inviting the anxiety.

What happens when you accept and stay with the anxiety is that over time, it diminishes. This is called habituation. I have often seen anxiety decrease (not totally go away) in a matter of mainutes. It is important to note that this may take longer. It is routinely suggested to spend an hour for exposure practice. Habituation generally occurs most quickly when you perform exposure frequently, you accept a higher level of anxiety, and you stay with it for longer periods of time.

Here are some ways he suggests responding to various "content:"

When obsessive doubts occur, responding to them with statements like "I'm glad that I'm having these doubts." "I'm not answering that question."
"If I imagine something inappropriate, then it means I'm a bad person - AND I CAN handle that."
"If I imagine something inappropriate, then it means Ill feel uncertain and anxious - AND I CAN handle that."
"If I don't check the stove, it will be my fault that the house will burn down - AND I CAN handle that."
"If I have a "bad thought," it means that I really feel that way - AND I CAN handle that."
"If X does/not happen, something bad will happen and it will be my fault - AND I CAN handle that."

The more you "play" by the new rules, the weaker the anxiety will become. Maintaining the anxiety rules, maintains the anxiety and makes it stronger. Several videos are available for viewing on Dr. Wilson's website ( or YouTube.
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