DIRECT EXPOSURE

In effective treatment for OCD, the most commonly used clinical technique is ‘direct exposure,’ sometimes also called ‘in vivo’ or ‘real life’ exposure. Here, an individual purposefully puts herself in situations that are associated with obsessional fears, and refrains from performing acts (compulsions) that would lessen her fear. For instance, in the case of a person with contamination fears, exposure might include touching objects or going to places that are irrationally feared as unclean. Most good OCD treatment involves constructing detailed lists of dozens of situations that cause obsessional anxiety, and figuring out ways to methodically expose oneself to them.

The therapeutic rationale is straight forward. It is exactly the same as in the treatment of simple phobias. If you have a terrible fear of cats, you must work towards the goal of picking up and holding a cat. Eventually, you will get used to cats. Likewise, if work towards exposing yourself to obsessional fears, you will ‘habituate’ to them.

Suppose a young mother develops the obsessional fear that she will drop her baby. In her mind’s eye, she sees herself picking up her child and then twitching, or suddenly jerking her body, or losing her balance in some way. As a result of the fear, she goes to great lengths to avoid picking up her baby. When she must do it, she seeks endless reassurance from her husband.

What’s the treatment here? The mother must be encouraged to take the risk of picking up her baby without asking for reassurance. This will almost surely need to be accomplished in small steps. First, only a short distance up from the crib, and then higher and higher. First with her husband present, then alone. If the mother can be persuaded to do this, she will overcome her fear.

The question for Christians is this: How does God fit in? The answer: In every way, for the basic problem in OCD is a lack of faith in God’s mercy and providence. If we would truly trust in Him, we would not fear anything at all. God promises that “all things work for the good,” and that he will “not test us beyond what we can bear.” The King James Bible uses the exact words “fear not” or “be not afraid” more than a hundred times. That’s because faith—trust in God’s mercy—is what God wants from us more than anything else. God wants us to be at peace through faith.

God has designed OCD specifically in order to strengthen our faith. Our intention in using exposure exercises is, from the clinical perspective, to induce habituation. From the Christian perspective, our intension is to grow in faith. In this particular case, what was most helpful to the mother was remembering: “It’s more important for me to trust God, than to be completely sure that I won’t drop the baby.” After suffering through her difficult trial, her fear normalized and her faith grew stronger.