Wednesday, October 18, 2006

OCD: An Explanation of Exposure & Response Prevention Part 2

Ok, so unfortunately, I never got around to writing the second example for this that I promised in the previous post but now I have some free time so I'm going to write it now.

Example 2:

In the first example I went for a very common type of OCD, I thought for this example I would look at one which is less common and show that the treatment is essentially the same with just a few refinements.

So the example I have decided to cover is perhaps one of the most disturbing and certainly a difficult one for non-OCD sufferers to understand. The example is a person who fears he has or will do something really terrible, in this case murder someone.

This may seem an extreme example but I have chosen it because it shows the opposite side to the illness, one where the compulsions and obsessions are harder to spot and many of the compulsions are done internally and how we may combat this.

Step 1:

As before we begin by making a hierarchy, I'm going to try and do this one in a little more detail as I believe its harder to put together than in the original example.

So we have highlighted that our Obsession is that we might be a murderer, it is now important to notice our compulsions that go along with this, both external (things we actually do) and internal (things we think).

Note the following list is not exhaustive but should provide a basis to work from.


1) Avoiding certain objects that could be used, i.e. knives.

2) Avoiding being alone with people.

3) Avoiding things containing violence such as music, movies, games, the News.


1) Repeatedly telling yourself your a 'good person'

2) Giving yourself reasons endlessly as to why you wouldn't do that

3) Comparing yourself to killers of the past, noticing similarities, desperately trying to find differences.

So we have now highlighted some external and internal compulsions, many sufferers are good at spotting their external compulsions but struggle to spot internal compulsions, successful treatment requires stopping both external and internal compulsions.

With these compulsions we can now as before create a hierarchy:

The Hierarchy:

We will now set our hierarchy as before and work down the list in order of difficulty (the order and contents obviously vary for each person)

1) Listening to music that talks about a killer - Difficulty 15

2) Watching a fairly violent movie - Difficulty 25

3) Watcing the News - Difficulty 30

4) Watching a very violent/senseless violence movie - Difficulty 50

5) Deliberately looking for similarities between yourself and a killer without looking for differences. - Difficulty 60

5) Showing yourself that your not actually that good a person - Difficulty 75

6) Give some reasons why you might actually kill someone one day - Difficulty 90

7) Being alone with someone and watching a violent movie - Difficulty 95

8) Having a knife next to your bed at night while your partner is asleep next to you - Difficulty 100

Now we have our hierarchy we simply proceed as before by doing each of the following until the anxiety/ Difficulty drops to 0 and then moving on to the next and then adding things as necessary in the list until we have combatted the whole list.

Note: As before this is a long process and very difficult, it is often two step forwards one step back, it is not an easy or a quick fix. Seeing a professional is ALWAYS the best idea.

For much more detailed articles see


Anonymous said...
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Calvin Thomas said...

Well, I did wonder how long it would take before somebody left pointless comments.

I will however reply to the initial post, all the others will be deleted and if it continues I'll simply stop comments or require registration. I truely hope that these posters are simply young teenagers who will grow out of this, it would be very sad if they were not.

In response to the initial post, first of all I am assuming the first comment was left as an insult however I didn't find it very insulting, I am a Christian and believe the Bible, is that what constitutes being a Bible Basher? If you are implying that I spend all of my time reading the Bible then you are mistaken, if you'd genuinely like a discussion on the merits of believing the Bible feel free to post comments arguing your side and I will gladly respond.

In response to the second, I should possibly have made myself clearer, I am sorry, I should have noted that I was going for software that is legal, also I would hazard a guess that you haven't tried the software I suggested, if you have and have any reasons as to why you don't think the software I suggested is a good option, please let me know.


Anonymous said...

wow, ur site is amazing, what an inspiration. i am also a christian and i think its brilliant what you do on these things. Thanks