This article offers some guidance regarding how to handle some experiences that people with OCD deal with.
Case #1: An Average Trigger or No Trigger
You’re walking down the street minding your own business when your obsession comes into awareness. There may have been a trigger or it may just have occurred to you out of the blue. It scares you, and your natural instinct is to start trying to figure it out. Or maybe your natural instinct is to try to push it out of awareness. You need to refrain from doing any of the above. Don’t try to solve it; don’t try to push it out of awareness; and don’t direct attention towards it. Let it be there, do nothing about it, and get back to whatever you were doing. Just remember that this requires a clear decision to refrain from rumination, as well as an understanding of the difference between awareness and attention.
Case #2: Sticky Days
Even on a day when the obsession is very present in your awareness, you must remain stalwart in your decision to refrain from rumination. Make the clear decision not to ruminate, and recommit to this decision any time you find yourself engaging with the obsession at all.
Remember that even directing attention is a form of engagement. Distinguishing between awareness attention is key on days like these. For help with this distinction, see here and here. Keep in mind that the distinction between awareness and attention is sometimes blurry (and trying to be too precise about this distinction will just lead to further engagement). So do your best to refrain from directing attention toward the obsession, without trying to push it out of awareness. The fact that it’s in your awareness doesn’t mean you’re ruminating, and as long as you refrain from attending and analyzing, things will eventually ease up.
The less you engage, the faster things will ease up. The more times you practice doing this, the less concerned you’ll be about days like this. The less concerned you are, the less you’ll engage. It’s a great cycle.
To help you refrain from ruminating, get involved with something else, like an activity or an unrelated thought process. You’re not trying to push the obsession out of awareness. You’re just getting involved with other things to make it easier to refrain from ruminating.
Case #3: A Major Trigger
Sometimes a trigger will make you feel like you’ve been punched in the gut and thrown into a vortex of terror and rumination. It’s like you’ve stepped into another dimension where your worst fear is eminently true and no evidence to the contrary seems to exist. Know that you are not alone in this experience: Most people with OCD have moments like this, when they are completely convinced that the worst is true.
This isn’t the time to give into compulsion: This is game time. Every exposure you’ve ever done was in preparation for this moment. This is the time to redouble your commitment to refrain from rumination (and any other compulsion).
But it’s really hard to refrain from rumination when you’re so physically upset, so when you’re majorly triggered, it’s important to calm your body down as much as possible. First of all, make sure that you’ve been eating, drinking, and sleeping enough; if you haven’t, address the problem. Next, it’s time to whip out your relaxation and distress-tolerance skills such as deep breathing, vigorous exercise, a hot or cold shower, or whatever you know calms you down. To be clear, these strategies are not meant to solve the problem; they are only meant to help you calm down so that it’s easier to refrain from compulsion. To reiterate that, these skills are only valuable inasmuch as they help you do what is actually important, which is to refrain from compulsion.
Remember to be compassionate toward yourself as you do your best to minimize rumination. It may not be possible to be perfect when you’re this scared. Just do your best to weather the storm, while doing everything you can to refrain from rumination as much as possible.
By not ruminating or doing any other compulsion, you are giving yourself the opportunity to learn that even intense episodes like this eventually pass on their own, and that you don’t need compulsion to get you out of them. The more you refrain from rumination during these episodes, the shorter, less intense, and less frequent they will become.
(Notably, encouraging the use of ‘coping skills’ is a practical ramification of discarding the idea of habituation in treating OCD. People who believe in habituation would actually tell someone not to calm themselves down, and to instead ‘lean into the anxiety.’ Since Rumination-Focused ERP discards the idea of habituation, and focuses on the elimination of compulsions, anything that facilitates the latter is encouraged.)