November 13, 2010

Feared Outcomes - An important step to consider.

I have been doing ERP now for about four months.  I have read many OCD books, and all of them discuss the importance of doing Exposure & Response Prevention in order to recover from OCD.  However, Dr Jonathan Grayson takes it one step further in his book “Freedom from Obsessive Compulsive Disorder”.  He emphasizes the necessity of getting in touch with your feared outcome (s) related to your specific OCD fears.  This is particularly important, because one can have several different feared outcomes related to one specific OCD fear, and if they are not addressed, recovery may not be possible, or may take longer. 
Discussing my feared outcome (s) is not something my OCD therapist has initiated, and my OCD therapist is from one of the larger OCD treatment facilities in the United States (we Skype on a weekly basis).  Why hasn’t she delved further into my OCD fears to help me to understand what my feared outcomes are?  I have no idea.  But it certainly does remind me that it takes years of experience in treating this emotional disorder to become thoroughly familiar with the way the disorder manifests, and skilled enough to treat it effectively.  (My therapist is relatively "young" in the field.)  That being said, my therapist is much better than the one I had until three months ago (he was giving me reassurance that my fears wouldn’t happen!), and I am making progress.  So – I have decided to use Dr. Grayson’s book as a “supplemental therapist”, and I have done the “Feared Outcomes Exercise’ myself. 
I have found that knowing and addressing my specific feared outcomes has helped me a lot, perhaps because most of my rituals are mental in nature.  Every time I exaggerate my fear in my head, I exaggerate it to the point of my feared outcome coming true.  I then remind myself that although my feared outcome coming true would not be an ideal situation, that I would have to learn how to cope. 
Two of my feared outcomes related to HOCD are:
1.       That I am in denial about being gay and that someday I will suddenly realize that I am a lesbian and will have to break up with my boyfriend and leave the life we have built etc etc.
2.       That I am missing out on the chance of true (perfect) happiness by not becoming gay (ie: there is someone "better" out there for me and it may be a female)
Two of my feared outcomes related to ROCD are:
1.       That I am missing out on the chance of true (perfect) happiness by not breaking up with my boyfriend. (ie: that there is someone “better’ out there for me)
2.       That I am in denial about loving him, and someday I will realize that and either have to leave him or have to live with him forever, unhappy and unsatisfied. 
I also have the fear that I don’t really have OCD, and that I might be better off in Psychodynamic Therapy.  And the list goes on………
Notice the irony here?  On one hand I’m scared I’ll have to leave my boyfriend because I love him, but on the other hand I am scared that I’m in denial and that I’m missing out on true happiness.  OCD just doesn’t make sense, which is why logic doesn’t work when battling this disorder! 
My next step is to do some script writing.  I plan to do some imaginal exposure, write out some scenarios where my feared consequences come true, and tape them.  I will then listen to the scripts several times per day.  I have been avoiding this task, because I know imagining my feared outcomes so vividly will give me a lot of anxiety.  I have been avoiding my thoughts for so long now that I don’t even know if I will be able to do it.  It’s my goal for this week. 
Have any of you gone through the process of considering your feared outcomes? 


  1. Definitely! I have found it really helpful to consider my feared outcomes, as well, in part because, even though I have a lot of the stereotypical contamination compulsions, my feared outcomes aren't necessarily the stereotypical ones. I don't fear getting sick or getting others sick. Instead I fear that my "true self" is some sort of lazy, filthy, unmotivated slob, and that, without my compulsions, without being so careful to do things "correctly" that I go to extremes, I will devolve into that filthy, lazy person I fear I might "really be" and won't know how to handle the shame and horror of my own slovenliness...yeah. Fun times.

    Anyways, I have found pinpointing some of my feared consequences helpful because it changes the way my therapists and I approach my exposures. A lot of times if my therapist gives me "permission" to do something "wrong" by assigning it as homework, it loses a bit of the threat that it seemed to hold before. Now, more and more frequently, I am given assignments but am forced to face the uncertainty of the subsequent questions that arise on my own. Like, "I'm supposed to touch this, but would my therapist really condone this exposure if he knew I was then going to touch this other thing and do this other activity? Would he think that it was imperative to wash in this situation if he knew the specifics of what's going on?"

    My feared consequences seem to morph as well over time. As I have gradually gotten better, OCD has jumped around, finding new ways to justify the same old compulsions it thrives on. Keeping up with it is sometimes hard, but ultimately, no matter what the underlying feared consequence, the treatment is the same: do the exposures despite whatever new, convoluted reasons OCD comes up with to avoid them!

    Good luck with your script writing! I have done a little bit of that, too, and I found it helpful, particularly for my fear of being an "OCD fraud."

  2. Fellow - thanks! Yes I agree - knowing your feared outcomes also changes your approach to exposure - makes it more "specific" and less generic. For me - it's one thhing to walk in the gay area of town, but there could be lots of reasons why I fear walking in the gay area of town. Knowing exactly why this scares me is important. I agree - feared consequences seem to morph a little as well as time goes on. OCD definitely finds a way of getting back into my head even when I think I've faced the fear.

  3. I also worry that I don't have OCD. For example, the psychiatrist only said I had depression with ocd symptoms. So maybe I'm lying when I say I have OCD. Appearently my fear is one of lying? Because then I'm sinful? But I already know I sin, so what's the big deal? Good reminder to look for what I'm really afraid of.

  4. First of all, I recognize so much of myself in this! Have you asked your therapist about feared consequences? In my own case, I spent the first 2 months in OCD therapy trying to conduct my own parallel therapy by reading 12 books on ocd, and not cluing in my therapist about my perfectionism about therapy. I think it's good to be direct--say you read about it in Grayson's book, and have started working on it. It was hard for me to do the feared consequence stuff--because like you, I spent so much time avoiding the thoughts.

    My therapist was telling me he had a client who was afraid of marrying her boyfriend because she'd never been with anyone else--and how did she know she wasn't missing out. He said she eventually learned to cope with the uncertainty--since she wasn't prepared to sleep with random men to find out, and even then, how many would be enough?

    I was in terror at age 20 that if I stayed with my boyfriend, I was missing true happiness because I might be a lesbian--the uncertainty was very painful, but what I didn't realize is that the OCD wasn't telling the truth--breaking up with him wouldn't have solved my fears--it would've latched onto something else--like, "Is this woman really the one I'm meant for?" or "Did I make a mistake breaking up with him?"

  5. Exp Woman - I definitely agree that I can get perfectionistic about OCD treatment. I often wonder "is this the best OCD therapist? If it's not - will I get better?" And on and on it goes. I had a similar ROCD obsession to what your therapist identified with my high school sweetheart. In he end, we broke up and obviously I'm happy now. That being said - I could very well have been happy with my high school sweetheart too, but I'll never know! Yes - OCD promises certainty if you just follow it's "rules". I have to remember that more. Prior to my last therapy session, I emailed my feared consequences and some written exposure scripts to her. We reviewed them, and I've been reading my scripts over 5 times/day. That seems to really help!!!

  6. Exp Woman - further to above - I would be interested to hear about what type of exposure you did to overcome your fears - or were you not in therapy at the time? Your feared outcomes from back then seem similar to mine, but you were able to get past it - there is hope!

  7. That's cool you emailed the feared consequence stuff to your therapist! I wasn't in therapy when I had the obsessions about my boyfriend--I didn't even know I had OCD. That was 23 years ago. I married him, and love him dearly. There is hope! The exposure was choosing to stay with him and marry him in spite of all the thoughts--I didn't know it was exposure at the time!

  8. Expwoman - thanks for the hope! You are right - little did you know but you were exposing yourself to your biggest fear by choosing to marry your husband despite all the thoughts. I can say that was very brave!!!

  9. Hey! I know this is a late response since this post is from last year, but I am just starting my ERP with my therapist, I'm into the first week of listening to my exposure recording of a scenario where I leave my husband, because, to quote you, I fear "That I am in denial about loving him, and someday I will realize that and either have to leave him or have to live with him forever, unhappy and unsatisfied." Your two explanations of your HOCD and ROCD are WORD FOR WORD my experience. I have overcome the HOCD by just embracing it, even making fun of it with my husband. I am still stuck on the "What if I don't love him?" thing but that is why I am doing the ERP. I know I need to embrace the uncertainty! Anyway, just wanted to thank you for posting this.

  10. Lindsay - thanks for your post!!! I totally agree with embracing it and the humour aspect. My therapist and I often do that, and it really seems to help!!! I hope you will keep reading and commenting - it's so great to interact with others who are experiencing the same thing! Thanks for commenting!!! Good luck with ERP - I find it very difficult, but it works!!!