Exposure to Life’s Uncertainty

Pittsburgh Therapy for OCD Uncertainty

Your therapist asks you to open a door with your bare hand instead of using your sleeve, and think of the possibility that you may have just touched dangerous germs.

or has you write a story about the possibility that you may have hit someone with your car on the way to your appointment and failed to notice it happening.

Or requests that you make a list of all the ways your interests, beliefs, and personality might change in the future.

If you are engaged in Exposure and Response Prevention (ERP) for OCD, you may have completed similar “exposures” to those listed above. And it would be easy to assume that you and your therapist are simply creating artificial scenarios in an effort to trigger your anxiety. But the truth is that your exposures, rather than being artificial situations, are actually meant to expose you to an important aspect of reality. They are meant to reveal to you life’s uncertainty. When you are struggling with OCD, you start to experience strong, negative emotions in response to life’s uncertainty, and develop compulsions (aka rituals) in an effort to remove that uncertainty. And so, you stop touching unfamiliar surfaces with your bare hands, or start repeating your route to work to make sure you didn’t hit anyone along the way, or create a scripted statement about never changing who you are, and start reciting it to yourself several times a day.

The truth is, however, that your compulsions (not your exposures) are the actual artificial scenario. At best, rituals only manage to provide you with the illusion of certainty, but they never actually remove the uncertainty in life. Almost everything in life is uncertain. How things will go with your grades or your friends or that upcoming job interview. What your actual desires and intentions might be. How life might change you in the future. Whether you’ve picked the absolute, perfect partner to marry. The accuracy of your memory. What bad things might happen to you or your loved ones in the future. All of these things are susceptible to doubts, if you really start to think about them. So as you involve yourself in exposures, it’s important to remember that neither you nor your therapist actually know, with absolute certainty, that there aren’t dangerous germs on the doorknob. And neither of you can completely rule out the possibility that you might have hit someone on the way to your appointment and not noticed it. And who knows how life might change you in the future. Your exposures aren’t meant to prove to you that your OCD is wrong, or that your fears are ridiculous. They are designed to help you accept the inevitability of ‘not knowing’ for certain, and practice living without your rituals despite the risks involved.

Life’s uncertainty is always there, right in front of you, accessible whenever you wish to think about it. And the goal isn’t to become some sort of uncertainty junky, constantly thinking about how uncertain life is. That would be awful and intolerable for anyone. The goal is to be able to accept, and live with, uncertainty. Because the alternative is not living a life at all.