Response Prevention: Living As If

In a previous post, I raised the question “What if?”  The words following “what if” can have a powerful influence on our behaviors.  Today I write about a related topic, “living as if.”  I took this phrase from the title of an interactive journal produced by The Change Companies.  The journal explores how one’s beliefs and assumptions about the world affect his or her behavior.  We live and act as if many things are true, even when those things are not guaranteed or are not accurate.

For example, when you approach a chair to sit down, you do not have a guarantee that it will hold you up.  But you sit down as if it will.  You might make a plan to see a movie with a friend in the evening.  You then go about your day as if those plans will come true, turning down other invitations and scheduling your day so you arrive at the theater on time.  In these examples, the assumptions are probably accurate.  Chairs usually hold us up.  We usually carry out plans with friends.  Occasionally chairs collapse, and people cancel plans at the last minute, but that doesn’t mean we refuse to sit or make plans.

Other assumptions or beliefs may not be accurate, or they might be unhelpful, or they might be misplaced.  People often encounter problems when they act on those kinds of assumptions.  If someone assumes they are not worthy of love, they may not demand respect from others.  They might stick around in unhealthy relationships.  Then the assumption becomes a self-fulfilling prophecy.

So how does this relate to OCD and ERP?  Here’s a possible scenario.  A young man has an obsessive thought. “That door knob looks dirty. What if I get sick and die?”  He proceeds to live as if the fearful thought is true.  He uses his sleeve to open the door.  When he gets home, he takes off the dirty shirt, washes his hands three times, and puts on a clean shirt.  Living as if the obsession is true.  Living as if rituals solve the problem.  Losing a chance to learn that the fearful thought might not be true.

A new mother thinks, “What if I hurt my baby?”  She starts to live as if she must protect the baby from her dangerous self.  She stops bathing the baby.  Stops using knives.  Refuses to be alone with the baby.  Stops using plastic bags at the grocery store.  Living as if the obsession is true.  Living as if avoidance and rituals solve the problem.  Losing a chance to learn that the fearful thought might not be true.

Sometimes it is helpful to decide to act as if another assumption were true.  The boy and the mother can make the self-fulfilling prophecy effect work in their favor.  They can decide to live as if the thoughts are not true, as if they don’t have OCD.  This is different from trying to convince oneself that the feared thing really is not true.  That process becomes it’s own torturous figuring-it-out ritual.  No, what I mean is deciding to live as if you won’t get sick from touching a door knob, as if you won’t kill your baby, or as if whatever obsession plagues you is not true.

There is no way to predict whether such things will happen, although they typically are low-probability events.  In the meantime, you can live as if it is okay to act differently than OCD suggests.  This seems to be the heart of response prevention.  Deciding to act as if the bad thing might not happen.  Deciding to act as if you will be able to handle the bad thing if it does happen.  Deciding to act as if you can overcome OCD.

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