So treatment focuses instead on getting comfortable with a constant lack of certainty, typically through a therapeutic practice called exposure and response prevention (ERP). It involves exposing yourself to a particular obsession while also resisting the urge to engage in the related compulsion, says Amanda Petrik-Gardner, LCPC, a Kansas-based licensed therapist who offers virtual therapy in multiple states for anxiety disorders and OCD. “So if you worry that not saying ‘I love you’ to your spouse will cause you to get into a car accident, we’ll practise having you drive without having said it,” she says.
You’ll initially feel much more anxious than if you were to just do the compulsion—in Bailey’s words, as if you’re taking “the biggest risk in the world.” One of the obsessions she’s worked with her therapist to challenge is that she’ll feed her dog using the “wrong” bowl and cause him to get sick or die (though nothing suggests an issue with the container). Rather than repeatedly swapping vessels, ERP requires her to just feed her dog anyway. Though the fear that something might happen to him still percolates in her brain, it isn’t as “hot” anymore, she says, after going through with feeding him many times.
Bullen has often done ERP with folks who believe that if they put an object down in the “wrong” way, something horrible will occur. The exposure involves having them plop it down in whatever way they deem incorrect and resist any urge to go back and move it. While they’re facing the uncertainty of the moment, Bullen is careful not to reassure them that everything will be okay—because it won’t serve them. Although she might be able to tell them with 99% certainty that something bad won’t happen as a result of how they move an object, their brain will still say, “But what if I’m that 1% chance?” she says. Instead, she uses “maybe, maybe not” statements to normalise doubt: “Maybe you move that pen and it has an impact, and maybe it doesn’t, but let’s learn to sit in that unknown,” she says.
Over time, ERP can help you acclimate to what’s often a deeply distressing reality for folks with OCD: Something tragic, terrific, or terrifying could unfold at any given moment, and no number of compulsions can ensure a positive outcome, however magical they may seem. “What happens is something called habituation,” Bullen says, which is kinda like what unfolds when you jump into a cold body of water. “Your body is shocked and telling you to get out, but if you stay in for long enough, you’ll habituate. The environment doesn’t change, the situation doesn’t change; your body and mind just adjust to it,” she explains.
Spiritual practices and beliefs can be a slippery slope for folks with magical thinking OCD
The tricky thing about the obsessions in magical thinking OCD is that they can sound like plenty of culturally accepted superstitions and spiritual practices. Consider ye old wood-knocking, or something like carrying a certain crystal, pulling a tarot card, or saying a prayer—all of them similarly purport to have an impact on your future that’s unexplained by logic or science. The difference is in how much significance and truth you assign to these practices. Plenty of people might see them as tools to support them on occasion, taking them with a grain of salt. But for folks with OCD, any of the above can become compulsions, meaning they feel totally mandatory and invoke distress and anxiety, Petrik-Gardner says.
