Updated: Jan 3, 2021
Having gone through proper OCD treatment (CBT/ERP), I have had some interesting dilemmas arise in the context of treatment itself. Recognizing opportunities for exposure have developed a strong salience over the years. I found myself consistently aware of times where I could do exposure. Things began to get tricky, because as you can imagine, the OCD-mind is a master at spotting triggers, especially with contamination fears. When I would be going about my day and recognize an opportunity for exposure I would begin to wonder if I should do the exposure every time I'm aware of it. An example would be walking by an elevator (that I didn't use) and having the thought "Touch the elevator button, it will be a good exposure". Does this mean if I don't touch it I'm avoiding? I wouldn't want that. If I do touch it, am I doing exposure compulsively (as a way to make sure I'm not avoiding)?
When I wash my hands in a public restroom I prefer NOT to look in the sink because if I see something "contaminated" I may end up washing excessively; an occasionally helpful principle of out-of-sight-out-of-mind. However, if I intentionally look in the sink and don't see anything triggering, then I feel reassured. I don't want to be avoiding but I also don't want reassurance. The most anxiety-provoking situation would be to look in the sink and see something I deem contaminated, however, this doesn't always occur. If I look in the sink, was my intention to get reassurance or to expose myself further?
I was listening to an episode of The OCD Stories podcast a while back and the guest was Dr. Steven Phillipson. Dr. Phillipson was one of the first psychologists whose articles and videos I stumbled upon in early recovery and his content always resonated with me. In this particular episode, Dr. Phillipson gave a name to the phenomenon that I described above and have experienced countless times in my life; he called it The Two-Tail Spike.
The two-tail spike is essentially being unsure if the action or inaction we took or are about to take has moved us further toward recovery or away. When the two-tail spike occurs, we need to make a decision and be open to having possibly made the wrong choice. So maybe we just did exposure compulsively, or maybe we avoided. I suppose we'll never quite know. In my case, I would either look in the sink or not and touch the elevator button or don't. Perhaps I moved towards recovery or maybe I moved away. It's a possibility I'll have to live with because getting stuck in rumination is not the kind of life I want to live, and I doubt it is for you either.
On a side note, this is why having planned exposure that is done at set times can be helpful. One reason it is helpful is because the decision is already made, we are doing this particular exposure at 1 pm today, no if, ands, or buts about it; the two-tail spike becomes less relevant. Secondly, it gives structure to our recovery program and makes our recovery process more quantifiable.
My suggestion is to vary your behavior. Back to the elevator button scenario. Sometimes I will touch the elevator button in response to my thought that I can touch it for exposure, other times I won't touch it when the thought comes up. Regardless of my particular response, I'll have to accept not being sure whether I just practiced avoidance or engaged in compulsive exposure.