Updated: Jan 3, 2021
I may develop a life-threatening condition and die any day now. Perhaps writing this is increasing the likelihood of it coming true (thanks The Secret). These are not pleasant thoughts to ponder, but despite their probability or improbability, they are still possible outcomes. Accepting these outcomes as possibilities is no easy feat, and acceptance itself is a rather abstract concept. However, if these are my core fears in life, it's important that I acknowledge, explore, and accept them, especially if I don't want to get bogged down in mental rumination over them. It's important for me to be open to my core fears because, after all, they are possible realities, and I'd like to live in reality and not a dream world.
OCD sufferers may not get the full benefits of recovery if their core fears aren't acknowledged and incorporated into treatment. The reason for this is that by not allowing ourselves to be open to the possibility of our worst fears occurring we are not embracing uncertainty and holding space for our fear. Embracing uncertainty is one of the ways in which we recover from OCD because we begin to learn that fear doesn't have to control us.
We embrace uncertainty by 1) acknowledging our fears, 2) accepting them, 3) doing exposure, and 4) living our freakin' life. There is a technique known as The Downward Arrow Technique. It consists of essentially identifying a fearful scenario and then asking ourselves "If this fear came true then what?" Not in the sense of our fear coming true not being a big deal, but rather how much worse can it get...like really. Not exaggerating our fear to the point it sounds so preposterous that it doesn't bother us or gives us reassurance, but rather REALLY thinking about what we're afraid of and what the next tier of that fear looks like. We repeat this process until we identify our core fears. Often times this can come about from just talking about the fear or even thinking about it. A more traditional downward arrow may look like this, for example, The pain in my back might be a malignant tumor and the doctor could have missed something > Doctor's might continue to miss it > It may progress and metastasize > I'll be in tremendous pain and have to go through miserable treatments > I won't be able to do the things I love > I'll fall into a deep depression > My partner might leave me > I may end up dying. While this ends with me dying, that is not my core fear. When I take the summation of my downward arrow I can extrapolate that I'm really afraid of physical pain, abandonment, and a large decline in life satisfaction. I can spend a little time looking for my cognitive distortions present in the fears and challenging some of my automatic thoughts in such a way I can create a more realistic story. For example, I may actually not get cancer, or if I do I may be treated successfully, but no matter what alternative story I come up with there is always the possibility that things take a turn for the worst. Hence, why I need to be open to this possibility. From here I can begin to think how my ideal self would hope to cope with my worst fear(s) coming true. Perhaps I'd join a cancer support group, or use the time to write. When I begin to think of how I would cope with the feared outcome, I am then allowing myself to mentally and emotionally open up to these frightening possibilities and in doing so allow myself to accept them a bit more. Another thing I can do is direct exposure-response prevention. I can watch videos with a cancer theme; I can read an imaginal script of me dying of cancer all alone; I can read stories about cancer. As I continue to practice this with various fears in my life I begin to grow more tolerant of the discomfort they produce. I also move toward acceptance of my thoughts, feelings, and the possibility of the feared outcome itself. As a result, it becomes easier to enjoy life in the present.