OCD has infiltrated just about every aspect of my life at some point. When I was in high school I used to be terrified that red marks on the desks were blood carrying threatening pathogens; I would spend significant amounts of time trying to determine whether the spots were blood or not. When I would play basketball I would be concerned that I was playing too aggressively or actually trying to hurt someone on the court. In romantic relationships, I'd doubt whether I did something immoral that would threaten the relationship, such as flirting with another person. At the gym (amongst numerous other places) I would question if I was rude or inconsiderate toward someone. One thing all these behaviors have in common is they are things I genuinely want to do and help me live a fulfilling life. I wanted to be at school, I liked basketball, I desired a connection with my partner, and the gym was my sanctuary. The quality of my experience with these behaviors was negatively impacted due to OCD.
At various points in my life, I would engage in behavior I wasn't proud of, such as vaping. During my vaping phase, I became highly concerned with whether or not the vape liquids I was purchasing were tainted with some kind of psychoactive chemical aside from nicotine. Often times I would feel different after vaping, and not in a nicotine-related way. This scared me so I would begin researching the companies who produce the products and see what kind of regulations they abided by. In short, I was looking for reassurance that the products weren't tainted with other substances that would intoxicate me. I brought this concern to an OCD therapist once and it was suggested that I continue to vape for exposure. Now, the difference between this behavior (vaping) and the others (basketball, gym, relationships, etc.) is that vaping is not something I genuinely wanted to do long term. In other words, the first set of behaviors are congruent with my values (what I genuinely desire), while vaping is not.
So what is one to do when there are obsessions and compulsions caught up in behaviors that are not congruent with our values? A behavior for one person may be value-congruent while the same behavior for another person may be value-incongruent. I am not the arbiter of what anyone's values should be, however some behaviors that may be value-incongruent more often than value-congruent are: pornography/unsafe sex, drug and alcohol use, and lying just to name a few. From strictly an exposure-response prevention perspective, the answer to my question is to keep vaping. For someone who watches porn (and doesn't want to be engaging in this behavior long term) and is afraid they see people who are underage on the internet, the exposure is also to continue to watch porn. For the person who smokes cigarettes and is concerned they are contaminating their cigarettes with "dirty" hands, the exposure is to contaminate the cigarettes and smoke them. The problem with following through in this way is that even if exposure is successful, the individual is usually left feeling bad because the behavior itself is incongruent with his or her values, therefore threatening the person's integrity. I prefer to look at the obsession within the problem behavior as a cue hinting at taking action steps toward behavior change that will be more in line with our values.
For some sufferers, it can feel as though we are not progressing or maintaining our recovery gains if we are doing compulsions within problem behaviors. I believe it is better to use the awareness of OCD within the problem behavior as motivation to do exposures in other OCD domains as well as to take actions leading us toward a more fulfilling life, which generally tend to be value-congruent behaviors.