What is a written exposure?

For treatment of Obsessive Compulsive Disorder (OCD), exposure treatment can come in many creative forms.  In some cases the OCD fear is based on an imagined outcome, and an in vivo (live in the therapy room) exposure is not possible. This is especially the case with dangerous or horrific intrusive thoughts.  In this case, we may use a written exposure to desensitize our client to their terrible thoughts.  

We begin by helping our client notice that they feel significant distress at the very idea of writing their fear down on paper.  For some, creating and seeing a written version of their worst fear feels unmanageable.  In this case, we would start by just writing a single word, or even just a single letter.  In one pediatric OCD case, where vampire attacks were the obsessive fear, we began just by writing the letter V over and over on many pages.  

As the exposure proceeds, it is important that the client be in touch with their distress and acknowledge how uncomfortable this process is making them.  However, it is important that the client not do any of their comforting/soothing rituals during the written exposure.  

One established technique is to create a two column page wherein one side is a one-sentence summary of the dreaded intrusive thought, s.a. “I’m going to hit someone with my car” and the other side is a 1-100 measure of levels of distress felt upon writing this sentence.  The client can then proceed to write the sentence over and over, and continually evaluate and write the subjective level of distress, until the distress levels start to drop.  At some point, the exercise becomes almost boring and somewhat silly.  

While seemingly simple, this written exposure can be a powerful desensitization exercise to an intrusive thought that needs to be confronted in order to be dispelled.  
Please contact Kairos Wellness Collective for a free consultation if you are interested in Exposure Response Prevention Therapy.