Is There a Difference Between Being Open to the Possibility of the Worst-Case Scenario and Going Along with It by Reading a Script?

[deValentin]

*Warning: samples of harm and blasphemous OCD scripts*

Recently a very interesting topic came up on the forum: the suitability of reading a worst-case scenario script to treat OCD. I’d like to share my thoughts on that topic and know what other members think. I already had some feedback from some.

I agree that we need to stop arguing with our OCD thoughts. We need to recognize that OCD is right in at least one domain: the worst-case scenario is possible. It’s useless to try to prove the opposite. The more we desperately try to take preventive measures or find irrefutable arguments to eliminate the possibility of the worst-case scenario, the less we manage to do it because our imagination is boundless and nothing is absolutely certain in this world. So, I understand the need to be open to the possibility of the worst-case scenario instead of trying to eliminate it at all costs, so it doesn’t grab as much our attention at the expense of normal living.

However, there is a difference between being open to the possibility of the worst-case scenario and going along with it or uttering words that are contrary to one’s beliefs. Some people call that last method making the unthinkable thinkable. Here are some samples of OCD scripts found on the internet to dedramatize the content of awful thoughts.

“I am going to snap and hurt someone. I will take a knife, cut my girlfriend's throat, then turn myself in and spend the rest of my life on death row awaiting execution.”

Maybe I take advantage of God’s grace by committing sins while just assuming He’ll forgive me. F*** God, F*** Jesus, F*** the Holy Spirit! Is that what I really think? Is that how I really feel?

The question is, do I want to trivialize the content of shocking thoughts or rather play down the fact that they may pop into my head from time to time?

In a variation of script reading, some people watch highly violent movies that make them feel uncomfortable to treat their harm OCD. Is it really necessary? I don’t want to be desensitized to gratuitous violence. I just don’t want to spend my life being compelled to eliminate all kinds of far-fletched possibilities instead of focusing on the here and now. I just want to get used to the fact that there are no absolute guarantees in life. Yes, anything could happen, I concede to that, but right now I’m trying to live my life in such a way I have no reasons to believe the worst will happen and content myself with those reasons in spite of the difficulties. Isn’t that good enough?

[Natureloverpeace]

While there isn’t a guarantee that a worst-case scenario won’t happen one can learn to differentiate their voice from the voice of OCD , know what their values are and know themselves well enough that they trust themselves to act according their values. Being confident that one isn’t a monster who is going to commit a worst case horrendous act that goes against their values doesn’t provide certainty but it is more than good enough.

[IStillHaveHope]

Hrm... Interesting point. I'm not a psychologist by any means, but I have studied it at college and continued to do so as I found it interesting. I'm saying this because, from what I know, facing what we are afraid of gradually, is the best way to reduce that fear over time. We grow accustom to it and our brain learns that this is not a threat. I have also read in some OCD books/threads is that the point of these techniques is to make yourself so bored with going over the subject that you're brain doesn't want to think of them when you don't have to.

As for the question of down playing vs trivializing it probably depends on the individual, but I know for me downplaying did not work. I knew logically that what I was worried about was extremely silly and unlikely, but it did not make any difference on the intensity or interval. I know for me, with medicine, the thoughts can be intense, but they also seem to fade with time. I guess my opinion is, these thoughts are ultimately trivial, so why not trivialize them? I wonder if it may be a sort of obsession or fear for us to "hold on" to them since we are saying that this feeling may be important.

Of course take all this with a grain of salt. I may be way off base with this

[deValentin in reply to IStillHaveHope]

I understand what you mean. Unwanted thoughts are ultimately trivial, so why not trivialize them? They don't mean anything.

I guess my discomfort came from reading, for instance, a Prolonged Imaginal Exposure script where a client with sexual orientation OCD is asked to imagine in graphic details some type of homosexual encounter (Scripting for Success IOCDF 2023- San Francisco). Personally, I don't see the point.

[IStillHaveHope in reply to deValentin]

I have heard about some pretty intense exposures in the past. For example I heard of someone with contamination OCD being asked to touch the rim of a toilet and then go and immediately eat afterwards. For me this would go beyond an OCD thought and just be disgusting. Maybe it's knowing the difference that matters? Lean into the discomfort but not to the point of violating ourselves? Some sort of reasonableness when coming up with exposures? I do agree with you that it is possible to take them too far. IMO an exposure should be challenging, but not overwhelming.

Sometimes I have trouble knowing if something I'm concerned about is reasonable. I usually ask my wife about these. I wait for a while before doing so and then limit it to only 1-ask as I don't want to seek reassurance. This does seem to help me determining what is "reasonable". Sometimes what I'm concerned about is reasonable, but most of the time it isn't

[Natureloverpeace in reply to IStillHaveHope]

Sometimes ERP gets a bad rap because there are a few providers who turn an ERP exercise into an episode of the Fear Factor. This is overkill and not necessary. Those types of overkill exposures tend to be generalized to the theme of OCD instead of custom-fit to the individual which can make them ineffective. The individual needs to be treated, not the theme.

Great strategy on not seeking out excessive reassurance , that’s awesome!