Imaginal Exposure You may be thinking, What if my fear is about doing something unacceptable to me or to society? I can’t do exposure with something that hurts someone or permanently changes who I am! To do ERP for ideas, we need to be more creative. Here’s where mindfulness plays a key role. To do exposure in the mind, we must create maps to guide us to the fear. We then follow those maps through a process called imaginal exposure. Another term for imaginal exposure that you may hear is scripting. It’s called this because you write a story, or a script, in which you describe your fear as if it were coming true. In an imaginal exposure script, you are writing that which will generate your discomfort. You are practicing inviting the worst of the worst instead of running from it. With each statement, you are trying to raise your discomfort level and hold it there. At the core of mindfulness is acknowledging that these are the thoughts going through your head. Rather than have you compulsively deny or avoid these thoughts that are going through your head, an imaginal exposure script blasts them from a megaphone. If you consider your unwanted thoughts to be like a train passing through your head, imaginal scripting is a way to pull it through. Compulsions are futile strategies for stopping the train, something that only results in more pain. An imaginal script typically starts with a basic admission that you have done something wrong, that you are currently the embodiment of something unacceptable to you, or that you will engage in some future behavior that’s intolerable. Here are some generic examples:
I will think about this obsession forever. I’m this kind of person. I will engage in an unacceptable act. I did a terrible thing.
See if you can use your mind in this moment to distill what you are afraid of and say that it’s true. Whatever crime you are compulsively trying to convince yourself isn’t real, go ahead and write it down here. Don’t be surprised if this brief activity is extremely triggering, and don’t beat yourself up if you feel unready to put these words to paper. Let yourself be aware that right now, this is an exposure, and try to allow yourself to feel whatever it elicits in you. If you were up to the challenge, then you’ve just written one of the worst things you could find at the far outskirts of your mind. You might feel your anxiety ramping up a bit with urges to analyze and process what you wrote. Usually when your intuition begins to talk, you jump in and shut it up with a compulsion. Here you will let it talk and talk and talk (this is the exposure), and you will resist reassurance and avoidance (this is the response prevention). So let’s use the mind to travel to the next scary stop on the mental landscape. What will you have to do next, now that your fear is a reality? Now that I’ve admitted this, I will have to… You may be feeling pretty uncomfortable right now. We’re not going to invest too heavily in a full-on exposure script right now, because you’ll be guided through that in part 2 for your specific obsession. Right now we’re just looking at the blueprints of the skill you’ll need to develop. So try not to take it too seriously just yet. If you need a break, take one and then come back. If you’re ready to move on, let’s consider that you’ve just written about engaging in some unacceptable behavior. What happens next?
How are you affected by the knowledge that you have acted on your fears? How are others affected by it? What will they do now that your fear has been realized? How do you respond to their reaction? What kind of person does this make you? How will you be punished for what you’ve done? Literally? Spiritually? Emotionally?
At what point are you incapable of taking it anymore? Then what happens?
When you attempt imaginal scripting, you have to be willing to let the OCD annihilate you. It’s learning how to take a punch, basically. It’s a different kind of fighting the OCD. It’s not trading punches. It’s getting in the ring and letting the OCD pummel you over and over again. But eventually, the OCD runs out of fuel / information. Pema Chödrön (1991, 105) describes a teacher’s metaphor of being knocked down by waves and repeatedly standing up again, despite the appearance of a new wave each time: “The waves just keep coming, but each time you get knocked down, you stand up and keep walking. After a while you’ll find that the waves appear to be getting smaller.” As with any exposure, you have to repeat it for learning to take place. There are two ways to repeat imaginal exposure.
One is to rewrite the story from scratch every day. Devote twenty to thirty minutes every day to entering that scary space in your mind and obsessing as hard as you can without doing compulsions. The story may change each day as you come up with new ways to generate that feeling of fear, but the script still follows the basic format described. Try to remember that the goal is to get that feeling going. That feeling is what you are avoiding as much as the individual thoughts. That feeling is what you need to learn to stop overresponding to.
Another strategy is to write one strong script and reread it several times in a row until you habituate to the discomfort. Or you may record your script in an audio format and play that recording back multiple times each day. The only danger with these approaches to imaginal scripting is that you may have a tendency to “zone out” when you reread or relisten to your script. This can be counterproductive. For scripting to work, you must obsess but, paradoxically, stay mindfully present with the material. That is what generates the discomfort for exposure. If you mentally wander off, you won’t see the same results.
General Exposures General exposures are not used as individual exercises but as constant reminders. The purpose behind a general exposure is to condition yourself to stop being surprised and impressed whenever a trigger comes up. This creates an environment of no escape, making it impossible to act on compulsions that feel effective. A good way of doing a general exposure might be to put a picture on the desktop of your computer that reminds you of your obsession. You can also take sayings, words,numbers, and so forth, and place them on sticky notes throughout your home. Take them down when you have guests if you’re concerned about it, and then put them back up when your guests leave. Wear clothes that remind you of your obsession. Drive through specific areas on the way to work that remind you of your obsession. Make your obsession something that cannot be avoided. Through this, you can begin to break down your resistance to the presence of the thoughts and move toward mindful acceptance. You will, of course, find these reminders upsetting at first, but they will stop bothering you in time. You’ll get triggered and feel an urge to do compulsions, but then give up because you’ll just get triggered again later by some other reminder. Once you get used to not responding, the general exposures stop being so threatening.
Flooding in the Moment Another ERP technique is to take the content of your thoughts, the experience of your feelings, and the intensity of your physical sensations and exaggerate them. Flooding a thought means taking that thought’s contents and purposefully magnifying them. This can come in the form of agreeing with the statement behind the thought, adding more aggressive language to the thought, or trying to increase the discomfort of your anxiety as a direct response to being triggered. You can use more-intense flooding as a short, internal-monologue version of an imaginal script. The thought may start with something like, What if that speed bump I just ran over was actually a body? The flooding exercise would be to respond with, It was a homeless man, and I just ran him over. He’s dying, bleeding in the street, and I’m going to wake up tomorrow with the police at my doorstep, here to arrest me for fleeing the scene of a crime. If you feel that you can go there in this moment, try to write a short flooding script below for your obsessive thought. Remember to resist the urge to analyze or neutralize how it makes you feel; instead intentionally raise the intensity of your discomfort.
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—-oooO—-
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———–Oooo—
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—-oooO—-
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