Reading time: 1 min 12 sec
This post comes with a trigger warning.
Look what’s happened?! A trickle of blood in my mug! I’ve opened myself to this scenario—apparently, best attack.
I should blame myself. I’m usually strong-minded. But today, I feel an urgency to soothe myself, and it draws me to it.
It knows my HIV problem well—it gave it to me.
It doesn’t see me mentally creep up behind it. Something more pressing compels me to do it. My mind pushes it away.
I lift mug to mouth, uncertainty luring me back to safety.
Anxiety rises, plateaus. I resist avoidance, sip the soup, anxiety falls.
Exposure-response prevention session completed.
This one-hundred-word drabble shows how the story’s character faces exposure to an HIV-intrusive obsession. She struggles between avoidance (not drinking the soup) and avoiding avoidance (drinking the soup). The conflict arises from the threat element associated with OCD. For example, “But what if a drop of blood from the chef’s finger has dripped into my soup?”
Take the threat factor away, and her response is more flexible. For instance, “The likelihood that blood has dripped into my soup is close to zero. Even if it did, it’s reasonable to say that the chef may not be infected with HIV.” She might also say, “And on the off-chance that the chef is infected, it still doesn’t mean blood will be in my soup; after all, he might not have a cut finger. And even if he did have a cut, it’s probable that he’ll have put on a bandaid to cover the wound?’
There are lots of worst-case scenarios for this character, and she’s drawn to the reassurance compulsion during the exposure. But she stands firm and completes the task. That is, by continuing to face her fear with response prevention (not yielding to reassurance and avoidance). She gets a grasp on probability and works with it, realising that the likelihood of being infected with HIV is low and to take that risk and live with uncertainty.
In short, cognitive improvement helps her follow through with the exposure and lean into raised anxiety until it peaks and falls. With practice, her HIV-obsession weakens and the urge to use avoidance compulsions diminishes.
Exposure-response prevention therapy is explained in detail in my book “Desire-Intrusive Thoughts: What to Do When Sexual, Religious, and Harm Obsessions Carry Unwanted Arousal.”