Hot take: requiring people with OCD to expose themselves to their worst fears or other related strategies to reduce those fears is at best unnecessary and at worst harmful.

/1 The problem in OCD is not fear of harm. Fear of harm is a natural, normal expression of core values. People do not have to forgo their ethics/values to overcome OCD.

/2 Problems in OCD:1)view that it is possible & essential to establish w certainty that one has not caused harm 2) overgeneralized responsibility for harm 3) view that obsessional thoughts are the vector by which harm may occur; 4) compulsions have self-perpetuating mechanisms

/3 Compulsions are natural products of important values - e.g., to be caring, conscientious, kind, responsible, moral. This is a central reason they persist.

/4 People seek treatment when their obsessions violate self-values and/or their compulsions violate other self values (e.g., a compulsion may be an expression of being a caring person but compromises ability to be a conscientious person, something equally valued)

/5 Requiring people to "get used to" or "reduce their fear of" dreadful situations, such as molesting their child or transmitting a fatal illness, is telling them that they have to choose between giving up their values or overcoming their OCD

/6 AND the problem in OCD is NOT that people fear harm coming to themselves &/or people they care about. It does not make sense, then, to address the *content* of the obsession; we must address the factors supporting the OCD system.

/7 If someone is afraid of dogs they may avoid dog parks but the focus of treatment is on exposure to dogs and exploring ideas about dogs that sustain the fear.

/8 In OCD people may be afraid of, say, articles about cancer, but exposure is to obsessional doubt about cancer while not engaging in strategies to resolve doubt, exploring ideas about the need for/ importance of certainty, need to do compulsion, & overgeneralized responsibility

/9 Exposing people to the feared outcome represented in the obsession: 1) doesn't address factors supporting the OCD system, 2) is noxious, 3) has problematic meta-messages, e.g., one can & should be neutral about feared outcomes, such as harming one's child

/10 Of course, if a central fear is of the thought itself it is important to do exposure to the thought w/out compulsions etc. evoking the uncertainty about the thought's meaning and importance and exploring ideas about thoughts and thought processes

/11 That's it, have @ me.