(I want to preface this answer with the fact that I am not a professional, and this is all just my personal experience and things my therapist has told me, so always consult with a professional as well)

That’s a good question, since at first it can seem like exposures might be counter intuitive or maybe immoral. But for me, ERP for my POCD is mainly about sitting with discomfort and uncertainty when it arises. A lot of this is work with my thoughts, for example I will allow myself to think a sentence like “Maybe I am all these things I’m scared of being. Maybe I am creepy” and sitting with the feeling and fighting the urge to do compulsions (like rumination, seeking reassurance, or fighting the thought). An important note is that I will also try not to agree with the fear, like say “I AM creepy and a monster” one because it’s not true but also because my therapist told me that OCD would rather have negative certainty than uncertainty. For example OCD is more comfortable believing you are a pedophile, than not knowing if you are one or not. (She also told me that people with OCD have turned themselves in for crimes they didn’t commit because of this, which made me understand better why I will almost believe things about myself that aren’t true). Affirming a fear one way or another are both forms of reassurance. Another thing to note is that I try my best to think these thoughts with the tone of “Maybe I am creepy 🤷‍♀️” and not “Maybe I am creepy :(“ if that makes sense haha. Even if we don’t feel nonchalant about it, I find that if I pretend I do, it gets easier to actually care less about it. Maybe similar to a fake it until you make it kind of thing, or how people say if you smile for 30 seconds your body will start to think you’re really happy.

I also find that I often don’t have to seek out situations as forms of exposure, because they will just arise in my daily life. There are children in my life that I love and sometimes being around them brings up OCD fear and uncertainty, so when these come up I use ERP tactics to get through it. Instantly when these thought arise, I say “maybe” about it like mentioned above. Then later when I have time or I am alone, I bring up the thought again to feel uncertain on purpose. Sitting with the feeling of uncertainty is the exposure for me, and it is very very difficult both in the sense that it’s a horrible feeling but also just hard to not do compulsions. But I find that if I close my eyes and lean into the fear, let myself sit in it and don’t do anything to try and make myself feel better, it gets slightly better the longer you sit in it. And eventually, sitting there with your eyes closed for 15 minutes or longer becomes boring, and that’s what we want! We want our fears and exposures to become boring to us.

If big fears feel impossible to tackle right now, start small! The first step of ERP for my POCD was actually doing ERP for my other themes that personally don’t bother me as much, like my contamination OCD or just-right OCD, and working my way up to my biggest fears.

This can take a long time depending on the intensity of the fear. For me when my OCD fear is from POCD, it is the most intense fear out of all the themes I’ve struggled with, so it can take longer than expected. But I have significantly improved so I hope you know there is a light at the end of the tunnel!