There’s a common misconception that memories are like video recordings that can be recalled and “played back” with complete accuracy. Unfortunately, memories are not perfect “real” recordings — they are easily distorted and reconstructed every time we recall them. Thus, by their very nature, memories are uncertain.
In obsessive-compulsive disorder (OCD), we may experience intrusive images and doubts (i.e. obsessions) that exacerbate the uncertainty of a particular memory. Each time we try to play back, analyze, or check the accuracy of a memory, we can add to that uncertainty. This creates a vicious cycle in which we become stuck trying to get clarity about the details of a memory, and even create a so-called “false memory.”
Especially when there is some ambiguity about a particular memory (e.g. if we were distracted or under the influence of alcohol at the time or if the memory was simply from a long time ago), we just simply can’t recall memories with absolute certainty. And the more we try to recall, the more we might confuse the details, leading to more doubt. For example:
Scenario 1: A guy worries about possibly cheating during a wild night out partying.
Joe is in a committed relationship. He went out drinking with friends at a nightclub the other night, but the next morning the details were hazy. He remembers dancing with a girl he had met, and at one point, going to the bathroom. He does not remember doing anything other than dancing with the girl, but the uncertainty starts eating away at him. Joe starts incessantly thinking:
Joe tries to review and piece together the events of the night in his mind over and over. He texts his friends to see if they could tell him what happened, and even goes back to the nightclub to try to recreate the events of that night. But despite all of this, Joe is still wracked with uncertainty and guilt. He becomes convinced that something happened with that girl in the bathroom and repeatedly gets tested for STDs. Joe may even confess cheating to his girlfriend, even though there is no evidence that anything actually happened.
Scenario 2: A schoolteacher questions a memory she has about an incident with a student from years ago.
Ariana has been an elementary school teacher for 10 years. Recently, she was reminded of an incident that happened when she first started teaching, in which she stayed after school to tutor a student one-on-one.
She remembers that the student was struggling and that she put her hand on his shoulder to comfort him. While recalling this memory, she suddenly has an unwanted and intrusive sexual image out of the blue. Even though she does not remember anything “wrong” actually happening, the sexual thought leads her to question her memory of the interaction. She begins to freak out:
She frantically tries to review the memory and reassure herself that nothing inappropriate happened, but she has difficulty remembering because it was so long ago. She starts to compare this memory to other memories of tutoring, trying to piece together her thoughts, emotions, and physical sensations at the time. It begins to interfere with her enjoyment and work as a teacher, to the point where she quits her job because she is afraid that she has done something inappropriate and might do so again.
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This vicious cycle and fear of a “false memory” is often centered around doubt or uncertainty about what happened in the past. We start to over-analyze and question, “Was this a ‘real’ or ‘false’ memory? Did this actually happen the way I’m remembering it?”
These obsessions can cut across all kinds of feared content and themes, for example:
Often, this cycle spirals further as we start to analyze the feared consequences and implications of the memory being true, and the fear becomes centered on doubt/uncertainty about the future, for example:
In our attempts to resolve this doubt, we might engage in any number of compulsions, for example:
Although the causes of OCD are multi-faceted, treatment with Exposure and Response Prevention (ERP) therapy can break the vicious cycle of obsessions and compulsions that keep OCD going.
In ERP, we practice leaning into the uncertainty that’s inherent in our lives and in our memories. Instead of avoiding uncertainty, we work on accepting it.
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With ERP, we can eliminate compulsions, handle the discomfort associated with uncertainty, and live meaningful lives despite feeling uncertain about past or future events.
ERP is best practiced with a therapist, who can help you take a gradual approach to treatment. An ERP-trained therapist will help you incrementally build the strength to tolerate uncertainty and resist compulsions. This is done by approaching feared triggers through deliberate exposures, and then working on resisting compulsion-based responses.
Examples of ERP exercises you may do with your therapist include:
The purpose of ERP is to practice and strengthen a different approach toward your intrusive fears. In the case of false memories (the doubt of a feared event happening in your past), the aim of ERP is to learn how to respond to the uncertainty of a memory head-on, with courage, compassion, and equanimity.
Schedule a call with our team of licensed OCD specialists if you’d like to learn more ERP and how NOCD may work for you.