An additional idea

Joop's ideas sound quite useful. Another option in this type of situation, when the anxiety is triggered by the action of someone else, is to simply wait for someone to inadvertantly trigger the anxiety and then have the client refrain from doing anything to "correct" the situation or to "prepare" for the upcoming situation. It sounds as though this will provoke significant anxiety for him but, if he tolerates the anxiety, it should be quite useful.

In some situations, it might be possible for him to ask the other person to intentionally perform the act or acts that trigger the anxiety. The client would then refrain from doing anything to correct the situation and would tolerate the anxiety. Or the client can imagine the other person performing the action that triggers his anxiety.

An additional idea would be to use these exercises as behavioral experiments as well as opportunities for ERP. To do this, the therapist needs to help the client state his concerns as testable hypotheses. For example, if the client encounters an unlucky number and does nothing to correct it, what will happen? How would that differ from the outcome on occasions when the client does not encounter an unlucky number or occasions when he encounters an unlucky number but "corrects" it. The ERP sessions can then be used to test whether the disasters which the client fears occur when he refrains from his compulsions.

In this case, the client fears that he will be harmed in some way if he doesn't do something to "correct" after he encounters an unlucky number. By simply keeping track of how frequently he is harmed after completing ERP sessions and comparing that with how frequently he is harmed when he "corrects" after encountering unlucky numbers, one can test his belief that it is necessary for him to "correct" after unlucky numbers.

Repeated, prolonged ERP sessions are needed to reduce the anxiety that perpetuates OCD but framing ERP as behavioral experiments as well can facilitate progress.

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