So let’s say you’re experiencing relentless, horrible thoughts about your partner’s intimate past. Maybe you’re asking questions, snooping, assurance seeking – or fighting with urges to do all the above.

We call this state of constant doubt and despair retroactive jealousy. It’s not fun, I know.

And you look up therapy or self-help for retroactive jealousy, and there are people like me talking about ERP exposure therapy. The gold standard treatment for obsessive compulsive struggles.

And what does it entail? Deliberately exposing yourself to triggers. Leaning into the thoughts about who your partner did or didn’t have sex with. Going there in your imagination – vividly – so you can get better at experiencing the discomfort (anger, disgust, FOMO, sadness) and not reacting to those desperate urges to fix it.

But the more you hear about exposure, the more awful and off-putting it sounds.

What if I can’t handle it? What if it makes my retroactive jealousy worse? Is this really what I have to do to break this obsession… to roll around in it?

I get it. As a therapist who uses ERP – exposure and response prevention – for all kinds of OCD issues, I’ve successfully treated RJ this way. But there are caveats.

When ERP for retroactive jealousy backfires

Nobody loves the idea of exposure therapy. It’s the therapist’s job to explain it properly – and do it properly. BUT it’s not for everyone, including a lot of people with retroactive jealousy.

The first challenge is finding the right level of intensity. We want to start small and gradually turn up the discomfort, whatever that might be for you.

Guys have a tendency (especially when they’re doing ERP on their own) to go straight to imagining what their partner did in full pornographic detail. Then they’re fighting with those thoughts for the rest of the day.

That’s not what we want, that’s not therapeutic.

For other obsessive compulsive issues like germs on doorhandles or trusting we’ve locked the front door, the scale of exposure is more obvious.

With retroactive jealousy, the thoughts are about someone else – our partners – and we have to be respectful of that.

For germs and doorhandles, we can ramp up imaginal exposure to our worst fears coming true – “I started another pandemic by not washing my hands properly” – and that can be therapeutic. Turn up the drama, do your worst OCD, because I’m realising I can see right through you. You’re not going to push me around any more.

But with RJ, there’s someone else to consider. You get home from your therapy session and your girlfriend says “Oh how did it go? Was it helpful?“

“Yes I think so, the therapist gave me an exposure script to imagine three times a day…“

“Oh that sounds good, what’s it about?“

“Well, it’s all about you having sex with the guy who lives upstairs and having the best orgasms of your life…“

It can be argued that there are some imagined scenarios we don’t need to get used to having.

And of course, with retroactive jealousy thoughts, images and mental movies, we’re envisaging worst case already. People have said to me “My mind is going there all day… how is more torture going to help?“

Well, there is a difference between deliberate, bring-it-on thoughts and intrusive thoughts. But it’s a fair point. Exposure therapy is a hard sell and it can backfire.

Are there alternative treatments for retroactive jealousy?

Yes – phew! Not counselling though. Therapy for RJ needs more structure than regular talk therapy.

If you spend an hour every week venting your thoughts about your partner’s past in a safe space, it’ll feel therapeutic. But you’ll get home and it’ll all fire up again. And then you’re talking about that next week.

Counselling can absolutely help with past trauma and depression. Sometimes that’s essential before we can really tackle the obsessive doubt. But it isn’t enough on its own.

Oh and not hypnotherapy for retroactive jealousy either, in my opinion.

I-CBT therapy for retroactive jealousy

So what are the options? Cognitive therapy is a good one, particularly a form called I-CBT (Inference-Based Cognitive Behavioural Therapy) which was developed specifically for obsessive doubts. 

I-CBT helps us understand the doubt that’s driving the problem – the ‘what ifs‘ about our partner or their past or the relationship that’s become so sticky.

Understanding how this doubt came to be – because it’s not random – and how it evolved into this constant, nagging narrative. And how it’s obscuring and overriding the here-and-now reality of our relationship with our partner.

Yes, there’s quite a lot to it. But at no point does I-CBT involve arguing with the thoughts OR doing exposures.

I-CBT has a different goal to exposure therapy. In ERP, we’re engaging with the anxiety to reduce it over time. To learn that we can endure it long enough for the urges to pass. Getting better at not asking, checking, researching, going down the rabbit hole.

With I-CBT, we’re aiming to render the doubt irrelevant. If the doubt has no meaning, the anxiety doesn’t kick in. Or the urge to do anything about it.

We’re simply sensing the reality of the here-and-now. We’re going into situations, not avoiding, living our lives, and the wheels come off the obsession.

I-CBT is an evidence-based therapy and I’ve found it effective for treating RJ. It can break the spell of that old narrative.

So should we choose exposure or cognitive therapy for RJ?

It’s good to have options. But which route might be best for you?

When we’re experiencing more than anxiety and uncertainty, I’d lean towards the cognitive route.

When retroactive jealousy thoughts are making us angry, sad or feeling like we’re not enough, it helps to understand why we feel this way.

Again, what’s the ‘what if‘? ERP doesn’t go there, it’s more ‘roll with the feeling, it will pass‘. And that’s true, but what if we can make the doubt irrelevant in the moment?

The same applies to the rigid beliefs, black-and-white thinking, shoulds-and-shouldn’ts that fuel retroactive jealousy. A cognitive approach can reveal the influences – the relationship history, the family values, the thing I saw on Reddit – that got mixed into the obsessional narrative. Let’s put this stuff into context – but out of the context of our actual relationship.

And it’s not either/or. Some people start with ERP, and realise that it’s not working out (having given it a proper go). Or exposure helped reduce compulsions but hasn’t quite cracked the obsessive doubt. This can be a good lead-in to some cognitive work.

Or maybe we do I-CBT and then do some exposure work. But it’s a different kind of exposure, because the doubt has shifted.

There are other therapy options too. EMDR can treat OCD and RJ. It’s a kind of exposure therapy but conducted in a very different way, using lights and eye movement to give you a novel emotional experience.

And Schema therapy and DBT are therapies that don’t rely on exposure. There’s no shortage of therapies out there, or therapists.

Exposure therapy remains on the table. ERP is established, evidence-based and can certainly treat retroactive jealousy. But other approaches such as I-CBT are equally valid and effective.

It shouldn’t take too many sessions to establish whether either approach is working for you, or whether it’s time to switch things up. Sometimes, that’s all part of the journey out of retroactive jealousy.