View original article published in Psych Central–

Noah didn’t care for ERP (Exposure and Response Prevention) therapy despite his struggles with harm OCD. Stories that he had heard from acquaintances and friends were not positive. In fact, one of his friends felt traumatized by ERP. He also indicated that he was asked by his previous mental health counselor to sit in front of a bunch of knives so he could habituate or get used to the feelings and sensations the knives created.

He said he had already been around sharp knives for three weeks while working at a knife shop temporarily while he looked for another job. His excruciating anxiety was off the charts. “I basically white-knuckled each day until I found a better job. I was exposed to knives all this time, and I’m still the same. ERP simply doesn’t work,” he claimed.

What do you value in life?

When Noah’s next therapist asked him, “What and who matters most in your life?” Noah indicated that all he cared about was to eliminate the intrusive thoughts and anxiety. It made sense to him as he believed that once he could control his thoughts and feelings, he could move on with life. Noah had put his life on halt believing that he could master his internal experiences (i.e., thoughts, memories, feelings, sensations, and urges) before he could strengthen his friendships, go back to school, date again, get married, and have a family.

During treatment Noah learned that behaving towards internal events as if they were external ones was not effective. For example, he could easily discard appliances when they weren’t working, but he could not remove thoughts or feelings when they were unpleasant. Viewing and treating internal events as if they were external experiences led him to get trapped in the OCD cycle.

Why is ERP effective?

Your mind’s inherent job is to protect you, and when you struggle with OCD, your mind works overtime. Thoughts that appear useful may lead you to avoidance and compulsions. When you avoid situations and become stuck, you are not able to disrupt the beliefs and expectations related to your anxiety and despair.

On the other hand, when you become proactive in facing your fears, you can truly learn and discover what happens. Instead of falling for your mind’s advice, you can be willing to interact with the experiences that bring fear but may also disconfirm your mind’s assumptions. You will discover that you have the inner wisdom to handle any situation even when it’s terrifying. However, if you don’t give yourself a chance, you’ll never know.

What may ERP look like for you?

Your treatment plan is personally designed. But learning occurs before, during and after exposures. You can focus on the things that are important and meaningful rather than trying to eliminate what’s occurring naturally.

Your treatment provider will guide you through ERP. The exposures are done randomly and not in a hierarchy because life does not take place according to your fear hierarchy. Life happens and you can learn to be willing to face whatever shows up, so you can cultivate the life you wish to live.

During Exposures:

As you increase awareness of your internal events, you will be able to acknowledge them as such — thoughts, memories, feelings, sensations, and urges. You can learn to welcome them, and you don’t have to like them. You’ll learn to make room for them because you know it is futile to resist them.

Your focus will be on your values — what you want your life to be about (i.e., relationships, employment, education, spirituality, etc.). What you’ve been missing out on because of OCD. The question you’ll ask yourself is, “If I act on my mind’s advice, will that lead me to living the life I want?”

You will also learn to accept the uncertainty that OCD brings. Though this is difficult, the more exposures you do, the more willingness you will develop in accepting uncertainty, which after all is part of life for every human being.

After Exposures:

You will recognize that life does not need to be about getting through the anxiety and fear. With repeated exposures, you will learn that allowing the emotions and sensations, instead of fighting them will give you more freedom to live purposefully. You will feel empowered as you practice the skills to develop more flexibility in your thinking.

After each exposure answer these questions:

• What did I learn from this experience?
• What can I do next time to be more flexible when I encounter a trigger?
• Where can I find more opportunities to practice the skills that will help me face my fears and focus on improving the quality of my life?

Noah learned skills to view his internal events with a different mindset. He acknowledged and allowed them to naturally come and go without having to wrestle with them. He was able to live the life he had yearned for. He recognized that he had a choice of whether to act or be acted upon by his OCD mind.

ERP is not about facing your fears and white-knuckling the situation. You already do that every day. Your therapist will provide skills to prepare you to do ERP. This practice can give you long-lasting results and enable you to live a richer and fuller life, even when the OCD mind spits out unhelpful thoughts.

Give it a try!

References

Craske, M. G., Liao, B, Brown, L. & Vervliet B. (2012). Role of Inhibition in Exposure Therapy. Journal of Experimental Psychopathology, 3 (3), 322-345). Retrieved from https://www.academia.edu/2924188/Role_of_Inhibition_in_Exposure_Therapy

Twohig, M. P., Abramowitz, J. S., Bluett, E. J., Fabricant, L. E., Jacoby, R. J., Morrison, K. L., Smith, B. M. (2015). Exposure therapy for OCD from an acceptance and commitment therapy (ACT) framework. Journal of Obsessive-compulsive and Related Disorders, 6, 167–173. Retrieved from http://dx.doi.org/10.1016/j.jocrd.2014.12.007.