Many of my clients ask what ERP stands for? Exposure Response Prevention sounds so formal and technical. Simply put, it is a process that creates ORDER out of mental CHAOS. It works by systematically facing your obsessions while abstaining from your compulsions. ERP is helpful when combined with lots of other skills.
ERP + Mindfulness = Treatment for Obsessive Compulsive Disorder
Many say, “that’s crazy, I am not doing that,” or better yet, “I can’t do it. I am incapable of stopping my compulsions”.
At this point I normally say.....that some of my most severe Obsessive Compulsive sufferers were capable of accomplishing the process and they were able to stop seeing me because of their significant success.
This technique starts with finding where we need to begin.
I like to begin with why are you here. Do you want to work on your OCD? What are the consequences of your OCD? What are your life values that may counter your compulsive behaviors? We need a constant reminder to keep you on track.
Sometimes one obsession is followed by countless compulsions. Starting small with one less intense compulsion and then working your way up to more intense compulsions. This is most effective. Some individuals have several obsessions so starting with an easier obsession can help build confidence and trust in this therapeutic process.
This process is started by you and your therapist when you create an ERP hierarchy, which is a list of obsessions, compulsions, and level of distress if you imagine abstaining from these compulsive behaviors. Then you gradually do each exposure.
in the inhibitory learning model you may start with anything that makes you anxious, any obsession and be mindful of that obsession in my office in real time, while abstaining from the compulsive behaviors. This teaches the brain to tolerate anxiety and a different message about your anxiety. The idea is that in OCD it is the way your brain functions so todays obsessions will change over time. Learning how to deal with this process no matter the trigger or the content is where true freedom occurs.
Mindfulness is another approach to manage the incessant obsessions in your head. Some individuals reach great improvement just from this skill alone. Mindfulness of the present moment is a distraction skill form the obsessions and compulsions. This skill can be seen as counter to ERP but is so helpful for OCD suffers.
Mindfulness is also used with your OCD when facing your obsession without doing a compulsive internal or external behavior.
CBT (Cognitive Behavioral Techniques)
CBT alone is not helpful for OCD because then suffers are compulsively challenging their irrational thoughts, but it can be used to stop compulsive patterns. I call it a wedge in. Like opening the door for sitting with your obsession while abstaining form your compulsions.
Common Cognitive Distortions for OCD
Thought Action Fusion: Thinking because you thought it you must have done it.
Black and white thinking: Things are all one way or all the other, no grey.
Catastrophisizing: This is thinking of the worst case scenario.
Magical Thinking: Linking rituals to changing outcomes in life.
Is Your Therapist Skilled in treating OCD?
Make sure your therapist is skilled in treating OCD as reassurance-seeking from your therapist can keep you stuck in your compulsions. Some people have anxiety and OCD. Having a therapist knowledgeable in treating both is essential to your success through these debilitating disorders. Inhibitory learning can help with anxiety and OCD. Are you ready to face your inner dragon, then ERP is for you!