Many of my clients ask what ERP stands for? Exposure and 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 clients 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 to the client.....Some of my most severe Obsessive Compulsive Disorder sufferers were capable of accomplishing the the ERP process and 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 of these values to keep you on track. What has OCD, specifically your compulsions, taken from your life? Have you forced loved ones to do your compulsions? Have your compulsions affected your children? How much time have you wasted in compulsive patterns? How much distress have your compulsions created? What would accepting uncertainty and ERP look like? Motivational scripts are best written with a trained therapist. So find the right one!
Sometimes one obsession is followed by countless compulsions. In ERP, what can be most effective is starting small with one less intense compulsion and then working your way up to more intense compulsions. 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 levels of distress when imagining abstaining from these compulsive behaviors. After the hierarchy is made, each exposure is gradually done.
In the inhibitory learning model you may start with thinking of any obsession that causes anxiety, being mindful of that obsession in my office in real time, while abstaining from the compulsive behaviors. This teaches the brain to tolerate anxiety and gives it a different message about your anxiety. The idea is that OCD is a product of the way an individual's brain functions, so todays obsessions may change over time. Learning how to deal with this process no matter the trigger or the content is where true freedom occurs.
Mindfulness is used as an exposure practice with your OCD by facing your obsession without doing an internal or external compulsive behavior. You can trace the sensation in your body or surf the compulsive urge.
CBT (Cognitive Behavioral Techniques)
CBT alone is not helpful for OCD because it can lead to compulsively challenging 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.
Catastrophizing: 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 because 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. If you ready to be free from OCD, then ERP is for you!