It’s completely understandable to find yourself searching for information about Exposure and Response Prevention (ERP) online. There are many guides out there, mine included here on MoodSmith, but with today’s article I want to fine tune ERP a bit, for those of you who are trying to help yourself. I’ve been working with OCD for two decades and expertly familiar with all the ways OCD can manifest and all the various different exposures used depending on the theme and I’ll do my best to share some of that knowledge.
Take, for instance, a client I worked with a while back – a chef who was utterly terrified of accidentally poisoning his customers. Every spice, every sauce, every garnish became a potential weapon in his mind. Or another client, whose constant texting her children to check ‘ if they had arrived’ was her way of keeping them safe when she could not see them; she was afraid if she did not text, something bad could happen to them.
These are just glimpses into the myriad ways OCD can weave its way into our lives. And that’s precisely why I’m so passionate about tailoring ERP to your unique needs. It’s not just about understanding the mechanics, it’s about applying it to the very fabric of your experience.
So, where do we begin?
Identifying Your OCD Theme
Think of your OCD as having a distinct personality, a particular “flavour” if you will. Recognising this is crucial for taking targeted action. So, what’s your OCD’s signature move?
- POCD (Paedophile OCD): Picture this: a loving parent, utterly devoted to their child, suddenly bombarded by horrific thoughts of harming them. The shame, the guilt, the sheer terror – it can be utterly paralyzing. POCD sufferers experience these abhorrent thoughts, despite having absolutely no desire to act on them. I once worked with a young father who was so terrified of these thoughts that he avoided being alone with his newborn. Through ERP, we gradually helped him reclaim those precious moments, replacing fear with connection. Learn more about POCD.
- HOCD (Homosexual OCD): Imagine a happily married man, suddenly plagued by intrusive thoughts about being attracted to other men. These thoughts feel completely alien, yet they trigger a cascade of anxiety and doubt. One of my clients, a successful businessman, became so consumed by HOCD that he avoided male colleagues and even his own brother. ERP helped him confront these fears and reclaim his life. Learn more about HOCD
- ROCD (Relationship OCD): Ever been in love? Now imagine that love constantly overshadowed by a nagging voice: “But do you really love them? Are you sure they’re the one?” These doubts, which might flit through anyone’s mind occasionally, become a relentless torment for those with ROCD. I worked with a couple where the woman’s ROCD almost sabotaged their wedding. Through ERP, they learned to navigate those doubts and build a foundation of trust and acceptance. Learn more about ROCD.
- Contamination OCD: This type of OCD is the one that most people, without OCD, are most familiar with, as I think it is the one most portrayed in the media.
- “Just Right” OCD: Imagine the frustration of needing to arrange objects perfectly, or repeat actions until they feel “just right.” This need for symmetry and order can become a relentless taskmaster.
- Intrusive Thoughts in General: These are the unwelcome guests of the mind – those disturbing, often violent or blasphemous thoughts that pop up uninvited. I often tell my clients that having intrusive thoughts is like having a brain that’s a bit too creative for its own good. It’s not about the content of the thoughts, it’s about how we respond to them.
ERP Exposures
Now that you have a better sense of your OCD’s “personality,” it’s time to take action. Remember, ERP is all about facing your fears head-on, without resorting to compulsions. It’s like learning a new dance – a dance where you lead, and OCD follows.
- POCD/HOCD: Instead of getting lost in a maze of mental analysis or reassurance-seeking, gradually expose yourself to the things that trigger your anxiety. This might involve:
- Looking at images related to your fear, but in a safe, controlled environment, and with the support of your therapist.
- If appropriate and carefully planned, spending time with children under supervision, while resisting mental rituals. This could involve reading to them, playing games, or simply being present with them, all while allowing the anxiety to be there without trying to fight it.
- Reading stories or watching films that touch on themes related to your fear, but with the intention of confronting the anxiety, not escaping it.
- ROCD: Challenge those relationship doubts head-on.
- Resist the urge to constantly seek reassurance from your partner. Instead, practice accepting the uncertainty that naturally exists in any relationship.
- Spend time with your partner without over-analyzing your feelings or the relationship. Engage in activities you both enjoy, be present in the moment, and let go of the need for constant certainty.
- If genuine relationship issues exist, address those separately through open and honest communication, rather than letting OCD be the puppet master.
- Intrusive Thoughts (all types): Don’t play whack-a-mole with your thoughts – trying to suppress them often makes them pop up even more. Instead, get comfortable with them.
- Write those intrusive thoughts down, say them out loud, or even record yourself reading them. This might feel incredibly uncomfortable at first, but it’s a powerful way to take away their power. You can try it right now, for example, If you really are plagued with intrusive thoughts that something you can do, will result in something bad happening, generally these thoughts are quiet in your mind, but to take the fear away, say them out loud in a silly voice – I always do the Eddie Murphy ice-cream song – I am not being flippant; when you say your fears in silly voices they really loose their power.
- Purposefully bring the thoughts to mind. This is called “intentional thought exposure” and it’s like shining a light on the monster in the closet – it might seem scary at first, but you’ll soon realize it’s not so terrifying after all.
- Allow yourself to experience the anxiety without trying to escape or neutralize it. This is where the magic happens – you learn that you can handle the discomfort, and that your feared consequences won’t actually happen.
- Contamination OCD: Gradually expose yourself to situations that trigger your fear of contamination.
- Touch “contaminated” objects in a controlled environment (doorknobs, public restroom surfaces). Start with brief touches and gradually increase the duration. It’s like dipping your toes in the water before taking the plunge.
- Wear clothes without washing them immediately after being outside. Challenge the urge to change or shower immediately. See how long you can tolerate that “unclean” feeling.
- Handle objects others have touched without immediately washing your hands. Notice the anxiety, but resist the urge to wash. You might be surprised at how quickly it subsides.
- Prepare a meal without wearing gloves, or eat food prepared by someone else. This can be a big step, but it’s incredibly liberating.
- “Just Right” OCD: Break free from the tyranny of perfectionism.
- Purposefully leave tasks slightly unfinished. Leave a dish unwashed, a picture slightly crooked, or a button undone. It’s okay, the world won’t end!
- Intentionally make minor mistakes. Misspell a word in an email or leave your bed unmade. Embrace the imperfection.
- Place objects asymmetrically. Challenge the need for perfect order and symmetry. A little bit of chaos can be quite refreshing.
- Wear clothes that feel slightly uncomfortable. Resist the urge to adjust or change. You might even find you enjoy the sensation!
- Embrace the discomfort of imperfection. This is a key step in reclaiming your freedom from “just right” OCD.
Core Principles of ERP:
ERP, at its heart, is about retraining your brain to respond differently to anxiety. Here are the key principles to keep in mind:
- Gradual Exposure: Think of it like climbing a ladder. You wouldn’t start with the top rung. Begin with situations that provoke mild anxiety and gradually work your way up to more challenging ones. This allows you to build confidence and mastery along the way.
- Response Prevention: This is where the “prevention” in ERP comes in. The key is to resist your compulsions, however strong the urge. This allows you to learn that you can handle the anxiety and that your feared consequences won’t happen. It’s about breaking the cycle of OCD.
- Habituation: Imagine the first time you rode a bike. It was probably scary! But with practice, it became easier and less anxiety-provoking. The same principle applies to ERP. The more you expose yourself to your fears without engaging in compulsions, the less power they hold over you. Your anxiety will naturally decrease over time.
5. Utilize Helpful Resources:
- OCD Action: www.ocdaction.org.uk
- NHS: www.nhs.uk (search “Obsessive-Compulsive Disorder”)
- The International OCD Foundation: iocdf.org