You may have heard about exposure with response prevention (ERP) therapy for OCD and related anxiety disorders, but if you have never actually experienced it with a therapist, you may be weary of this form of treatment. Perhaps you have seen one of the reality TV shows where 6 patients live together in a home, facing their absolute worst fears on a daily basis, led by a seemingly sadistic doctor who refuses to let them have a moments’ relief from their relentless anxiety. You may have been left thinking, “There is no way I could ever handle confronting my fears like that.” Although these shows are very useful in educating the public about effective CBT treatment of anxiety, these shows also tend to highlight the most sensational aspects of ERP and can leave the viewer feeling slightly terrified.
Sadly, I have had many clients tell me that after seeing these reality TV shows, they felt too afraid to seek out an ERP therapist, despite their awareness that ERP is the most effective form of therapy for anxiety. Well, the truth is that ERP is definitely challenging and very uncomfortable, but it is doable and you ARE brave enough and strong enough to handle it, with the right support system.
What is ERP?
ERP is a specialized form of cognitive behavioral therapy that was designed to help clients to gain a sense of mastery over their experience of anxiety. ERP involves repeated exposure to situations, people, places, things, images, and ideas that provoke or trigger distress. Exposure can be “in vivo” or real life encounters, such as going to a public area and touching “contaminated” surfaces. Exposure can also be “imaginal” such as listening to a story that describes a worst fear coming true. When facing these triggers, the client is prevented from responding to their distress with safety behaviors such as avoidance, escape, or rituals. Rituals, or compulsions, are behaviors or mental actions, that someone engages in in a desperate effort to reduce distress or to avoid a dreaded outcome. For example, a compulsive response might be to recite a specific prayer repeatedly in an effort to protect my child from harm.
In ERP therapy, we do not identify a client’s very worst fears and then immediately throw them straight into the ring to face them head-on. Rather, we first identify obsessive thoughts and fears, and then we work together to create a list of potential situations, places, people, things, ideas, that might trigger your fear/distress. After rating the intensity of each trigger, we then arrange the triggers in hierarchical order and we create a plan for facing the triggers together, starting with the the least distressing trigger and moving gradually towards the most upsetting triggers.
Retraining the Brain
We face triggers repeatedly so that the brain will “learn” through repetition, that the trigger is distressing, but not truly dangerous. The client learns that distress, while at times quite intense, does eventually reach a peak and begin to come down on its own with enough exposure. Clients learn to ride the wave of anxiety without giving into their sometimes overwhelming urges to engage in a safety response. Through exposure therapy, we literally retrain the brain to no longer view the triggering situations as dangerous, and we discover that we can indeed tolerate distress without giving into our urges to escape or seek relief.
What is the pay off for going through this process of brain “retraining”? My response can be summarized in one word: FREEDOM. Through ERP, you will findthe freedom to live a full life, no longer bound by the rules and restrictions that your anxiety created for you. You can go places without living in fear of becoming utterly paralyzed with panic, you can watch the news, or read stories without fear of an abhorrent thought being triggered and ruining your whole day. You can go to Disneyland without feeling like you have just walked into an incubator of disgusting germs and viruses. You can speak in front of a group without melting into a virtual puddle of humiliation. You will still have waves of fear and distress that hit you from time to time, but these relatively small waves never threaten to deter you from your daily plans, because now you know how to ride those waves. You are a competent swimmer. You can navigate even the roughest of waters.
If you are ready to give ERP therapy a try, then I am happy to walk beside you down the path to freedom. It will not be easy or painless, but I can promise you that it will be liberating, and we will probably have some good laughs along the way.
*If you are interested in seeing an Episode of “Obsessed” featuring Dr. O’Connor, you can purchase episode 10 (Phillip and Kerrie), season 2, from iTunes.