Doing ERP is Hard
Hello Everyone,
I hope you are all doing well in the midst of our ongoing struggle with the pandemic, especially since we’re seeing a new surge in people getting infected. I intend to post an update on managing during this new surge in the near future, but today’s post is on a different topic. Exposure with response prevention (ERP) is such a crucial part of the treatment process for OCD, it’s a topic I’ll return to repeatedly. So here is another post about the importance of doing regular ERP work if you truly want to manage your OCD. Here is a previous post about how to do ERP.
It’s usually not too difficult to convince people that ERP is a good idea, but it is much harder to get them to actually do it. Let’s explore why that is the case. The primary reason is that if ERP is done correctly it is hard. Facing what you fear is difficult. If your OCD has been its usual devious self (see previous posts here and here), then it has made you believe what it is telling you is accurate - “If you touch that doorknob, you will get sick!”, “If you don’t arrange the cans in the cupboard properly, your mother might die!” or “Since you think that little girl is pretty, you must be a pedophile!” So touching the doorknob, not arranging the cans properly and looking at the little girl will all feel very scary. Doing ERP correctly usually means doing hard things, so if the ERP feels hard then you’re probably on the right track. Being willing to take the chance that you might get sick and touch that doorknob anyway is the start of the way out of your OCD.
Most people have some insight into how exaggerated their OCD thoughts are, but still buy into them just “in case this one time it might be right” or “it only takes a moment to wash my hands so why not just do it and be safe”(two of the many cognitive distortions and beliefs that OCD can use on you). Though recognizing the errors in your thinking is a useful and important step, I think it is only part of the process and it is the ERP that truly makes the difference.
Another important aspect of doing ERP successfully is being open and willing to feel uncomfortable. If you’re gritting your teeth and white-knuckling your way through the process it likely won’t be as effective as it could be. A more productive way to look at the ERP process is to expect it to be hard and be open and willing to feel that discomfort...even welcome it as a sign that you’re on the right track. And if you really want to go for it, then seek out opportunities to feel this discomfort regularly.
Another mistake I see many of my clients making is after making some progress and experiencing some relief from their OCD, they slow down doing the ERP or even stop altogether. They get tired of doing the hard work involved or may fear that if they keep going they will lose some of the gains they have made. Often towards the end of doing ERP my clients are getting to the more difficult items on their exposure hierarchy and they decide they’ve gone far enough. Unfortunately, if they leave the final items on their hierarchy undone they are at significant risk of relapse. If your surgeon said he decided to not remove all of the cancer, I don’t think you’d be very happy.
OCD is a tenacious stubborn opponent, but with persistence, it can be effectively managed. I hope this short post will encourage you to persevere with your ERP.
As always, I welcome your questions and comments.
Stay well,
Dr Bob
