So you’ve learned that the cycle you’ve been caught in—which drags you repeatedly from obsessive thoughts, to mounting distress, to compulsive behaviors, only to create fleeting relief before starting all over again—is most likely obsessive-compulsive disorder (OCD).
And if you’ve learned that you have OCD, you’ve likely also begun learning about how OCD can be treated, which means you’ve probably heard something at this point about exposure and response prevention (ERP) therapy. ERP helps people handle fear, anxiety, and uncertainty without engaging in compulsive behaviors that compound stress and interfere with everyday life as a coping tactic. It’s considered the most effective treatment for OCD, and research shows that around 80% of people with OCD experience significant improvement after ERP.
As you’ve learned about ERP, you may have seen that the goal of this therapy is to teach you how to “tolerate distress.” But isn’t escaping distress the point of OCD therapy? Surely your best treatment option isn’t one that will just leave you stuck constantly contending with unpleasant feelings—right?
Right! Despite some misconceptions, ERP is not about just learning to “get used to” the extreme feelings of distress that OCD symptoms can cause, and accepting that you’ll feel that way forever. Instead, it’s about learning that the initial discomfort created by an intrusive thought is something that you can survive, without relying on compulsions to cope. Once you understand that, the discomfort will create less and less distress over time—which means less suffering.
What is habituation, really?
Learning to tolerate discomfort through ERP is not the same as agreeing to stay uncomfortable forever. It’s about reducing the power that discomfort holds over your actions, so that it no longer creates distress so potent you’re driven to engage in compulsions.
ERP helps you hone this skill through a process called habituation. When you engage in a compulsion every time you encounter something that triggers your OCD, it teaches your brain that the trigger is truly dangerous, and reinforces the idea that you must engage in the compulsion to keep yourself safe. This response becomes a driver for keeping the vicious cycle going.
On the other hand, when you repeatedly encounter the trigger in a controlled setting like ERP therapy without engaging in the compulsion, your nervous system learns that you do not actually need the compulsive behavior to keep yourself safe, and that the threat is not real. The trigger becomes less activating over time, until it no longer creates the same feelings of fear and anxiety. Think of it like walking into a room with a distinct odor—the longer you stay in the room without running out, the more you get used to the scent, until it fades into the background.
Not everyone habituates in the same way, and progress isn’t always linear, which means that you may not find that your OCD symptoms reduce immediately, and you may feel frustrated by what seem like setbacks throughout your journey. Ultimately, however, that’s not evidence that the process is broken. Tolerating discomfort in the immediate means experiencing less distress in the long run.
The difference between acute distress and ordinary discomfort
The feelings of anxiety, fear, and panic that OCD creates are often so overwhelming they can seem intolerable, so it makes perfect sense that being told to “tolerate” unpleasant feelings could seem unfathomable. When it feels like alarms are ringing and every moment is an emergency, that’s the acute distress that OCD is putting you through now. These aren’t the feelings ERP will teach you to tolerate—they’re the ones it’s designed to reduce.
The feelings that OCD creates are not related to genuine threats. Rather, they’re taking the things you care about and latching onto them, warping them in the process. While OCD wants you to believe that failing to follow the cycle from mounting discomfort into compulsion will have dire consequences, it actually won’t. This is what ERP teaches your nervous system.
Take the example of the strong smell: If you walk into your roommate’s bathroom and it smells like both ammonia and bleach, you should walk back out because chances are they’ve accidentally created chlorine gas while cleaning. That’s not a smell you should get used to, because it poses a real danger. But if you walk into your grandma’s house and it smells like mothballs, the reality is that while that scent may be unpleasant, it only puts you in danger if you have a mothball allergy. Learning to tolerate the mothball smell at your grandma’s—habituating to it—doesn’t harm you, and it may even allow you to spend more time with someone you love.
The goal of ERP is not to resign you to constantly living with the way OCD makes you feel right now. It’s to help change how OCD affects you by removing or reducing the compulsions that have been reinforcing the cycle of fear. Over time, that distress can decrease, so that what’s left is much more livable.
ERP decreases distress by changing how you respond to discomfort
You can absolutely learn to manage your OCD symptoms and reduce the five-alarm-fire level of distress they bring you, and learning how to tolerate discomfort is the first step. But ERP is all about taking those steps at a manageable rate, alongside a specialty-trained therapist. You’ll start small, talking through both your most urgent obsessions and compulsions and your values, so that you can create a roadmap that’s specific to you. As you experience more controlled exposures to the things that trigger your OCD, and increase your ability to resist compulsive behaviors in response, your body learns in real time that the triggers don’t pose a danger.
For example, if you often engage in the compulsion to check whether you’ve turned the stove off before bed, holding off on checking, reducing the number of times you check, and potentially working your way up to forgoing checking entirely will all help you learn to quiet the distress that emerges when you experience an intrusive thought about accidentally leaving the stove on. When you hear “learn to tolerate discomfort,” it can feel like you’re being told to deal with being anxious and afraid forever. But ERP means just the opposite. It teaches you the skills to stop feeding the fire of your fear.
If you’re struggling with OCD and haven’t started ERP yet, you can learn about NOCD’s accessible, evidence-based approach to treatment by connecting with a NOCD Member Advocate on a free call to find out how this type of treatment can help you. NOCD offers live face-to-face video therapy sessions with OCD specialists, in addition to ongoing support between sessions, so that you’re fully supported during the course of your treatment. All NOCD Therapists specialize in OCD and receive ERP-specific training and ongoing guidance from our clinical leadership team, and they understand how crucial ERP therapy is.
