When you hear or read about exposure and response prevention (ERP) therapy, what stands out is probably exposures: exercises designed to gradually expose oneself to feared stimuli. While exposures are a necessary component of ERP treatment, that doesn’t mean they’re the most important part.
In fact, doing exposures alone accomplishes nothing without the second component of ERP: response prevention. I tell my members that I could expose them all day long to their fears and it would do no good whatsoever unless they resist engaging in compulsions in response. Here’s how that crucial part of ERP works.
Distress intolerance in OCD
When people have OCD, they have learned to respond to scary thoughts or obsessions with certain behaviors called compulsions, which can be mental or physical. These compulsions reinforce the false belief that they cannot tolerate feelings of discomfort or anxiety about their obsessions and OCD triggers. People are often very aware that their compulsions are illogical or unhelpful, but they feel a strong urge to engage in them in order to feel short-term relief, resulting from a belief that they are unable to deal with the distress and anxiety they feel.
This is known as distress intolerance. When people with OCD feel that they cannot tolerate the distress caused by obsessions, they resort to compulsions, which reinforce the OCD cycle and make their distress worse over time. In order to learn that they can, in fact, handle these uncomfortable feelings, they must re-teach their brains that they don’t need to rely on compulsions, and that their feelings will pass on their own.
There’s an old adage: if you always do the same thing, you will always get the same results. This rings true for OCD: the compulsions that one does often provide temporary relief from the torment of the obsessions, but they reinforce the mistaken belief that obsessions pose an actual risk and require urgent action to resolve. The problem is that distress and anxiety don’t require any response—they will go away on their own. Compulsions actually lead to more distress in the long run, and often take up more and more time as a result.
Long-term relief happens when you respond differently
By practicing response prevention, people with OCD learn that they can indeed handle intense feelings of anxiety and doubt about their obsessions without engaging in compulsions. They may not like it, but they can get through it. As paradoxical as it may sound, the more they allow themselves to feel these emotions in response to their obsessions and fears, the less they fear them, and the less they feel the urge to engage in compulsions over time.
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Sometimes response prevention might look like not responding at all. Sometimes it involves what we call “non-engagement responses” like telling oneself “Okay,” “Maybe so,” “That’s fine,” or similar things that resist compulsions and the resulting short-term relief. Sometimes, response prevention can mean actively engaging in one’s wishes and desires. For example, if someone engages in compulsive avoidance, then their response prevention might actually involve doing the thing they typically avoid! In all cases, the goal is resisting what OCD wants, which is attempting to quell uncertainty, fear, and anxiety in the short term by engaging in compulsions.
I know: it’s easier said than done. That’s true! ERP is very difficult work, and when OCD has such a strong grip on one’s thinking, it takes a lot of determination to fight back. As with anything important in life, it takes time and practice. When you commit to actively, consistently changing your behaviors in response to obsessions and anxiety, you start to break the cycle of OCD.
Response prevention isn’t suffering for the sake of suffering. It isn’t doing hard things just to prove that you can. It is learning that you can live a fulfilling life and not be controlled by obsessions and uncomfortable emotions. It is discovering that you are stronger than your OCD. You are capable of experiencing hard things and doing hard things in spite of the discomfort they may bring. And in time, you’ll be able to feel less anxiety and discomfort when OCD is triggered.
ERP can teach you to respond differently
ERP does involve facing your fears, but it is not dangerous. Everyone with OCD experiences triggers in their everyday life, whether or not they’re in therapy. The only difference is that those in treatment are making a conscious effort to address these triggers and respond differently. They are learning non-engagement techniques so that they can break the OCD cycle. It is far more dangerous to live with untreated OCD than to engage in exposures during ERP.
Specialty-trained, qualified, and licensed OCD specialists will never ask you to do things that go against your values or that will cause you or others harm, nor will they ever force you to do anything that you are unwilling to do. Instead, a therapist who specializes in providing ERP therapy will guide, support, and motivate you. They will come up with reasonable and creative ways for you to safely, gradually face the fears that are holding you back from living the life that you want to live.
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If you have any questions about starting ERP therapy or need more information about the treatment, please don’t hesitate to book a free 15-minute call with our care team. On the call, we’ll assist you in either getting started with a licensed therapist at NOCD who has specialty training in OCD and ERP, or connect you to other resources that might be helpful.