Whether you experienced the onset of intrusive thoughts and compulsions for the first time as an adult, or you’ve lived with them your whole life, learning more about obsessive compulsive disorder (OCD) can bring up many complex emotions. You might feel relieved, overwhelmed, emboldened, curious, scared, or any number of things. For the first time, you may have a name for what’s happening, a community to connect with, and a way of explaining your experiences to others.
Knowing what’s going on can also mean that you have a better understanding of what’s needed to address it—but sometimes taking that next step to get specialized help can feel hard, or even scary. And when it comes to OCD treatment, you may have heard that it’s all about doing hard things. If your past experiences with therapy have focused primarily on building self-compassion through open-ended conversations, nervous-system regulation, and self-soothing tactics, then learning about OCD treatment for the first time might feel especially intimidating. And it’s true that it’s different from other common therapy approaches—but the reality is that building self-compassion is just as key to ERP as it is to other forms of therapy, even if the steps you take to get there seem less familiar.
Exposure and response prevention (ERP) therapy works by teaching you to gradually confront your fears while you learn to respond without performing compulsions. Over time, this gradual exposure can help you learn that compulsions aren’t necessary to keep you safe, helping you learn to better regulate your emotions in the face of triggers. You should always be guided through ERP therapy by a qualified professional who specializes in treating OCD. While ERP involves sitting in discomfort, it should not be harmful. When practiced by a qualified, highly trained professional, it is the most effective treatment for OCD—and contrary to some misconceptions, it should be grounded in self-compassion.
Self-compassion and ERP therapy
Being deliberately uncomfortable can seem like the opposite of the point of therapy. After all, many people seek therapy to alleviate discomfort and find a sense of safety. Some people worry that because ERP works by introducing deliberate discomfort, it won’t be trauma-informed or help them feel more at ease. But the key to ERP is increasing your tolerance for discomfort, without putting you in a situation that is actually unsafe—so that you learn the difference between real danger and fear of danger.
The reason this is so important is that the sense of danger OCD makes you feel, and the distress that fear causes, are what makes people feel like compulsions are necessary in order to stay safe. Effective ERP therapy also takes into account your life experiences, including traumatic ones, so that you can confront intrusive thoughts and images—including those that may relate to difficult life experiences—without being retraumatized.
You have every right to ask your therapist or potential therapist about these concerns, along with any other questions you might have. Doing so is itself a form of self-compassion, because it requires you to care about yourself and your treatment, and show up for yourself. In return, your therapist should be able to answer you thoroughly.
And to be very clear, what they should tell you in response is that ERP can be trauma-informed, it’s designed to help you find a greater sense of ease with yourself and your surroundings, and self-compassion is crucial. Any good ERP therapist won’t just tell you to confront your fears; they’ll guide you through techniques for responding without resorting to compulsions, while making sure to move at a pace that works for you. If self-compassion isn’t a key part of your ERP, you’re not seeing the right therapist. ERP therapy is meant to help you learn to trust yourself again and regain your sense of self and identity—all of which requires more self-compassion, not less.
Self-compassion vs. compulsive self-reassurance
One pitfall that people with OCD should look out for, and that good ERP therapy can help you learn to identify, is the slip between self-compassion and compulsive self-reassurance. While self-reassurance can feel different from the common OCD safety behavior of reassurance-seeking, because you aren’t turning to other people, it can still be compulsive and fuels the OCD cycle.
For example, if you feel the need to immediately “counter” every negative thought with an opposing positive one in order to reassure yourself that you’re canceling or balancing out your obsessions, you may think that you’ve found a way to control intrusive thoughts. But in reality, you’re engaging in a compulsive ritual in an attempt to keep your thoughts under control, which only reinforces the idea that it’s unsafe to let go for even a moment. Self-compassion, on the other hand, allows you to stay grounded in the knowledge that scary, disturbing, taboo thoughts do not define you, and just because you think them does not automatically mean they will become reality. You can know these things without needing to actively reassure yourself of them every time a new thought appears.
Self-compassion is also crucial to ERP because ERP can be hard work. Facing your fears, even with the guidance of an empathetic, highly trained therapist, can be tough. And you may have moments where you feel frustrated with your inability to make an immediate change. But being kind to yourself throughout the process—including and especially when you engage in a compulsion even after trying to resist—is key to ensuring that you’re resilient enough to try again. And that’s often where the real progress happens.
Taking care of yourself during and after ERP
Because ERP can be challenging at times, it’s good to have loved ones you can lean on, and strategies in place for caring for yourself. Some practices that NOCD Community members have found helpful include:
- Make a plan to engage in activities that bring you joy or make you feel closer to yourself: Maybe you want to get an ice cream, meet up with a friend, or read a book in the park after your therapy session so that you have an activity to look forward to and to boost your mood afterwards.
- Share what you’re going through with friends and loved ones: You don’t have to share the details of your OCD or treatment with anyone, unless you want to. But if you’re considering doing so, explaining OCD and the process of ERP to trusted loved ones can help make sure that you have support throughout the process. That might look like a loved one offering to make you dinner after a long session, engaging in one of your joyful hobbies with you, or just being aware that this is a time when you could use some additional support (without engaging with reassurance-seeking).
- Remember your “why”: Many people go to ERP with specific goals in mind, like wanting to be able to enjoy family time without fear they’ll harm their loved ones, or wanting to get back behind the wheel of a car with confidence. Focusing on these goals can help you recenter after a difficult session.
- Allow yourself to focus on the positive: It can be hard to acknowledge small wins when you wish things could change overnight, but every bit of work you do is more than you had done before.
Like any therapy that leads to serious change (even for the better), ERP can feel hard, frustrating, and uncomfortable at times, but it should never be genuinely unsafe—and a qualified therapist will make sure that you can recognize the difference between those feelings.
At NOCD, we are careful and thorough in building our team, so that we can ensure all of our therapists are highly qualified to provide specialized, personalized, and empathetic OCD care of the highest caliber. Every NOCD Therapist undergoes in-depth evaluation and extensive training ahead of hiring. Once they join our network, they continue to receive cutting-edge education and consultation with expert clinical leadership.
At its core, ERP is about learning to tolerate discomfort and uncertainty so you can feel more present in your life and trust more fully in yourself. Working to give yourself this skill, even when it’s hard, is the very definition of self-compassion.
