Monday, May 9, 2011

OCD A to Z: E is For Exposure and Response Prevention Therapy(ERP)

Stacy Nichols - Exposure Therapy 20" x 34"

When I first realized I had OCD, about 7 or 8 years ago, I joined the International OCD Foundation and started receiving their newsletter. As much as I learned from the excellent articles, I assumed that Exposure and Response Prevention Therapy(ERP) wouldn't work for mental obsessions, things happening in my head. Thoughts seem like the substance of our minds, unmovable. Another E word that came to mind was "endless," as a way to describe the thoughts that hang on like thistles on your socks after a hike.

But ERP does work as a treatment for mental obsessions, Pure O, intrusive thoughts. I am so much better than I was before I started ERP 4 years ago. Yes, at first it seemed like trying to see through muddy water, and having an experienced Exposure therapist helped me get far enough away to see the patterns and processes of the OCD.

In a nutshell, ERP is exposing yourself to a thought you don't want to have, or situations that evoke that thought, and then preventing yourself from responding with compulsions in order to make your anxiety go away. So if I have the thought that the ache in my side is appendicitis, which strikes fear into my heart, because I need to know for sure, and right now, an exposure could be saying "Yes, I may have appendicitis. I don't know for sure," and response prevention could be staying off google, not researching the symptoms, or calling my doctor, or going to the emergency room, or poking at my side to see if it still aches. And the ultimate result will be less sensitivity to that thought, an ability to let it float in and out, and continue on with my life.

I encourage anyone who suffers from mental obsessions to seek out an ERP therapist. Check the IOCDF's list of therapists, and also their list of OCD support groups. And read Jonathan Grayson's Freedom from OCD. He published some articles in the IOCDF newsletter about obsessing about obsessing which finally led me to seek help for my OCD.


History of Exposure Therapy

Exposure Scripts for Pure O and Health Anxiety


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  2. I, too, used to believe that ERP would not help. I basically have a Pure-O form of OCD except that googling medical issues certainly counts as a compulsion! But the majority of my OCD is in my mind and my thoughts. The vast majority. I've tried ERP in the past without success but I do think some of the scripts suggested in Grayson's book (specifically for health anxiety or hypochondria) are good ones. They are realistic and seem to hit the mark with the intention of learning to accept uncertainty in our bodies as well as with the medical establishment and 'diagnoses'. Do you have any other health anxiety scripts you'd be willing to share? I'm not particularly skilled at writing these! :-(

    1. I will look to see if I have more I can share, but ultimately, what helped was having an exposure therapist who helped me identify what my feared consequences were, and write a script that specifically addressed it, so if you have the opportunity to find an experienced ERP therapist, that could really help. Treatment Providers

      Accepting uncertainty in my body is definitely a core issue--and also realizing that I focus on certain parts of my body more than others, and that I *can* live with uncertainty, as hard as it seems at first.