ERP Therapy – An Analogy

This week I’d like to share a post that first appeared on January 31, 2012.

by winnond

by winnond

One of the reasons I became an advocate for OCD awareness was to spread the word that exposure and response prevention (ERP) therapy is the therapy of choice for treating obsessive-compulsive disorder. Unfortunately, I sometimes come across first-person blogs where OCD sufferers equate this therapy with torture, and therefore refuse to try it. Others feel it may be helpful but are just too afraid to attempt it.

On his blog, Dr. Steven Seay compares ERP Therapy to an exercise program, and using this analogy, really sets the record straight as to what this therapy involves when dealing with a competent therapist:

I often think about ERP as an exercise program for your brain. Why do people exercise? Typically to improve their quality of life in some way — be it related to health, aesthetics, or the way it makes them feel. People don’t take up exercising for no reason at all–it’s always purpose-driven. This is just like ERP. Why would you do it? Because it’s going to enhance your life in some way.

The analogy can be taken a bit further, though.

Exercise is not a singular activity. It’s something that’s often based around targeting a particular muscle group or certain aspect of health. People who want big biceps do different exercises than people who want to lose weight. This is similar to ERP. People who want to be less bothered by unwanted thoughts (e.g., thoughts of hitting someone with your car) do different exposures than someone who is afraid of contracting a deadly disease. The form of the “exercise” reflects a specific therapeutic goal.

Moreover, there are multiple ways to target the same muscle group. People who want to work on their abs might consider crunches, leg lifts, push-ups, etc. In ERP, there is no one exposure that will help you get better. Instead, there is an array of options that might work for you.

There’s also the hierarchical nature of exercise. If you want to get stronger, it’s smart to start with light weights and build up to heavier weights. It would be downright dangerous to attempt a 500lb bench press without proper training. In ERP, going for that “10″ on your hierarchy is ill-advised at the beginning of treatment. Before going there, you need to lay the proper groundwork first. A gradual approach might take more time, but it will get you to the destination without subjecting you to unnecessary injuries.

Finally, the world is full of different types of trainers. Not everyone is a drill sergeant. The best trainers will listen to you, work with you, and try to understand where you’re coming from. They’ll then use their expertise to design an individualized plan for you that is based on your goals, preferences, and perspective. The best therapists I know follow this same approach to treatment.

My position is that if you’re completing an exposure under duress, you’re unlikely to benefit from it. It’s the process of choosing to face your fear (and willingly embracing the uncertainty that comes with it) that really makes the difference.

Thank you, Dr. Seay.  Here’s hoping your words inspire all OCD sufferers to “hit the gym!”

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What If the What Ifs Come True?

I will be sharing some of my older posts this week and next. I hope everyone is having a great summer (or winter, depending where you live :)). This post first appeared on January 17, 2012.


by Master isolated images

by Master isolated images

In browsing OCD forums and blogs, I have come across some posts that, on the surface, seem to demonstrate that OCD makes sense. In one post, a woman talked of having to perform a certain set of rituals to keep her husband safe when he traveled for work. For whatever reason, she was recently not able to complete these rituals, and wouldn’t you know it, her husband was in a car accident where he sustained minor injuries. Another post involved a mother who was terrified of transferring germs to her young child, and lo and behold, the child contracted a nasty viral infection.

So if the first woman had performed her rituals the day of the accident, would the accident still have happened? If the second woman had washed her hands just one more time, would her child have gotten sick? The answer, of course, is we really don’t know.

Uncertainty, which we know fuels the fire of OCD, is simply a fact of life. In the course of our lifetimes, good things will happen and bad things will happen and we can never be sure, from one day to the next, what awaits us. Whether we suffer from OCD or not, there are bound to be challenges and surprises for all of us, and we need to be able to deal with them.

And that’s what I find so interesting about the above cases. These OCD sufferer’s “what ifs” came true, and they handled the situations just fine. When the “something bad” finally happened, it was manageable; much more manageable, in fact, than their OCD. The obsessions and compulsions and the havoc they wreak on lives are often much worse than the “what ifs” are when they actually do come true.

I am reminded of another post I read a while ago on The Beat OCD Blog. In her first-person blog, Ann comes to the realization that the only really bad thing that had actually ever happened to her was………..obsessive-compulsive disorder.

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OCD and Emotional Contamination

by FrameAngel

by FrameAngel

I was in a public restroom last week and came across something I had never seen before: a toe opener. This particular one was attached to the bottom of the main door which allowed me to open it with my foot instead of my hand. My first thought was, “What a great idea,” and my second thought was, “People with contamination OCD aren’t the only ones who don’t want to touch doorknobs. They are loaded with germs.”

I think many of us without OCD can understand, to some degree, the contamination issues of those with the disorder. Just look around. There are signs in restrooms insisting we wash our hands so we don’t spread disease, and instructions as to the best way to do this. There are hand sanitizer dispensers in supermarkets and other public places. Moms now bring shopping cart covers for their babies and toddlers to sit on to avoid germs. The examples go on and on. We can relate.

But there is another type of contamination OCD that, while not uncommon, is less talked about, perhaps because it is less “acceptable” and harder for those of us without OCD to comprehend. Emotional contamination involves fearing that certain people (or places) are contaminated in some way, and therefore must be avoided at all cost. The OCD sufferer might have had a negative experience with the person in question, might feel there is something undesirable about the person that might “rub off” on them, or might not even have a specific reason for their fears. Those of you who saw the recent show about OCD on ABC News “20/20″ might remember that one of the girls with OCD could not be near either of her parents, and was living temporarily with her grandparent. I believe this is an example of emotional contamination. How heartbreaking it must be for all involved when the “contaminated person” is someone you love.

One aspect of this type of OCD that stands out to me is how quickly this magical thinking can snowball. Of course, this can be true for other subtypes of OCD, but it just seems so pronounced with emotional contamination: Fear, and subsequent avoidance, of a person might then extend to avoidance of any place that person might have been, any people who that person might have associated with, or any item that person might have touched. Before we know it, the OCD sufferer’s world has become so small that he or she might be housebound, unable to breathe the same air as the “contaminated person.” This great article gives a good explanation of emotional contamination, and details a case  study as well.

The good news, of course, is that the treatment for emotional contamination is the same as other types of OCD. Exposure and Response Prevention (ERP) therapy, by all accounts, works well for this type of OCD. If you suffer from emotional contamination, there is so much hope for your recovery. Please take that first step to find a competent therapist, so you can reclaim your life as soon as possible.














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OCD in The Media

 renjith krishnan,

renjith krishnan,

Almost three years ago, I wrote a post expressing my frustration with the way OCD and other brain disorders were typically portrayed in the media. Since that time, there have been glimmers of hope: The movie Silver Linings Playbook (which I have seen) and the HBO show Girls (which I have not) seem to portray more realistic pictures of life with mental illness. The media was on the right path.

Or so I thought.

I recently came across this article about an upcoming movie and the heading made my heart drop: “Denzel Washington is a Killer With OCD in The Equalizer.” I don’t know how OCD will be portrayed in this movie, but the fact that “OCD” and “killer” are in the same sentence is enough to make me cringe. Here is an excerpt of what Mr. Washington has to say about OCD:

“You can be obsessed with a lot of things. It’s just that, OCD seems that people know certain things; people count or wash their hands or things like that. You could be obsessed with microphones or phones or chairs. I don’t know what makes it happen, but it’s just obsessive behavior…. I think it’s the fear. You fear something, so you try to handle it. I don’t know if ‘control’ is the word for it.”

It seems to me that an actor portraying someone with OCD should have a deeper understanding of the disorder. Of course, that’s not what bothers me the most. What bothers me is the association between the words “killer” and “OCD.”   I am concerned about OCD being depicted accurately. As we know, the obsessions connected to OCD are always unwanted and never acted upon. Violent obsessions (in addition to other obsessions) torment OCD sufferers because they totally go against who they are, and how they live their lives. Will this movie make this clear? I guess we will just have to wait and see, but I’m not feeling too optimistic.

I have higher hopes for the indie film, The Road Within, which recently premiered at the LA Film Fest. Dev Patel (from Slumdog Millionaire) plays a young man with OCD, and the two other main characters in the movie suffer from anorexia and Tourette syndrome. In this article, Dev talks about the tremendous responsibility of playing a character with OCD:

To play a character with OCD felt like a tremendous responsibility.” – See more at:
To play a character with OCD felt like a tremendous responsibility.” – See more at:

“I met people with OCD and read tons of books. After meeting the real sufferers, you realise how serious this infliction is, and its torment. It can consume the person to the point where they can’t step out of their own bedroom.”

For those whose lives have not been touched by OCD, the media likely plays a huge role in their perception of  the disorder. And while, overall, I am pleased that OCD continues to receive attention, what we want and desperately need, is the right attention. Whether that will be the case with these two movies remains to be seen.

I met people with OCD and read tons of books. After meeting the real sufferers, you realise how serious this infliction is, and its torment. It can consume the person to the point where they can’t step out of their own bedroom.” – See more at:


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Overcoming OCD: A Journey to Recovery

by jannoon028

by jannoon028

This past fall I wrote about my newly completed book being included in The OCD Book Festival in San Antonio, Texas. While its name has changed, the story and message have not, and I am happy to announce that Overcoming OCD: A Journey to Recovery will be published by Rowman & Littlefield in January of 2015. I have added a “My Book” tab at the top of my blog for the purpose of keeping everyone updated as the publication date approaches.

Aside from being a memoir which recounts my son Dan’s journey through severe OCD, Overcoming OCD: A Journey to Recovery has expert commentary interwoven throughout by Seth Gillihan, PhD. Those of you who follow my blog might be familiar with Seth’s guest post written in September 2012: Mental Rituals, OCD, and ERP. This post has received more comments than any other entry on ocdtalk.

Because of this collaboration with Seth, the book is not only a memoir, but also a useful guide for all those whose lives have been affected by obsessive-compulsive disorder. My goals in writing this book have been the same as my goals in writing this blog: To spread the word that OCD, no matter how severe, is treatable, and Exposure and Response Prevention (ERP) therapy is the treatment of choice for the disorder. While I have many people to thank on the road to publication, I’d like to take the opportunity now to thank YOU, my readers, for your support of my blog and what it stands for. I am grateful that so many of you have chosen to share your struggles and triumphs with me, and am inspired daily by your strength.

OCD can be a relentless, insidious disorder, with the potential to destroy lives. It is my hope that Overcoming OCD: A Journey to Recovery will educate OCD sufferers and their loved ones, and encourage them to fight this horrible illness, so they can live their lives as they choose, and not as OCD demands.


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An Interview


renjith krishnan

renjith krishnan


For anyone who might be  interested, I was recently interviewed by Helen Barbour over at The Reluctant Perfectionist:

I hope you’ll check out her wonderful blog!

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OCD, Medical Professionals, and Stigma



The Internet is amazing. Those with OCD and other brain disorders, who previously might have felt so alone, now can connect with others who often easily relate to their struggles. People share their highs and lows, successful and unsuccessful treatment paths, and all kinds of anecdotes. I’ve learned a lot from reading others’ blogs.

A couple of months ago a blogger, who I follow and consider reputable, wrote about her brain disorder and the stigma she has encountered. A common topic, right? Well, usually. What surprised me (though maybe it’s not so surprising to others?) is that the stigma she experienced came from a health care provider. Once the physician (not her regular doctor) saw the medications listed on her records, he decided that her physical complaints were “all in her head.”

An isolated incident? It doesn’t appear so. Since reading that post, I’ve read similar accounts on other blogs, and have even received an email from someone whose visit to the emergency room (for a physical illness) ended with the realization that those with known mental health issues were assigned a different color hospital gown to distinguish them from “normal” patients.

There has been a lot of discussion on these blogs as to how this discrimination should be handled, from switching health care providers, to not seeking help when needed, to filing a complaint (which just might confirm your “craziness”), to lying about what medications you are taking.

This news has been a real eye-opener for me. In my own experience visiting healthcare providers with my son Dan, I never witnessed blatant discrimination. Of course, nobody knows what anyone else is really thinking, but I never felt that any comments made, or actions taken, were questionable. Sure, I have my share of complaints about how Dan was treated, but they are mostly related to what I feel was mistreatment of his OCD specifically, and not due to the stigma of mental illness.

Obviously this information is disturbing on so many levels. I hate that those who need help might not seek it, or might not be treated well. And how unfortunate it is that there are so many dedicated and caring professionals out there who now might not be trusted, or even approached, by people who have had these experiences.

Perhaps what’s most upsetting to me is that I’ve always thought that fighting stigma began with education and awareness. But these health care professionals are supposedly already educated, and already aware, of what various brain disorders entail.

So what do we do now?


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