ERP Therapy, Drugs, and Anxiety
By the time my son Dan entered a residential treatment program for obsessive-compulsive disorder, he’d already been taking an SSRI for a while. A benzodiazepine and an atypical antipsychotic were soon added to his regimen. Side effects abounded, but we were told in no uncertain terms that Dan needed these meds so he could tackle the Exposure Response Prevention (ERP) Therapy (a type of cognitive behavioral therapy and the frontline treatment for OCD) that loomed before him.
When I updated Dan’s therapist outside of the residential program, he was concerned. “One of the most important aspects of ERP Therapy is being able to really feel the anxiety that comes along with the therapy.” I understood it was a fine line between giving meds to reduce anxiety (so he would be able to participate in therapy) and having anxiety reduced too much (and therefore not feeling the discomfort that is necessary for therapy to be successful).
In this post, Dr. Marla Deibler talks about this issue and how it relates specifically to the use of benzodiazepines and the treatment of panic disorder, which she treats using cognitive behavioral therapy. Two of the problems she sees that might occur with the simultaneous use of benzodiazepines and CBT are:
…a risk of psychological dependence. So frequently, I see patients who are fearful of leaving benzodiazepines behind, as benzodiazepines have been their only source of potential relief, albeit minimal. Benzodiazepines can undermine CBT treatment, in this way, as it unintentionally validates their belief that they cannot control the anxiety and must rely on external forces to do so.
… benzodiazepines can be counterproductive to CBT. The aforementioned problems notwithstanding, benzodiazepines, which enhance the action of the neurotransmitter, GABBA (Gamma Amino Butyric Acid), resulting in a “calming” or dulled excitatory response. In essence, it dulls the emotional experience, thereby reducing the potential for anxiety/panic intensity.
While it is easy for me to look back and say that Dan was overmedicated at the time, the truth is he did benefit from the ERP Therapy he learned at this program. Could he have done it without all of these meds? My guess is it would have been more difficult in many ways, but it would have been possible, and maybe the benefits would have been greater. I’ll never know for sure. I do feel strongly that Dan should have been weaned off at least some of his meds once he left the program, but that never happened. One medication kept replacing another and different combinations were tried, all leading to a host of problems.
I’m not a therapist, but in my opinion, it is crucial that we all be allowed to, even encouraged to, feel what we really feel. Whether we are dealing with fear, anxiety, grief, or a multitude of other emotions, recovery can only genuinely begin when we acknowledge, not avoid, our deepest feelings. How else can we truly work toward healing?
Entry filed under: Mental Health, OCD. Tags: anxiety, atypical antipsychotics, Benzodiazepine, Cognitive Behavioral Therapy, exposure response prevention therapy, obsessive compulsive disorder, OCD and healing, Selective serotonin reuptake inhibitor, treatment options for OCD, understanding OCD.