ERP Therapy, Drugs, and Anxiety

pensive manBy 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?

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8 Responses to ERP Therapy, Drugs, and Anxiety

  1. Tina Barbour says:

    Good, thought-provoking post, Janet! I think it’s important to deal with the emotions, too. I don’t think medications necessarily get in the way of that. It depends on what medications are used and the effects on the person. And it depends on what the medications are treating.

    In the case of severe depression, from my experience, medications have been necessary to get me to a place where other ways to deal with the depression could even be tried. The medication doesn’t keep me from having to deal with the feelings that help to feed the depression. And believe me, I feel them. With the OCD and GAD, I can still very much feel the anxiety.

    With that said, I am on an SSRI. I have an anti-anxiety medication, Klonopin, that I take everyday, but I take a low dose and I don’t feel like it dulls my feelings. I do know of others who have had a problem with that, though. It’s a complicated issue, and I appreciate you discussing it and bringing it out in the open.

    • ocdtalk says:

      Thanks so much for sharing your thoughts, Tina. I totally get what you are saying and you have such a good understanding of what your medication does (and does not) do for you. That’s really important also, I believe.

  2. kris says:

    I am so thankful that you write this blog Janet, your posts are always very thought provoking. When I first sought help, I didn’t know what I had. OCD was not diagnosed for awhile, but that was my fault as I felt more comfortable sharing the depression side of my illness and was embarrassed to share the checking rituals I was doing. I did not know OCD existed. I was completely over-medicated by doctors and I was so depressed I could not advocate for myself. That is my biggest fear and concern, how many people are in that same state with no one to advocate for them.
    It is a long story, but thank the Lord for my family and for a doctor that walked into my life (he saw me when my regular doctor had to go out of town) and recognized I was over-medicated. Miraculously, this new doctor (who I promptly switched over to) was an OCD Specialist who had OCD himself. I personally think he was sent straight from God to me. Everything changed for me from that point. He did give me an SSRI for depression and once I responded to that, he taught me about exposure response therapy. One thing that he told me was that the benzodiazepines (which other doctors urged me to take) would be extremely detrimental to me and I was going to have to learn to tolerate anxiety to overcome it. Did I enjoy hearing that? No, but I so admire him saying that to me.
    There are definitely drugs that improve peoples lives so I am not anti-medication but I also think we live in a world where people would rather rely on a drug for conditions that healthier eating, exercise or lifestyle changes could have an impact on. I have seen with my mother in law how she has to take drugs to cure side effects from the original drug and I wonder sometimes is she is benefiting from all this. (Sorry this is such a long comment.)

    • ocdtalk says:

      Kris, Your comment is not too long 🙂 and everything you say is so valuable. First of all, I agree that your doctor must have been sent straight from heaven. How incredible that he stumbled into your life when you needed him the most! I agree with you about people being prescribed drugs to deal with side effects of other drugs. This happened to my son. Then in becomes a huge mess and you can’t tell what side effect or symptom is from what. Also, as you say, being able to either advocate for yourself or have someone advocate for you is crucial. OCD is tough enough without having to deal with improper treatment. Thanks so much for sharing,

  3. Abigail says:

    As for not feeling feelings… Some of the feelings we feel aren’t even accurate. For example, feeling utterly hopeless and worthless is not a feeling I need to feel; it is a feeling of disease. So if I can take a medication that saves me from that deep darkness, I’ll go ahead and do it. And if the SSRI I take just happens to change my brain chemistry enough that I no longer see some OCD issue as so dangerous and pressing, I’ll take that, too. And I’ll do ERP, too, on OCD issues that become a problem despite medication. But that is my personal approach, and every one needs their own approach.

    I haven’t had much experience with benzodiazepines. Once after the ER, lorazipam worked a miracle and let me deal with life and rest for the time being. Actually, there were a few situations I’m thankful for it’s help getting through. But since then, I think the miracle effect lessened, and I wasn’t going to take more than prescribed to try to get it back, since I didn’t want to get addicted. The combination of less results, avoiding addiction, and my doctor telling me I couldn’t drive on lorazipam served to keep me out of that particular issue.

    • ocdtalk says:

      Thanks for commenting Abigail, and you bring up an interesting point. When I was talking about feeling “real” feelings, I was thinking of not covering up grief, etc, but as you say, feelings that are a result of a disease might be a different story. It does get complicated, doesn’t it? Thanks for sharing, Your comments are always thought-provoking.

  4. The Hook says:

    You may not be a therapist, but you know your stuff, dear lady.

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