This week I’d like to share a post that first appeared on January 31, 2012.
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!”
My son will be needing to decide if he wants to face this or not very soon. For years, we simply could not afford the therapy. He found a place within walking distance that is going to help him and it is pro bono. I’m a bit embarrassed we have to do it this way, but I am so happy for him! Maybe things will start to look up for him now.
I’m so glad to hear you son will be getting the ERP therapy he deserves! I will be thinking of you all. Please keep me posted!
Good analogy, Janet. I hope others reading it will realize that ERP doens’t have to be something to fear.
I told my therapist when i first met her, that i wasn’t going to do that ‘touching stuff that’s dirty to get used to it’ thing. She said that was fine, so we worked on thought records etc. After a year, i got frustrated and decided i was going to touch that mailbox/ mail or die trying. That was my first experience in deliberate erp. I first practiced in my mind, so i got used to the dread feelings, then did it for real. It wasn’t as bad as i thought it was going to be, based on my practices. I still think of it as self torture, tho, heh, heh.
Thanks for sharing, Karin. I have heard so many people say what you have written: “It wasn’t as bad as I thought it was going to be.” That dreaded anticipation! Wishing you all the best!
Love, love, LOVE this. I think the analogy is absolutely perfect and spot on. ERP is gym training for a healthy mind.
I agree Sunny. And sometimes we just have to drag ourselves to the gym!
I like the second part of the analogy, but I remember when I started, on the list of things I didn’t want to do, EVER, was ERP. The gym is just kinda like something most people would rather not do, you know? So I think that gives people who “take the plunge” for ERP even more credit!! Also, I love what Granny K said about ERP therapists sometimes doing “pro bono”….I just think that’s an incredible gift and so kind (and needed).
Absolutely, C! I agree…those who tackle ERP are some of the bravest people I know! Also, it is heartbreaking when I hear of someone who is willing to try ERP but can’t afford it. Yes, we need more qualified therapists and better health care coverage (I know, that’s quite a wish list). Thanks for sharing.