ERP Therapy – An Analogy

by winnond

by winnond


This post first appeared on my blog in January 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 those with OCD equate this therapy with torture, and therefore refuse to try it. Others feel it might 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 those with OCD to “hit the gym!”

This entry was posted in Mental Health, OCD and tagged , , . Bookmark the permalink.

6 Responses to ERP Therapy – An Analogy

  1. Interesting analogy – and apt, it seems to me. Thanks for reposting for those of us who weren’t following in 2012.
    (Madelyn Griffith-Haynie – ADDandSoMuchMORE dot com)
    ADD/EFD Coach Training Field founder; ADD Coaching co-founder
    “It takes a village to educate a world!”

    • Thanks for commenting, Madelyn. Hope all is well. I agree it’s good to share some of my older posts now and then!

      • I like to do give an archival post a new turn in the spotlight because, although I find my own site easy to navigate, I know from going to other blogs that finding older content can sometimes be a headache, just because I didn’t design them.

        If the person who DID were to come to, I’m sure they’d say the same thing! (anything NOT listed as “recent” content on the sidebar can always be found via my archives dropdowns at the bottom middle of every page, btw)

        In any case . . . if my earlier readers were around 5-6 years ago, they probably didn’t read my posts like there was going to be a test – lol – so they will be “brand new” to them anyway, given how memory works.

      • Makes sense to me!

  2. Laura says:

    Thank you for sharing information on ERP! It isn’t easy, but it can be so effective.

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