ERP Therapy: Better to be Proactive or Reactive?

by stuart miles

This post first appeared on my blog in March 2011. I revised it slightly and think it is worth sharing again…..

I recently read this blog post which brings up a discussion that occurred at an OCD support group. I think almost everyone with OCD who has used exposure and response prevention (ERP) therapy would agree it can be very effective. One of the problems with it, however, is that by its very nature it is anxiety provoking. Who wants to willingly subject themselves to sometimes seemingly intolerable levels of anxiety and discomfort?

So the question is: Do you seek out these anxiety provoking experiences, even going so far as to create them yourself, or do you just wait for them to come to you? You know they will, sooner or later.

When my son Dan began dealing with his severe OCD he would often say to me, “Make me do this,” or “Make me go here,” or “Don’t let me do this or that.” I don’t think either of us realized it at the time (I know I certainly didn’t) but he was instinctively engaging in ERP therapy. At that point, he had not had any proper treatment for his OCD. Still, even in his debilitated state, he somehow knew that exposing himself to what he feared most was his ticket out of the torturous cycle of OCD.

To those of us without obsessive-compulsive disorder it might seem like a no-brainer. If this is the therapy that works, of course you should continue to practice it as much as possible. Sure, easy for us to say. But if you have OCD, and your brain has been relatively quiet for a while, why would you want to shake things up? Why not enjoy the peace when you have it and deal with whatever you need to deal with when it comes along?

There is no right or wrong answer here. Or is there? OCD is tricky and often rears its ugly head when you least expect it to. The more you choose to embrace ERP therapy, the better your chances are of beating OCD at its own game. So should you try to enjoy the calm before the storm, or should you create your own storms regularly in hopes of completely changing the weather pattern?

I’d choose the latter.

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13 Responses to ERP Therapy: Better to be Proactive or Reactive?

  1. Shayna says:

    I suffer from symptoms of OCD, but nothing too inhibiting. I’ve done ERP for my eating disorder and social anxiety thought and I can say it has helped me immensely. In my treatment programs, we had ERP groups twice a week but now that I am in individual therapy, my therapist and I have planned a few. We have some for us to do together and others for me to do on my own. The ones we do together are more rigid but the ones on my own are more of a “need to” basis. For example, when I have to make a phone call or get dressed up and go to dinner. I think having some planned and others more fluid is the way to go. That way, it is confirmed that there will for sure be exposures in your life, just in case the “need to” ones do not appear as often as you had hoped.

    • Thanks so much for sharing, Shayna, and I’m glad to hear you’ve found ERP helpful. Everything you say makes a lot of sense to me, especially being sure that there are exposures in your life. Hope to hear from you again!

  2. Daniel Walker says:

    You’re right. ‘Cos It doesn’t end when i am comfortable with the one obsession. It may still be there waiting to take me out when i least expect it.

  3. Abigail says:

    I think that this is a personal choice, and I choose to take breaks if my brain will allow it. ERP is difficult enough that I have to be really frustrated with my OCD to find it worthwhile. On the other hand, life is often also a continuous, usually low level, exposure for me, so maybe I do engage in it all the time, just not officially. Your post suggests that the OCD will flare up in the future, which is probably – almost certainly – true. But when it gives me a break, I intend to enjoy the break. If I could know that it would get much worse in a couple months, should I tire myself out immediately, or conserve strength? Maybe I have a bit of learned helplessness in this area. I don’t find a one-to-one correspondence between my engaging in ERP and my OCD decreasing. If I did, it would be easier to justify ERP to myself. But to me, OCD responds somewhat to ERP, but not completely. So I am not as inclined to engage in ERP unless I’m really frustrated with the OCD

    Thanks for sharing your perspective. You got me thinking!

  4. Tsaheylu says:

    Excellent post. Although I am just learning makes sense to retrain my brain…and be proactive vs feeling like a “sitting duck.” And then when a storm hits..theres not enough mind muscle and confidence to shrug it off.

    I am working through an ACT therapy workbook…which seems helpful…especially in really putting a face to the demon…the thief that has robbed so much from my life. OCD affects everything…for me..its not just one thing..but the tendency to engage uncertainty with hyper-vigilance. And its a lie…excessive vigilance doesn’t make me feel safe…it makes me a prisoner and ups the anxiety due to energizing the very thoughts that one tries to avoid😜 so yes..avoidance is the fastest way to the longest road to recovery.


    • Hi T, Thanks for sharing and it sounds as if you have a good understanding of your OCD and how to fight it. I love your last sentence: “avoidance is the fastest way to the longest road to recovery.” I don’t know if you’ve seen this post I wrote about ACT but maybe you’ll find it interesting:

      • Tsaheylu says:

        Thanks for the link to your article on ACT. Yes…it seems complementary when used with ERP. Top down..relational (ACT) vs Bottom up (ERP). Bringing in one’s values..and bigger picture can certainly motivate one to commit more to ERP. We lose so much to compulsions…and fearing and fighting sometimes make one sink down further into the quicksand.

        The ERP is like you mentioned in your the “alcoholic removing the alcohol first” to begin road to recovery. Regaining one’self through abstinence.

        And ACT provides an understanding..compassion and chance to reclaim one’s sense of self through values amd meaning.

        Thanks for sharing your moatbexcellent articles!


      • Tsaheylu says:

        “Most excellent” lol

      • Thanks for reading it! I love your synopsis of the relationship between ACT and ERP!

  5. Tsaheylu says:

    Still just learning. The mind is tricky. I was reading in an ACT Workbook…about acceptance being akin to “willingness” to feel whatever it is we are feeling. Tough to do after years of mastering “trying to avoid” what we feel. So we begin “acceptance” work thinking its a ticket to not escape hatch. So we are still caught in a the old way of wanting to control…to somehow avoid the feelings. So I guess learning about what “Acceptance” and “willingness” REALLY mean is foundational and takes time. Practice amd “undoing” the mental programming that promised relief..but only imprisoned one more.

    That’s where I am at. Just learning where ive been stuck..why..and that there is a possibility of reclaiming my life…but its through a different foreign as another country and language. But “foreign travel” can help one grow and elighten and make life better. So I am here.


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