Lessons from Exposure
The gold standard treatment for OCD
Hello! Today I’m giving a brief explanation of the treatment that has by far helped me the most in finding relief from OCD1.
The excerpt below came from a longer essay I shared on my friend Kelsey Aldringer’s Substack this week. In the piece, I explore many different facets of the posture of exposure. This piece was written for a broader audience than those with OCD. Please hop over to read the full post and leave some love on Kelsey’s Substack. :)
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Exposure and Response Prevention for OCD: the act of facing your fears without falling back on any of your safety behaviors; the gold standard for OCD treatment.
“You want me to do what?” I ask my therapist.
“Move toward the fear on purpose,” he calmly, and perhaps a bit smugly, repeats.
The internet cautions me to protect my peace, use ice packs for anxiety, and master breathing exercises.
In OCD treatment, I don’t get any of that.
My therapist goes on to explain that in Exposure and Response Prevention (ERP) you expose yourself to your fear or trigger, commit to not responding with your normal compulsions (response prevention), and ride out the anxiety by doing nothing.
Nothing! In the face of paralyzing anxiety.
Again, you want me to do what?
Over time, the ERP process can rewire your body’s fear response, teach you that the danger is not real and that you can do hard things.
Exposure therapies are, by definition, uncomfortable.
The first time I try an exposure, my heart pounds and I bristle, much like the moments right before a cold plunge. I write out my fears one by one on a sheet of printer paper my kids haven’t yet claimed for their art projects.
I am the worst friend that ever existed because I didn’t text her back.
I am the worst teacher that ever existed because I did not grade their assignment the moment they turned it in.
I list out the worst case scenarios, and agree with them.
I ruined her day, her weekend, her life.
She will never talk to me again.
I let my students down.
I ruined their semester, their careers, their lives.
I’m going to be fired.
Everyone knows I’m a fraud.
Every choice I make is wrong.
My anxiety ratchets up…until it doesn’t.
Written out, my fears don’t look so menacing. Written out, they look a little ridiculous.
I state them out loud and I feel even more ridiculous.
My body buzzes, but I feel a glint of excitement amidst the anxiety. Is this a hint of badassery, too?
I feel like I’ve unlocked a superpower. Like the lights have been turned on.
I don’t need to protect my peace. Peace isn’t actually the point.
Exposure has taught me I’m stronger than my fears. If I open myself to the dark, I make room for the light. I remove my defenses. Move into the world, uncovered.
It’s a posture.
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You can read the rest of the essay and let me know what you think here.
A few more tidbits about ERP:
In past posts, we’ve reviewed what the OCD cycle is and how to respond to intrusive thoughts/feelings. Like much of what we’ve learned already, the treatment for OCD will also feel counter-intuitive to what you want to do. Instead of avoiding triggers or moving away from discomfort, Exposure and Response Prevention actually requires you to move toward the fear—this is the exposure part. If you are in the throes of OCD, it won’t be hard to find opportunities for exposure; you’re most likely being triggered many times a day throughout your normal life. The trickiest part—and what makes ERP effective—is the response prevention, or not engaging in any of the compulsions or safety behaviors you normally would when triggered. Before attempting ERP, I would encourage you to look back at the non-engagement responses to OCD—Allow, Acknowledge, Accept/Agree. If you continue to do compulsions during your exposure, you’ll continue to fuel the OCD cycle.
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I’d love to hear from you! If you’ve tried ERP, how was the experience for you? If not, would you be willing to try? What other treatments have you found helpful for OCD? And if you don’t have OCD, how do you think embracing discomfort could benefit your life?
I am not a therapist and this is not therapy. I am just sharing what has been helpful for me. I also want to say if ERP hasn’t helped you in your OCD journey or you’ve had a bad experience, I am sorry. This doesn’t mean you’re doing anything wrong. There are other treatment options available and many people I know use differing combinations of each, such as ACT, medication, and I-CBT. Please reach out if you’d like help accessing additional resources!