ERP Has a Branding Problem
Exposure & Response Prevention (ERP) is the gold standard in evidence-based treatment for OCD. Here at Bull City Anxiety & OCD Treatment Center, we’re pretty into it. ERP is kind of our jam. But we’re not oblivious; we hear the whispers about ERP. It’s scary. It’s barbaric. It’s robotic. Maybe we’re biased, but we think ERP is pretty alright; it just has a bit of a branding problem. It’s not cozy and comforting. It’s not a feel-good, wellness journey to the spa. Maybe it’s the name — it sounds pretty hard core. Whatever the issue, we think there are some misconceptions about ERP that we’d like to clear up.
Myth #1: ERP is cruel
OCD is a debilitating illness. Not to be Debbie Downer, but OCD is correlated with all sorts of upsetting things. It impacts quality of life, daily functioning, and much more. But here’s the good news: there’s a really effective, evidence-based treatment. So if you ask me, the only cruel thing here would be withholding a potentially life-saving treatment.
Myth #2: ERP will make you anxious.
Do you know what else makes you anxious? OCD! No one comes into our office feeling blissfully anxiety-free. We’re not asking our clients to do or experience anything that they’re not already dealing with every day. The difference is that we’re asking our clients to take control. Rather than living in fear of their anxiety, we’re going on offense. We’re telling OCD that we’re not going to be pushed around anymore and we’re going to show it who’s boss. So yes, ERP involves eliciting anxiety, but it’s really just choosing to be anxious rather than having OCD choose for you.
Myth #3: ERP is overwhelming.
One of the goals of ERP is to break your OCD down to size. We create an exposure hierarchy so that we can systematically and gradually approach feared situations and experiences. We have nothing to gain by giving you more than you’re ready for. We want you to build off of your successes. We want you to incrementally feel more capable and confident when facing your anxiety. We do this by taking smaller steps, repeating exposures consistently so that you can grow more accustomed to them without feeling overwhelmed. And most importantly, we collaborate along the way so that you are never doing an exposure that you’re not ready for. You will never be forced to do anything you’re not on board with. You will always be 100% in control of your treatment. We’re here to guide and support you, but never to make you do anything.
Myth #4: ERP doesn’t work for mental compulsions.
ERP is a little trickier with mental compulsions, but still effective. Disengaging from compulsive thoughts is not as straightforward as resisting a tangible compulsion, like hand-washing. It requires time spent building awareness of compulsive thought patterns and implementing non-engagement strategies to strengthen response prevention. So there are some extra steps, but ultimately we’re talking about the same thing: our goal is to disrupt the cycle of reinforcement that perpetuates OCD by eliminating any behaviors (even mental behaviors!) that function compulsively.
Myth #5: ERP is just facing your fears.
There are two parts of ERP. The exposure part is, indeed, about proactively confronting fear. Most of our clients are already doing some aspects of exposure. They’re coming into contact with anxiety and their feared triggers on a daily basis. But these incidental daily exposures have not resulted in improvements because they are not doing the second part of ERP — response prevention. This is the special sauce. It’s what makes ERP effective. By removing compulsions, you allow your brain to come to more accurate conclusions. It learns that you are able to avoid catastrophe, tolerate distress, and feel uncertain without any terms or conditions attached. You don’t need rituals or compulsions in order to resolve these experiences. This is what ERP is all about — it’s an opportunity to experientially provide your brain with a corrective experience so that it can learn and come to more adaptive conclusions about risk and danger.
Takeaways:
We know ERP can sound intimidating. But we promise, we’re not sadists who enjoy your distress. We’re compassionate therapists who know how effective ERP can be and we want relief for you. We want to help you access a treatment that can be a gamechanger for folks with OCD. If you have any questions or reservations about ERP, please reach out to us. We’d be happy to walk you through it and help you get a better sense of what this treatment is really like.