Lately, I’ve been talking to some brave, amazing people who are planning to tackle cognitive-behavioral therapy (CBT), specifically exposure and response prevention therapy (ERP). I know it’s the right next step, they tell me. Any advice?
Glad you asked. Here are my suggestions as you prepare for ERP.
1. Read and research! Don’t go into this (incredible but difficult) therapy with your eyes closed. I believe that the more you know about what ERP entails and what will be expected of you, the better. In fact, I have a friend who had done enough research on it that he realized only one or two sessions in that he knew more about ERP than the therapist did– instead of wasting time, my friend was able to stop meeting with that therapist and find an expert in ERP.
2. Have an open heart. ERP is not the same as talk therapy. You will be given homework and made to go through exposures that are intended to spike your anxiety. Before I started ERP, my psychiatrist gave me this advice: “Think of a mother, Jackie. A mother would do anything to help her child. You must be willing to do anything to help yourself.” By its very nature, you will be expected to do things that you do not want to do (AT ALL). Do them anyway.
3. Surround yourself with the RIGHT support system. What you need are cheerleaders, people who will be your biggest fans and encouragers. What you absolutely do NOT need are enablers– because they will only be hindering the ERP process. Educate your closest friends about what ERP entails and ask them upfront to not baby you or enable your OCD. When they offer you reassurance or do anything to enable your obsessions and compulsions, they are siding with your disorder against you, instead of with you against your disorder. This is going to be hard for both sides. Tough love is not fun … but it is good.
4. If you’re the kind of person who prays, pray hard.
For those of you who have experienced ERP, what advice would you add?
Jackie, this is a great post with so much good info. I think learning about ERP Therapy before you begin is so important, for all the reasons you say.
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Thanks Jackie. Am really enjoying reading your blog.
One thing I would add is finding a therapist who you feel absolutely comfortable with on a personal level, as well as one who is experienced and confident and fully trained in CBT specifically for OCD.
The (ERP) exercises I was asked to do felt totally counter-intuitive at the time, and a big part of me was worried that doing them might actually make my OCD worse. On a deep-down level, at the time of doing the exercises, I did not fully believe in the CBT theory behind them. However, I had come to trust my therapist as a deeply compassionate human being. And so I agreed to do the exercises despite being very frightened, and despite still being very sceptical about CBT.
To my joy and amazement the CBT, and the ERP exercises in particular, proved completely life-changing. And in retrospect the worst part was my intense anxiety before doing the exercises, not actually while doing them. After doing them I felt very strange …. having just done something that was the opposite of the compulsions I’d been doing for the previous 24 years … and then elated …. but not frightened!
Another thing I would add is to ask your therapist if they are able / willing to conduct some of the CBT in the actual place where your OCD is worst. I was very fortunate to have two intensive CBT sessions in my flat. This was very frightening (having my therapist and a trainee come to the very epicentre of my OCD) but at the same time was very moving (that somebody was willing to block off a chunk of their diary to come to the place where my OCD was most severe and where I’d battled with it for so long on my own). Looking back on it, I think probably 80% of the total change from my CBT sessions came from those two intensive sessions at home. But they would not have been possible without the more standard outpatient appointments beforehand when I came to trust the therapist and prepared for doing the intensive sessions at home.
Karen, thanks for your insight and for sharing!
I had a different experience from you actually– I was distrusting of my therapist … but desperate. And it still worked. 🙂 I guess I trusted him ENOUGH to continue the exposures, but he and I never connected deeply or personally, though the man is now one of my heroes.
So, while I think that it would be an OPTIMAL experience to have a great relationship with your therapist, I don’t think it’s necessary at all. The important thing is that you have to trust in ERP, even if you have a wildly different worldview from your therapist. Does that make sense?
Great advice, Jackie!
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I am two session into ERP. I deeply trust the therapist, he is a great caring person. I plan to do all the homework, but I am scared of what happens if it doesn’t work. My wife and children have been greatly impacted by my OCD. For several years it was there, but it didn’t have much impact on their lives. It was mostly just mine, and even then it was moderate but not debiliatating. Ever since a panic attack three months ago, the OCD (scrupulosity) has been devasting to me, my wife and children. It has morphed from the original theme. A mostly normal future hangs in the balance. I am scared. I can’t live like this. I went through a period of suicidal thoughts. Two SSRI’s knocked me otu of the game with side effects. To make matters worse, since the panic attack I have been in a major depression and also suffer from continuous anxiety. I am lucky if I sleep 3 to 4 hours.
Christopher, good for you for getting into ERP! You’re doing the exact right thing for yourself and your family. It took me till about week ten or eleven for things to really click for me, so KEEP IT UP!!!!
You might want to check out this post as well: https://jackieleasommers.com/2013/11/10/a-detailed-post-about-erp/
I tried EPR Therapy its really, really tough- but its better than living a life of OCD- so I do really recommend it- it was my last hope.
You’re absolutely right, Rachel. That’s what I tell people all the time– it’s one of the hardest things you’ll ever have to do, but it’s not harder than daily life with OCD.
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This blog has been an eye opener for me. My 13 year old daughter has been diagnosed with OCD and has been seeing a psychologist she loves for a couple months now. Tonight is her first ERP session and she’s pretty nervous about it. I read this article to her and it had eased her mind a bit, so thank you all for your comments. (Even if they are 4 years old lol)
It’s so hard watching my daughter battle with this. My husband and I do everything we can to help her manage but I feel as if we’ve exhausted every option, so I’m thankful her psychologist recommended ERP after reading so many positive outcomes with it.
Wish her luck. Something tells me it is going to be a difficult process but well worth it in the end.
Shauna, I am so glad this helped … And so glad your daughter is doing ERP!! She might fight against it, but it is the very best thing she can do for herself. I am proud of her. Please tell her so!
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I find myself constantly coming back to the basics: exposure therapy works; it is hard but not harder than life with OCD; prepare your support system.
Blessings to everyone who tonight is battling this enslaving disorder. I think of you all the time. Today I had multiple opportunities to share about the freedom I have found. It is always good for me to remember what I have come through and how much joy was on the other side.
It was worth walking through the fire. I have NEVER regretted ERP.
I went through ERP and had fantastic results. It was a huge blessing for me, and I thank God that he gave me the courage to try it.
I am no expert, but i did have a really bad case of OCD, which got a lot better after ERP, so here are my recomendations, that in hindsight, were key to my success.
NOTE: my ocd did not get worse with ERP (it got so much better) even though the treatment was very intense!
If you qualify for ERP therapy, and you are considering it, then do not let fear keep you from going. The only caveat is to make sure you find an expert who treats ERP because it is specialized therapy. For example, my therapist was willing to meet me outside of their office for exposures, because my ocd spiked at a particular place. I also recommend finding someone who has experience with whatever ocd you are facing. For example, my therapist had experience with germ ocd, harm ocd, religious ocd, sexual oreintation ocd, etc… so i knew they were highly qualified. they should also give you exercises so you can do your own exposures.
As for ERP, It seems counterintuitive at first, since the patient will go through exercises and narrations that are asking them to run towards their fears (instead of running away from them), which in turn causes anxiety to spike, and while super anxious the patient will be asked to temporaily stay in that state while resisting compulsions that are normally used to reduce the anxiety. If you face the obsession and not give in to the compulsion, then the cycle breaks, which in turn makes you less anxious. That is where “exposure and response prevention” comes from.
My treatment was gradual at first (small fears first then you move onto bigger ones) also, my initial exposures were designed so that anxiety was moderate so I could handle it, and then over additional sessions, they were changed to more intense ones.
For me, it took me about 12 sessions to complete treatment. I noticed some big gains after the first couple of sessions so i knew it was helping. After treatment i am a new person. I still have the ocd, triggers, and the spikes, but it does not cause much distress anymore. Before ERP my distress level was a 10 and it was constant. My life sucked.
So heres an example of what what ERP might look like. let’s say you have germ OCD. You may be asked to touch a door knob and not wash your hands afterwards for 5 minutes. As the sessions go on, and you grow stronger, you may be asked to do the same excercise, then refrain from washing for 15 minutes. Eventually, beloeve it or not, you will be able to do the excercise then not wash at all! Or, one exposure may be a narrative, where you write a short story, and in this story you get a little dirty, or exposed to germs, etc… over the treatments, the story may get more and more disgusting and intense, so you will be in a situation that gets really dirty, and theres no place to wash up etc…
As the sessions and exposures go on, the anxiety for each trigger gets weaker, which in turn makes the spikes less intense. Consequently for me, the ocd got better over time.
Again, the key is to find a qualified expert who has a lot of experience in OCD and ERP, because you will be asked to do things that will make you feel temporarily uncomfortable and the therapist will need to work with you at the right pace so that you are not overwhelmed. They should be willing to leave their office to do an exposure where you need it. So for example, if you are afraid of heights they should be up for going with you to a balcony etc… to face that fear.
Like some of the previous comments, I was anxious before starting too, and I was scared that it would make my condition worse. But i was wrong! that’s just the ocd trying to keep you in the bad place.
In fact thats how i first came across this blog. Jackie had wrote some content on ERP and it gave me the confidence to try it. Thank you jackie you are such a blessing from the Lord! Hopefully this post will do the same for someone else!
Ashley, can I re-post your comment as a blog post by a guest blogger? I can make it anonymous, use your first name, OR use your whole name, if you’d like. Let me know what you think. I just think this comment is SO helpful and I want to unbury it from the comments section and make it its own post. Thoughts?
Sounds like a great idea. Please proceed and use my screen name for the post. Also, I was hoping to send you an email to share with you how your blogged has helped me. Can you please send me an email?
Yay!! Thank you! Feel free to email me at firstname.lastname@example.org!
I am going to write a sort of long post and I’m sorry about that.
Jackie, I’ve known your blog since 2013 when I believe I started having HOCD. I started asking myself if I was gay when I was 20. Never really had a boyfriend because I wasn’t into DATING. but damn I’ve had crushes on men. Then my family started asking questions and it freaked me out. Anxiety was horrible for months! Henre being put on medications. I was just sleeping in the bed with my mom and thought “girl you wanna have sex with her or what?!” Then writing a A and thinking it was a penis. .. it IS weird to say, but it has to come out. Sorry. It calmed down a bit, I had thoughts here and there but no big attacks. 2017; a few days ago I started a new job but a few days before my OCD kicked in. I Can’t leave my job but it feels like going crazy. I can barely eat a meal a day. I also know when I was a kid I had these OCD moments where I needed to repeat the same patterns every night. I needed reassurance from my mother all the time. This post is long, I’m sorry. I’m really starting to consider ERP. no matter if a form of OCD goes away, another one will take place, right? We have to attack the roots.
Thanks for your sweet message, Cindy! I’m so sorry for how horrible things have been lately. I know in my life things had to get pretty bad before I was willing to do ERP. Maybe you’re there now? If you’ve been following my blog for years, then you know that Erp is my very best suggestion. Don’t quit your job. Tell yourself that OCD is not able to follow you into your workplace, that you will deal with it anywhere but there. Then in the evenings and weekends find an ERP specialist and take the OCD out of that part of your life too. I believe in you.
You’re absolutely right. At work I’m kind of able to change my mind and keep myself busy. When I got home today I just broke down and cried to my mom like a little child. I was stressed out because it is a new job, but deep down I knew it was more than that. I just didn’t talk to her about it because I knew it was the compulsion part seeking comfort. I feel drained. But you’re right; sometimes we need to hit a wall to realize maybe it’s time! I couldn’t really afford therapy before, but I think I’m gonna try really soon! Again, thank you. ❤
I’ve been reading your blog alot the past few days because I feel it’s the hug I need right now.
I would love to send you an email -if you want, that is, to explain a bit more. I want control over this. Not the other way around.
Also; I’m so happy to know you’re also an INFJ ( random sorry! )
We’re so insightful people and deep! But anyway; you’re a precious thing and God bless you for doing what you do sweetie. Xo
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I started ERP for HOCD and I’ve had my first proper session for ERP. I had 5 low grade exposures to do by myself and intially they were hard, but now they are easier (don’t get me wrong I still get the thoughts, but I just let them be). And honestly it felt like I have gotten my life back and I am enjoying things a little bit more. My therapist is fully booked so for now, I can only see her once in three weeks. Unforuntately my anxiety has start to come up again and I’m trying my hardest not to do mental rituals/compulsions. The anxiety is a lot less than it was during my peak HOCD days. Is it normal during the ERP process to still have anxiety creep up?
So very normal!!! You sound like you’re on the exact right track and I’m thrilled for you. ❤
Thank you so so much. You’re such a source of inspiration. I read your blog everyday to push myself to do my exposures and be strong so you have no idea of the impact you’re having on our lives ❤️
One last question- you said CBT does or does not work in 12 weeks. This slightly scares me, because I only see my therapist once in three weeks and I’m not on any medications, so I’m afraid if I don’t get better in 12 weeks basically I’m doomed hahah 😦
Thanks again lovely for all your insight xx
I wouldnt worry about the 12 weeks thing … it was something said to me early on, but I’ve since encountered lots of people who have done ERP longer!!
Also, THANK YOU. You have no idea how encouraging your comment is.
One last question!! I’m doing my best not to mentally ritualise and neutralise any thoughts be and just ‘ride the anxiety’ out…my ocd surrounds HOCD…and I’ve been getting intrusive thoughts about my female therapist 😭 it’s tough because now I want to go find a different one but she’s honestly amazing and so compassionate and is helping me heaps… I know there’s a thing called emotional transference ? Is that what my OCD is latching on to? Do I continue with ERP?
Your OCD is just being itself … trying to make you miserable any way that it can. I would trust the process of ERP and keep going! I really believe that life will look so much clearer and some of these things may even feel silly in a couple months. ❤
Hi Jackie I’m in the twin cities area and i have an appointment with Dr Donahue next week! I found out that you went to him and i was really surprised that he could get me in so quickly. I have a question for ERP…does it ever reveal that you actually are a lesbian when in fact you are so scared of it?
I have never heard of someone with hocd who had ERP “reveal” something 😊 and thats not what Dr. Donahue is doing either. But you will be asked to try to become comfortable with the idea… Because that’s how OCD loses its power.
I’m so glad you’ll get to work with Chris Donahue. He changed my life forever!