I’ve written elsewhere on this blog about Exposure and Response Prevention therapy (ERP) and how different my life is after I underwent an intense 12 weeks of this type of cognitive-behavioral therapy. ERP is exactly what the name says it is: you are exposed to something that will trigger your obsessions and then you are prevented from responding with a compulsion that will relieve your anxiety.
For example, someone who has contamination obsessions and hand-washing compulsions might be made to touch garbage and then is not allowed to wash her hands. Instead, she sits with that anxiety, feeling it intensely. If someone has HOCD obsessions and seeking reassurance compulsions, she might have to look through a Victoria’s Secret catalog and is not allowed to ask, “Am I gay? Am I straight?”
So, what happens when you have Pure-O obsessions? What if your obsession is that you will kill your newborn daughter and your compulsion is to stay away from her crib? What if your obsession is that you’re going to blaspheme God and go to hell and your compulsion is repeating a prayer in your head?
Then what? You can’t really kill your daughter (um, big DUH there, but you get it!) and you can’t really go to hell, so how in the world are you able to practice an exposure then?
“little sad song” by *TrixyPixie on deviantART
Imaginal exposures, baby. Brilliant and brutal.
In situations like these, what you might be expected to do is to write down all the ways you could kill your daughter, read it into a digital recorder, and then listen to it over and over. Or maybe you’ll create a story in which you go to hell, where you’re forever condemned, and you read that story again and again.
If you’re an obsessive-compulsive, trust me, these imaginal exposures are going to FREAK. YOU. OUT. They will be so triggering and so terrifying that your anxiety is going to spike, no problem.
Meanwhile, no compulsions allowed.
Meanwhile, ERP is re-wiring your brain.
Meanwhile, you’re stepping toward freedom. And “all” you had to do was listen to a story.
This was my particular brand of ERP actually. I had to listen to my recording for about 80 minutes a day until my anxiety levels (self-measured at the beginning, middle, and end) decreased by 50%. For the first ten weeks or so, my anxiety levels were NOT dropping, and I very nearly gave up. I mean, why put myself through this misery and terror every day if it was doing no good?
Sometime during week eleven, those anxiety levels started to drop. I developed a whole new way of looking at my intrusive thoughts. I tiptoed up to OCD. I can still remember the day when I was listening (again) to that horrid recording, and instead of feeling anxious, my thought was, “This is getting so annoying.”
And then I laughed … because … because finally. You know what I mean.