ERP & Imaginal Exposures

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

“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?

But then.

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.

what it was like

B.C.B.T. (Before Cognitive-Behavioral Therapy):

I was in bondage to obsessive-compulsive disorder for over fifteen years; I was depressed, overwhelmed, scared, sad, and I felt guilty all the time. I was terrified of thoughts and wallowed in grief and terror for over a decade.

Doubt and this lingering wrong feeling were the normal for me; it was only for small periods of time (sometimes even seconds) that I felt peace.  I worried about ridiculous things– like that I might cause someone to kill him/herself or that I would sexually abuse a child.  I wondered if Jesus was really Satan and if people were really demons, if everyone was pretending to be my friend just so that it would hurt worse when I found out the “truth.”  I woke up in the morning and felt sick to my stomach within a few seconds.

I worried about hell, about my soul, about whether or not my prayers could reach God.  I wondered if writing fiction was the same as lying and if writing about the hard things in life was displeasing to God.

This niggling feeling of unease was constant– sometimes it was at the back of my mind, lingering there in the background, and sometimes it was at the forefront, screaming at me like a siren that SOMETHING IS WRONG.  Peace was fleeting and momentary, and I had to keep asking after it: do you think this is okay?  Do you think this was wrong?  Do you think I’m going to heaven?  Do you think I should worry about this?

I cried a lot.  Sometimes I fell asleep with quiet tears, and sometimes I would WEEP and KEEN while my roommates could do nothing to comfort me.

It was a cycle of horror: I would obsess and stress about A Particular Issue for two to three weeks, until I had completely exhausted myself in every way, and then it would fade into the background.  But only for awhile.  It or another obsession would attack again in a week or so.

I felt alone and scared and not even the gentle hand of a friend on my back could bring relief.  I felt deep confidence that I was condemned and doubted everything else.  At times, I lost my grip on reality and thought I was really, sincerely losing my mind and would end up in a straightjacket or room with padded walls.

I felt hopeless.

A.C.B.T. (After Cognitive-Behavioral Therapy):

I hated almost every minute of CBT and (at the time) thought my therapist was a BEAST, an unfeeling monster.

But twelve weeks later, I was in charge of my OCD and not the other way around.  I knew that I had been a victim and not a monster.

I am living in freedom, I do not suffer from intense intrusive thoughts nor do I feel the need to perform my compulsions to relieve any anxiety, and the quality of my life has improved SO SO SO much.   I don’t have to confess everything all the time or seek reassurance from my friends.  I don’t doubt the tiny decisions I make each day.  I am okay with uncertainty.

And I know it’s not a cover-up!  I know that CBT didn’t work like a band-aid, covering up my problems and making me blind to them.  It worked like an electrician: it RE-WIRED my brain.  Now I can think like a “normal” person.

I still have bad days, just like everyone else.  Sometimes I am sad, bored, cranky.  I fight with friends and hurt because of it. But it’s all in the normal course of life; I experience these the way that others do.  I begin each day at zero instead of at -1000, handicapped so that I have a million miles to make up before I can even deal with things the way others do.

GLORY TO GOD for leading me to CBT, which has UNLOCKED MY PRISON. I am MYSELF now: joyful, creative, secure in my relationship with Christ, and not living behind a mask. My smile is REAL, and I love my life and my God and myself! I give credit to Jesus Christ for such an incredible rescue. Thank You, Lord, for two years of freedom; I am looking forward to an eternity of it.

Would you like to learn more about CBT?  I am happy to answer any and all of your questions with complete honesty.