Guest Post: My ERP Experience

With her permission, I am sharing a comment from ashley1234567890, one I found particularly insightful.

And here she is …

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!

Worth Saying Again & Again

Exposure therapy is the best avenue we know of for treating obsessive-compulsive disorder.

Close up of hand drawing gears mechanism with chalk

ERP (exposure and response prevention) is what every OCD expert will suggest as the frontline treatment for sufferers.

It works.

It’s hard and scary, but it works.

Catering to compulsions is a band-aid on cancer. It treats symptoms. It cuts leaves off a weed.

ERP is chemotherapy. It goes after OCD itself. It digs out the root.

On this blog, you’ll only hear OCD treatment recommendations for:
1. ERP
2. ERP plus praying for a miracle
3. ERP plus meds
4. ERP plus meds plus praying for a miracle.

You can learn all about ERP therapy at jackieleasommers.com/OCD.

A Reunion with My ERP Therapist

For OCD Awareness Week, OCD Twin Cities had an event– a panel of OCD experts plus one special guest: yours truly. Interestingly, one of the experts on the panel was my own ERP therapist and personal hero, Dr. Chris Donahue. I have not seen him since the last day I graced his office with my presence on the day I finished ERP therapy back in 2008, though we have communicated via email, and I have sent many, many people his way for help.

I only joined the panel for the last fifteen minutes or so. For the majority of it, I was in the audience. There was this weird dichotomy going on for me: on the one hand, I was listening to this man who saved my life, who changed everything for me, who pulled me out of darkness and into light, out of slavery and into freedom; on the other hand, his voice is the voice of my exposures (I did imaginal therapy, listening to an audio recording … and it was in his voice), which were some of the most difficult things I’ve ever, ever had to do in my life. So there was this push-pull thing going on while he spoke.

Then, later, I joined him. I was able to sit next to my hero and publicly tell an audience, “This is what this man did for me. This is what life was like before, and this is what life is like now, and they are unrecognizable.” I turned to him and said, “Thank you.” He said, “You’re welcome.” It was a simple exchange … but so layered. So many things going on in my head and heart.

In any case, I am grateful. With every year that goes by of freedom, I more and more shed my identity as someone in bondage. ERP therapy saves lives. For some of us, it changes everything. It did for me.

For lots more information about OCD and ERP, go to jackieleasommers.com/OCD.

dr donahue 2

Sweet Freedom

freedom in redAlison Dotson, president of OCD Twin Cities, and I were emailing recently about how sometimes we feel as if we say the same thing post after post, article after article, especially since they usually involve our own stories with OCD, and history doesn’t change.

But I reminded her that even if we’ve heard our stories over and over, someone else might be hearing it for the first time. Not to mention that sometimes those of us with OCD need to hear the truth multiple times before it is finally able to sink into our heads and hearts.

So here it is again:

I was in bondage to obsessive-compulsive disorder for twenty hellish years. I was plagued by ugly, intrusive thoughts that caused me intense anxiety and even terror. Many days I felt completely out of control of my own thoughts, and I hated the ugliness that polluted my mind. I was sad, lonely, depressed, lost, engaged in an ongoing war where the battlefield was my own brain.

And then an amazing psychiatrist named Dr. Suck Won Kim gave me not only a prescription but also the phone number to a cognitive-behavioral therapist in the area, along with the warning that ERP therapy “will be hell” and the encouragement that I had to do it anyway.

And I did. For twelve grueling weeks, I practiced the exposure therapy assignments set out by Dr. Christopher Donahue, and after twelve weeks of hell … I was free. Free for the first time since I was seven years old. I could barely even remember what freedom felt like, what it felt like to be master of my own thoughts, to rule over my OCD instead of having it rule me, and so it was actually a little scary at first.

But let me tell you: you get used to freedom, joy, and light pretty darn fast.

The last five years have been magnificent.

Please, please ask me questions if you have them.

For (lots!) more about OCD and ERP, go to jackieleasommers.com/OCD

Image credit: Jesus Solana

A Detailed Post about ERP

ERPI have written many times about Exposure and Response Prevention therapy, and lately, many people have been contacting me for more details about it, especially how they can do ERP on their own from home.

GIANT DISCLAIMER:
I AM NOT A THERAPIST.  NOT EVEN CLOSE.  

I am an obsessive-compulsive 31-year-old female who successfully underwent a twelve-week ERP experience four and a half years ago.  I say “successfully” because at the end of the twelve weeks, I then spent the next year and a half without obsessions or compulsions.  (Can you even imagine?  It sounds like a different life, right?  It was.)  In the three years after that, I have only had a handful of obsessive bouts (probably fewer than five), which I have been able to manage well with my ERP tools and which didn’t last longer than one day.  You can gauge for yourself if that sounds like success to you.  For me, it has been like happy freedom after spending twenty years in slavery to OCD.

With all of that said, I’m going to give my very best advice in this post.

SKIP TALK THERAPY AND PURSUE EXPOSURE AND RESPONSE PREVENTION THERAPY.  Talk therapy (where you spend an hour with a therapist discussing your problems) can actually, in some cases, perpetuate your OCD, especially if your compulsions include confession and seeking reassurance.  Your talk therapy sessions will essentially become one-hour opportunities for you to confess to your therapist and seek reassurance from him or her.  That is the opposite of what you want to do.

FIND A COGNITIVE-BEHAVIORAL THERAPIST WHO IS SKILLED IN ERP.
Begin by asking him or her questions about the techniques they use to treat OCD.  If the therapist doesn’t mention cognitive-behavioral therapy or exposure and response prevention therapy, keep looking.  You don’t want to waste your time spinning your wheels with someone who doesn’t know how to do exposure therapy.

WHAT WILL USUALLY HAPPEN IN ERP:
Your therapist will begin by asking lots of questions to get a real understanding of your OCD.  Remember, there are several different kinds of OCD, and in order for your therapist to really mold your treatment plan around you as an individual, he is going to need to ask for lots of details.  If it seems like he is zoned in on what will cause you the most anxiety, you’re probably right.  In ERP, your therapist is looking to trigger your anxiety and then prevent you from doing anything to alleviate that anxiety.  (Good times!)

You will probably create a fear hierarchy, a list of various things that would cause you intense anxiety.  Then you’ll probably start with the least scary item and work your way up to the top.  The top item on your fear hierarchy will probably seem IMPOSSIBLE.  Continue anyway.  By the time you actually get to that item, ERP may have already re-wired your brain enough to be able to handle it.  I need to repeat: focus on the item you’re at, even though the temptation is to stress about the next, scarier item.  Your therapist is not going to force you to do anything, and it’s going to be a better experience for you if you simply focus on each individual day and what you have to do that day.

Your exposures will be specific to you, though, in general, if you have contamination fears, you will probably have to interact with things that you deem unclean (in fact, probably with things that really are!).  If your OCD is more concerned with order, you may be asked to sit with things out of place.  If you have HOCD, you may be asked to read LGBT literature or to look at scantily-clad members of your same gender.  If you have harm thoughts or other anxieties that you’re not able to actually expose yourself to, you’ll likely need to do imaginal exposures, which may involve writing graphic stories and then reading them or possibly recording the story and listening to it on repeat.

If you’re doing this on your own (and are not guided by a therapist), I recommend doing the recording.  It was more anxiety-inducing for me to listen to a recording than it was for me to quickly read over the story I had written.  Make the story bad– the worst things you can imagine.  And perhaps opt to use lots of details: instead of just using large, blanket statements like “I am thinking a blasphemous thought, and I will go to hell for it,” try “I think of cursing God, and I know I will go to hell, where I will be lost and alone forever.”  Describe it.

The first time you do your exposure, keep track of your anxiety level, 0-100, where 0 is no anxiety at all and 100 meant you were clawing at the ceiling.  Then, every time you do your exposure, rate your anxiety level at the beginning, middle, and end of it.  Keep doing that exposure until your anxiety level is half of what it was when you first started.  Then, you can probably move on to a higher, scarier exposure on your fear hierarchy.

If your exposure (when you start it) is not causing you much anxiety, then chances are you have something a little off.  You’ll need to talk to your therapist or think through your exposure to see if you’re hitting the nail exactly on its head.  (I read a story once where the OC thought her obsession was one thing, say, worrying that she would hurt her child, but the exposures weren’t causing intense anxiety, so she and her therapist took a closer look at it, and together they realized that her actual, larger fear was that she would never know if she would hurt her child … similar but a little different, enough that they changed her exposure to fit better.)  If you have been doing your exposure for a while and the anxiety levels are dropping, then that is a good thing, my friend.  That means that ERP is re-wiring your brain correctly.

Keep all your anxiety ratings in one place so that you have a visual representation of how ERP is working as you watch the anxiety levels drop.  It may be a while before you start seeing a downward movement.  That’s okay.  Keep going.  In my experience, my anxiety levels didn’t start to drop until about week ten.  After that, they plummeted quickly.

ERP is a scary experience, so I do recommend paying the money to see a therapist IF you can afford it and IF the person is well-trained in exposure therapy.  If you decide to create your own ERP experience, buy a book that will guide you, such as Stop Obsessing! by Edna Foa or Freedom from Obsessive-Compulsive Disorder by Jonathan Grayson.  Talk to your friends and family ahead of time and spell out for them what your compulsions are, asking them to not aid you in these, even when it is difficult.  It may be helpful for you to tell them that aiding your compulsions is akin to them being on Team OCD instead of Team You.

Many people choose to pair ERP with medication.  I did.

I spent fifteen years with OCD before I was diagnosed, then another five before I began ERP.  That was twenty years that OCD stole from me, so when I began ERP, I essentially knew it was my last hope, short of some supernatural miracle.  You might not be mentally in that place yet, ready to put your nose to the grindstone and make it happen.  You’ll know when you’re ready.  Just know this: most obsessive-compulsives I talk to who have gone through ERP say their big regret is not pursuing ERP sooner.  ERP is hard … but it is not (not-not-NOT) harder than living daily life with OCD.

And what is happening while you go through these exposures?  I meant it when I said that your brain is being re-wired.  In this therapy, the brain changes, allowing an obsessive-compulsive more room to live with uncertainty (the root of it all).

ERP gave me back my life.  I am happy again, have joy again, love life.  I no longer fight a daily battle with my own mind.

Related posts:
OCD, ERP, & Christianity
ERP & Imaginal Exposures
Preparing for ERP Therapy
Medication vs. Exposure Therapy
All About CBT

How to Care for the Obsessive-Compulsive in Your Life

hugMy friend Amy recently requested that I write a blog post about how to care for an obsessive-compulsive friend or family member.  I thought it was a great idea!  Here’s my best advice:

1. Get them into treatment.

The best, most important thing that you can do for the obsessive-compulsive in your life is to do whatever it takes to get them into a treatment program.  OCD is treatable with Exposure and Response Prevention (ERP) therapy.  Don’t balk at the cost or make them feel guilty about it.  A co-pay in exchange for their freedom and joy?  Throw yourself 100% into the task of getting your beloved OC psyched about therapy.  Read success stories online and share them.  Educate yourself.

2. Find out their compulsions and don’t aid them.

Ask your OC what his or her compulsions are.  Ask again after they’ve started ERP.  And then steer clear of enabling those compulsions.  This is difficult to do, especially if one of their compulsions is seeking reassurance.  With all your heart, you are desperately going to want to reassure them that X won’t happen, or that Y is okay, or that Z won’t end badly.  Don’t do it.  Doing so is siding with OCD against your loved one.  To side with them, you have to stand strong against OCD and not enable their compulsions.  It’s okay to say, “I don’t answer OCD’s questions” or “we can’t know that” or “I’m not going to aid your compulsions.”  Set up a standard answer with your OC ahead of time and then stay strong.

3. Find out their exposures and help them practice.

Ask your OC what their exposures look like and– if possible– help them practice.  Keep your eyes open for opportunities for your OC to practice their exposures, and encourage them to do so.  Stay in the room if they need you to.  Hold them afterward while they cry.  Continue to starve the enabling bug inside of you!

4. Be a cheerleader.

Encourage, encourage, encourage!  Think and speak positively.  Stay excited about ERP, even when your OC feels like a failure.  Don’t let them entertain the thought of giving up.  Remind them of all the ERP success stories.  Believe that hope and health are just around the corner.  Remind them that freedom is so close and so worth it.

5. If you’re the kind of person who prays, pray hard.

A Metaphor for Obsessive-Compulsives

A new friend came over to my apartment the other week, and we got to talking about Exposure and Response Prevention (ERP) therapy, and I shared a metaphor with her that I’d like to share with you now.

We put out fires, but what we need to do is shoot the arsonist.

arson

The problem with attempting to “solve” an OC’s obsession is that, as soon as it’s solved, a new obsession will take its place.  In that way, you’re only putting out fires, not dealing with the root issue, which is an inability to handle uncertainty.  For years and years, I watched my obsessions hop from one thing to the next.  My compulsions– and even my talk therapy sometimes– were shortsightedly stamping out the flames in one corner of my mind while OCD set a new fire in another corner.

How can you possibly manage to keep up that way?  It’s not sustainable.

That’s why I agree with so many of the OCD experts in this country that the best way to fight OCD is with Exposure and Response Prevention therapy.  ERP is so very different from most standard therapies.  In it, obsessive-compulsives are exposed to a trigger that prompts in them deep anxiety; then they are not allowed to respond with an anxiety-easing compulsion.  Instead, they are forced to sit in that discomfort.  Doing this repeatedly actually re-wires the obsessive-compulsive’s brain in a way that they learn to live with uncertainty and their quality of life improves dramatically.

It’s been four years since I turned my attention from the bonfires to the disorder that was setting them.

It’s been a good four years.

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.

OCD Stockholm Syndrome

First things first, I am a guest blogger on Monday at my friend Hannah’s blog, Prayers of Light.  Over there you can read a little something I wrote about Digory Kirke, about finally getting to hear the rest of the story.  Fellow Narnia geeks like me and Hannah are more than welcome to check it out!

Let’s talk about OCD Stockholm Syndrome, yes?

OCD.  Obsessive-compulsive disorder.

Stockholm Syndrome.  When hostages love their captors/abusers.

OCD Stockholm Syndrome.  When obsessive-compulsives ironically cling to the disorder that holds them in bondage.

“OCD Stockholm Syndrome” isn’t a real term, but it’s a real thing– and one I don’t think we talk about that often.  It’s confusing and senseless, and I don’t claim to understand it myself.  But this blog is in the business of shining light in dark places (mmm, lights all around!), so I thought I’d write about it.

I hate OCD.  I really do.  I think it is an ugly, vile, reprehensible disorder that steals joy and leaves people in shackles.  So, tell me why it is that, after my cognitive-behavioral therapy was over, I asked my therapist, “Do I still have OCD?” and when he said, “Yes,” I felt relief.

I think I was worried about what I would lose.  OCD had woven its way through me and entangled itself so deeply through me that a big part of me was worried that I would lose my personality if I lost OCD.  I also thought I’d lose my reputation as the “thinker” amongst my circle of influence.  As a Christian, I worried that I would lose my desperation for Christ if this disorder vanished because, after all, hadn’t it motivated me toward loving my God?

Once I watched a talk show where an audience member asked a question to the girl on the stage suffering from anorexia.  The audience member had formerly been through treatment for anorexia herself, and she asked (with incredible insight), “Sometimes don’t you feel like anorexia is your best friend?” and the girl on the stage answered, “Yes.”

At the time that I watched this talk show, I had not yet undergone ERP, and I remember thinking, I understand that.

It’s bizarre, I know.

When I communicate with other obsessive-compulsives, there is often a theme of therapy-avoidance that runs deeper than just a distaste for the hard work and anxiety that characterizes Exposure and Response Prevention therapy.  There is this deep-seated worry that ERP will not only erase OCD and anxiety from their lives– but a part of themselves.

I didn’t like to talk about this with people because it seemed so contrary to everything I stood for.  How could I hate OCD with everything inside of me– and yet still cling to it with such a quiet desperation?  It made no sense, and even to this day, I still have not figured it out.

freedom

But I wanted to talk about it on my blog because it’s a real thing– a real thing that sometimes prevents sufferers from the relief that is available to them.  I don’t know a lot about this strange phenomenon, but I do know this: I was worried about losing my personality, reputation, and desperation for Christ, but now that my OCD is under control, I am finally the Jackie I was supposed to be; I am still a deep thinker but now my thoughts are productive and not circular, and I actually have a greater capacity for deep thought because I am not sent reeling in terror by my thoughts; and I finally feel the nearness of God.  Whatever was lost doesn’t compare to what I gained.