5 Months of OCD Questions

Back in November, I noted that 99% of the questions I’m asked are related to HOCD. So I tried to write ONE GIANT REPLY (which you can read here), but it didn’t stop the questions from pouring in.

Frankly, I was exhausted and overwhelmed by HOCD questions, especially when I felt like I’d shared everything I could on the subject. But of course, everyone wants a personalized answer. I understand that, but I’m also not an HOCD expert or any kind of therapist.

So I let the questions sit for a while. Especially when I have a link to the above article right in the form where people can ask their questions.

But today, home sick on the couch, I wanted to tackle some more. A lot more. 🙂

Here we go.

I’m doing self-directed ERP now but I don’t know when should I stop doing exposure works. Do you have any clue?

I do. When you begin, you should rate your anxiety level 0-100. Continue to rate your anxiety level before, during, and after each exposure. Keep doing the exposure until your anxiety level drops to 50% of your original level.

Since my onset of OCD, I’ve become plagued with these fears and dark thoughts…especially the feeling that i am an a ‘bad’ person. Who will hurt others or myself. i feel unworthy and yearn to be the person i was before this illness- light and ‘good’ and kind. I fear greatly that I am an awful and terrible person. Is this normal and what can be done to help?

It is normal for OCD. 🙂 This sounds a lot like a combination of harm OCD plus hyper-responsibility plus depression, if I had to guess! ERP therapy will help. Check out http://www.jackieleasommers.com/OCD.

I don’t know anymore if it’s compulsive or not.. I used to watch different kinds of porn like gay or cuck*old to figure out what I may like.. I watched it but didn’t think about it a lot afterwards but felt disgusted.. like hijacked..maybe I’m looking for an excuse.. Just tried to sleep when images of a porn came and scared me.. like that must be the final proof that its not HOCD.

Proof that it’s not HOCD? To me, being scared or feeling wrong about it is proof that it is HOCD. ERP will help!

Please read https://jackieleasommers.com/2017/11/01/hocd-4-steps-to-freedom.

I live in a country where there is probably no erp therapy available (I’d be very surprised if there was), and these apps you listed are for iOS, i have an Android :(. Do you have any other tips/resources for self therapy? Thanks ❤ much love. I appreciate what you are doing :))

(My kind of ocd is religious one if that matters, I’m a christian) 

Hello dear one, yes, if you have Facebook, try the Pax the OCD Bot (just search it in your Facebook searchbar). This article might also help: https://jackieleasommers.com/2014/10/05/self-directed-erp-therapy.

You don’t have any intrusive thoughts then? Or you do, and just don’t care?

I don’t have them nearly so often! When I do, I am usually able to pass them off now because ERP has re-wired my mind not to give them more worth than they deserve. On the occasion (usually once or twice a year) that the intrusive thoughts do get to me, I use my ERP tools and exposures and usually can get past it within a matter of hours and a good nap.

What is erp, to be honest? They expose you to your fears until you don’t care/find they annoying? Sorry for my ignorance

ERP is exposure and response prevention therapy. Here are some links where you can learn more:

About CBT/ERP
Gaining Certainty through Embracing Uncertainty
Resisting treatment?

What life was like before & after CBT
Obsessing vs. Brainstorming: before & after
A Detailed Post about ERP
ERP is the RIGHT Answer
Better than a Band-Aid
Embracing Uncertainty
What CBT was like for me
Will treatment change me?
Why You Need CBT/ERP
Have Reservations about ERP?
Preparing for CBT/ERP
ERP & Imaginal Exposures
Uncertainty is the Key
The Problem with Seeking Reassurance
Finding a cognitive-behavioral therapist
Medication vs. Exposure Therapy
Can’t afford CBT/ERP?  Try this app or do self-directed ERP!

 I already am no longer afraid at my thoughts, no longer check, i just find them to be annoying as hell. Will i live with this “annoying friend” forever? Ugh. (i mean i believe one day God will heal me but while He doesn’t, will i just have to tell my brain to shut the hell up everyday? Man is that annoying). Thanks 🙂

Essentially, are you saying that you still have intrusive thoughts but they don’t cause you to perform compulsions? This is just real life, unfortunately! Everyone has ugly thoughts that come and go. The important thing is that when they come, they can also go. If you have a hard time letting them go, then ERP is your answer.

I’m afraid to go thought erp because my ocd is the religious kind. Is the doctor going to “make” me (i know no one can make anyone do anything, it’s just a manner of speech) do bad things (ex denying Jesus, wich i wouldn’t do not now not ever but my brain keeps shouting at me to do so)? I rather live my life like hell then actually going to hell, thank you

Completely understand that. Here’s a fictionalized version of how I had to approach such a tricky concept: https://jackieleasommers.com/2012/09/05/tipping-point-my-entry/

I really don’t want to be gay and I used to be so confident in my sexuality (I’m a girl btw) I just recently got a boyfriend and I didn’t like him that much but I still kinda liked him and I thought being with him would make me know I’m not gay but for some reason I just don’t want to hang out with him does that make me gay 

Doesn’t make you gay at all. Probably just means what you said it does: you don’t actually like him that much. Don’t date a boy as a compulsion to prove your heterosexuality. Date a boy because you truly care about him. ERP can help with both HOCD and ROCD. Check out http://www.jackieleasommers.com/OCD.

I think I have HOCD but I’m not sure. My therapist is doing CBT but I don’t think it’s ERP and it’s making me anxious. Like what if this therapy goes know where and just becomes me talking about my problems.(what happened with my last therapist). Should I trust that she knows what she is doing? Her Website says she does CBT so by saying she does CBT does that mean she is also an expert on ERP? 

CBT (cognitive behavioral therapy) is the umbrella term, and ERP (exposure and response prevention therapy) falls beneath the CBT umbrella. The best way to know if your therapist knows what he or she is doing is by educating yourself about what ERP looks like. I suggest reading the posts at http://www.jackieleasommers.com and also going through the list of questions to ask a therapist at https://iocdf.org/about-ocd/treatment/how-to-find-the-right-therapist.

am I actually recovering from HOCD? I am trying to manage my intrusive thoughts and no checking as well. I’m feeling much better however what’s causing me anxiety is that all my straight attraction is gone for a toss. I have had no history of experimenting with girls or having a crush on them. But I feel  scared. I have always wanted to be with a guy. Will my attraction for guys ever come back?

ERP cannot change your sexual orientation. But I do hear from many sufferers that their attraction to others (the opposite gender if they are straight and have HOCD; same gender if they are gay and have HOCD) vanishes for a time. It’s normal for OCD.

Hi Jackie, I’m not having any kind of anxiety over my thoughts anymore. So I woke up and I got a feeling which said “I want to be lesbian” but there was no anxiety that followed. Which freaked me out. And today I was like okay fine, what if I am? That doesn’t change anything. But i know i want to be with a guy. Does that mean I’m recovering or does it mean I’m gay? I want to be with a guy.

This is meant gently and tongue-in-cheek, hon: “there was no anxiety” is followed immediately by “which freaked me out.” Which means there was actually still anxiety. 🙂 Your thought process here is actually correct! But I suspect it will still be bothersome for you until you do ERP. This will help: https://jackieleasommers.com/2017/11/01/hocd-4-steps-to-freedom.

G~Always thought of myself as straight,loved women and the female body always had 100s of crushes. Lately ive watched some gay porn and it actually has excited me to a certain point and i hate it so much.have felt like i would enjoy doing certain things and cant believe im thinking like this. Even been losing my attraction for the female body which i used to be crazy for. Is all this hocd related?

Very, very consistent with the HOCD experience. ERP can help! https://jackieleasommers.com/2017/11/01/hocd-4-steps-to-freedom/

So I’m a 16 year old and a female, for he past few months I’ve been having a thoughts like “what if I’m bi? Or a lesbian?” I know deep down that I’m not but these thoughts are making me think I am. I’ve always liked guys my whole life and have had crushes on them. I’ve never had a crush on a girl or liked one either. It makes me anxious every time I’m around a girl could it be HOCD?

Sounds exactly like HOCD! Exposure therapy can help: https://jackieleasommers.com/2017/11/01/hocd-4-steps-to-freedom/

I keep on crying idk what to do I feel alone I keep on thinking about having s*x with other girls but when I think about i get discussed I’m only 14 years old I can’t be going through this please give me advice on how to control it or get rid of it please I cant even look at my friends anymore without thinking do I like hereading? It’s really uncomfortable and weird I can’t stop crying please help

Oh you poor dear! OCD is hard at any age, but to be 14 and dealing with it … and with something as personal as HOCD … so uncomfortable and lonely and difficult. Exposure therapy can help. It’s up to you whether you’d like to tell your parents what you’re dealing with in detail, or whether you’d like to just tell them you’re confident it’s OCD but you want to discuss details only with a therapist, or if you’d prefer to do ERP on your own. Here are some links that might help:

Can’t afford CBT/ERP?  Try this app or do self-directed ERP!
https://jackieleasommers.com/2015/07/29/hocd-a-letter-to-loved-ones/
Also please considering trying Pax the OCD Bot on Facebook. Just look it up in the FB searchbar and enable it. It’s a computer program, but feels like you’re chatting with a therapist for real!

Is it a normal symptom to feel an urge to kiss the same sex then get extreme anxiety during hocd? I feel so lost.

That is almost the literal definition of HOCD! ERP therapy can help: https://jackieleasommers.com/2017/11/01/hocd-4-steps-to-freedom/

Jackie, I need help. My boyfriend and I are believers and he has been struggling with OCD. Much of it is related to his faith. He just graduated Bible college and he can convince me it’s all spiritual warfare. I’m exhausted, he is too but he doesn’t think he’s OCD. I’ve looked all over for a therapist who does ERP near Rochester NY and I can not find a male. He won’t go to a woman. Plz help!Thanks

My OCD specifically attacked my faith. It goes after the things that are most important to a person, so that makes sense that– for someone like your boyfriend who cares about scripture and God– it would attack that in his life. I hope he will read through the following posts:

OCD & Christianity
(or other religious scrupulosity)
OCD, ERP, and Christianity
I’m a Christian and Take Meds!
Unashamed of my OCD
Is the thought from OCD … or God?
God’s Sovereignty, OCD, the Cross, & His Purposes
Is Mental Illness a Spiritual Issue?
Is ERP Sinful?
OCD & Faith (or Lack Thereof): a Double Interview

The past year I have been struggling with a  fear of selling my soul through intrusive thoughts. I recently had a thought that if I didn’t write everything I write in perfect grammar, then my soul belonged to Satan. I didn’t fight the thought as I usually do, and this was before I learned that I was supposed to ignore the thought. Does that mean that I meant the thought?

I’ve had similar thoughts before. I think most people have, except that for those of us with OCD, it’s far harder to say, “Well, that was ridiculous!” and move on. 🙂 ERP therapy changed my life in this manner; I’m not being dramatic. I hope it will help you too. Lots of details at http://www.jackieleasommers.com/OCD.

I think I am suffering from hocd I’d like to talk to you about it please

Hi friend! I am not a therapist. Here’s how to find one: https://iocdf.org/about-ocd/treatment/how-to-find-the-right-therapist/

Also consider trying Facebook’s Pax the OCD Bot. It’s just a robot, but it feels like chatting with a therapist!

Is it normal to feel false attractions and feelings towards the same sex with OCD. I was clinically diagnosed by 2 doctors with OCD yet I still doubt I have it and am scared that some things aren’t OCD even tho I never felt them before this obsession started. Sometimes I notice that the “attractions and feelings” are just normal feelings and such but they feel really real and unwanted and scary.

This is all normal for OCD. In fact, doubting that you have OCD is also normal for OCD– I’m not sure I’ve ever met someone with OCD who hasn’t doubted that they truly have it! Exposure therapy is the key to disarming the doubt. Check out http://www.jackieleasommers.com/OCD.

Continuing from the false feelings and attractions thing. So they don’t feel good and I get them for my sister and mom too!!! And objects like random objects! They confuse me because they feel like attraction or something but I know it can’t be cause it just doesn’t make sense but it can feel pretty real. How do I know for sure they aren’t real??? What if I’m bi/gay??? I fear both I fear all attra

cont’d below

Continuation again these attractions and such Do not feel good no matter how much my mind convinces me they do like I don’t lay back and just think about them and be happy no I fear them and hate them and when they show up it’s like LEAVE ME ALONE YOU RUON MY LIFE. Ok do u think I really have hocd???? How do I know for 100% sure I don’t feel anything for the same sex I don’t want to feel anything 

OCD is a real beast, isn’t it? It goes after things that are most important to us, like our personal sexuality and even the pure feelings we have toward our families. You can take down this beast of an illness with exposure therapy. Check out http://www.jackieleasommers.com/OCD.

Our son, Nick is 17 yrs old, turned 16 yrs old, and developed signs of depression. He appears to have HOCD. Older brother revealed to family that he was gay. Nick was then 13. Nick was a very social and talkative kid until the last 2 yrs. One love – very gifted competitive swimmer. Seeing a therapist and psychiatrist,, taking meds- not seeing great results. No ERP close by? Struggling terribly.

First of all, it’s clear you are an amazing parent. Great work!! ERP is truly the answer here, and the great thing about it is that you don’t need a professional in order to do it.

Read this post about self-directed ERP. Also consider the free app nOCD or the Facebook bot Pax the OCD Bot. They are both amazing tools.

Hi jackie, I’m suffering from i think religous OCD, i keep on praying until i am satisfied with my praying. Also i am thinking about Jesus Christ is different from God, can you help me please? Thanks jackie

The important thing here is to understand that OCD is an illness, treated like an illness. You don’t treat OCD with learning theology. You treat it with ERP therapy and meds, okay? Once you do that, then you will be able to enjoy your relationship with Christ and dive wholeheartedly into theology in a healthy way. Check out https://jackieleasommers.com/2017/07/25/does-my-erp-therapist-need-to-share-my-faith.

I am being treated by a Psychiatrist for depression/anxiety. I am also rather sure i have OCD, as I have all the symptoms but I am afraid to tell my doctor about my intrusive HOCD related thoughts as they are strange and taboo. I am also worried she will think I am crazy and maybe not know about HOCD. My HOCD is also under control now and that making me procrastinate telling the DR. Any advice?

I can appreciate the fear that goes into telling someone about taboo intrusive thoughts. If your therapist or psychiatrist is an OCD expert, they will not be shocked at all. This is common territory within OCD. Unfortunately, many doctors and therapists are still unfamiliar with OCD/HOCD and end up giving awful advice that only makes things worse. The more you educate yourself on OCD and HOCD, the more you will be able to recognize whether or not your therapist/psychiatrist knows about it!

This article may help: https://iocdf.org/about-ocd/treatment/how-to-find-the-right-therapist/

Dear Jackie, sorry for another HOCD question (I am a straight male), I know HOCD can make you feel a loss of attraction to the sex you’ve always been attracted to, but can it make you fearful of that sex? This occured after reading an account from a female perspective of HOCD that got me really confused, like I’m now afraid of women despite wanting to be attracted to them like my normal self.

I hear narratives like this all the time. I always say “normal for OCD.” 🙂 ERP can help, friend. Check out http://www.jackieleasommers.com/OCD.

Hi Jackie,

I’ve been suffering with hocd or what I think is hocd for just over 3 years. I have just recently started to see a cbt therapist. I was wondering when you went through this did you have a nagging feeling constantly in your head. Also how did you accept the uncertainty that all of this brings to get rid of the obsessional ruminations. 

First of all, check out https://iocdf.org/about-ocd/treatment/how-to-find-the-right-therapist. It’s important to find a therapist who truly understands OCD and how to treat it with exposure therapy.

Secondly, ERP therapy is how you learn to accept the uncertainty. It takes about 12 weeks, and it’s very hard, but it’s life-changing. It re-wires your brain back into a healthy pasture. 🙂

Hi I’m not sure if Hocd or am I gay or bi I keep checking gay porn hundred times a day but my mind telling me I like it but I have no arousal then when switch to female I get aroused instantly so I can’t figure what going on 

The key word here is “checking”– that is a very, very common compulsion. ERP therapy can help: https://jackieleasommers.com/2017/11/01/hocd-4-steps-to-freedom/

Was diagnosed with other types of ocd, but now not sure if I have HOCD or gay? Always had crushes on boys/had straight relationships.I feel like my personality is straight but once I started worrying I was gay i put pressure on sexual arousal to men/penises and now it feels like I’m no longer sexual attracted to men but am to women..emotionally speaking/crushes never wanted to be with a woman. 

You can have OCD and then experience many different “themes” within it. For me, until I treated OCD with exposure therapy, my themes just got harder and worse as I went along untreated. Once I treated OCD for one theme, it took care of them all. 🙂 Read about it at http://www.jackieleasommers.com/OCD.

Hi Jackie I’ve think I’ve been suffering from pocd but I can’t tell it started once I graduated high school I’m an 18 yo male I had never worried I was attracted to kids but now I’m constantly worried about it all of a sudden I started having thoughts of kids but in sexual situations and they tormented me I’m seeing a therapist and she says it’s ocd but I’m scared it’s not

Ahhh, the doubting disease … where it even causes us to doubt whether we have it! What you wrote is the textbook description of POCD, and it means that you actually value healthy sexuality and would never hurt a child. That’s why you have all the anxiety and torment! (A pedophile would enjoy it.) Exposure therapy can help, even though it is really difficult. It’s 12 hard weeks, but it is wayyyyy better than a lifetime plagued by such thoughts. Check out http://www.jackieleasommers.com/OCD.

Is this HOCD or am I in denial?  I am 13 and I suffer from depression and anxiety, a month ago I thought to myself ‘what if I’m gay?’ Which stared this torment. I had never had any crushes on girls only guys and I felt it getting worse each day. Now I feel like I have no orientation but still an plagued with thoughts images and sensations. I don’t know if it’s the antidepressant or I’m in denial. 

May I introduce a third option? What if it’s not the antidepressant OR denial, but you just suffer from HOCD, a treatable illness? ERP therapy can help, truly: https://jackieleasommers.com/2017/11/01/hocd-4-steps-to-freedom/

Hi Jackie, I was in therapy but left because the exposures were too scary: he wanted me to ‘agree’ with my thoughts…I was worried I was aroused by horrible sexual intrusive thoughts, so I would say “yes, I was turned on by that!” I saw that this is basically what you did?  I thought saying “maybe I was” would be effective, too…or even “it’s just OCD.”

I completely understand this. Here’s a fictionalized version of how I was able to side-step things in ERP and still beat OCD: https://jackieleasommers.com/2012/09/05/tipping-point-my-entry/

hi

Hello buddy. 🙂

I’m a 16 year old girl who is struggling w HOCD. I am 99% sure I have HOCD. However, when I read about the difference between gay and HOCD or even about gay, my mind makes me feel like I am truly relating to the gay side of things even if I relate more to hocd when it comes down to it. Is that normal?

OCD/HOCD will make you doubt everything. Does the idea give you anxiety or stress? If so, that’s very telling! Try to take deep breaths and continue to read up on HOCD. Knowledge is powerful!

Hi Jackie, this question is also about HOCD, it’s just that I can’t find anyone who at the moment has the same problem. Not only am I scared of people of the same sex but also of people of the opposite sex because I’m so worried I might not be attracted to them. So basically I am avoiding both genders.. What should I do? Should I be doing ERP for both?

As you can see, I was asked this question (or something similar) by two other people even in this thread! So you are not alone. 🙂 Do ERP for HOCD, and it should eventually kick everything else’s butt too. I did ERP specifically around my religious/spiritual obsessions, but it also took care of any other themes I was experiencing too, because ultimately ERP is restoring a healthy brain wiring to you.

Hi Jackie i am 15 year old girl and i feel like am going crazy. I think i am dealing with HOCD i never been diagnosed with ocd before but am not sure i been dealing with this ever since i was 13 but i never told anyone or gotten help. I feel like it’s different this time i feel like am always in denial. I have lost my attraction to the oppsite sex it it depresses me.i always had crushes on guys

You’re not crazy. As you can read above, what you’re going through is a very common experience within HOCD, even down to losing attraction to the gender you’re usually into.

It’s up to you whether you’d like to tell your parents what you’re dealing with in detail, or whether you’d like to just tell them you’re confident it’s OCD but you want to discuss details only with a therapist, or if you’d prefer to do ERP on your own. Here are some links that might help:

Can’t afford CBT/ERP?  Try this app or do self-directed ERP!
https://jackieleasommers.com/2015/07/29/hocd-a-letter-to-loved-ones/
Also please considering trying Pax the OCD Bot on Facebook. Just look it up in the FB searchbar and enable it. It’s a computer program, but feels like you’re chatting with a therapist for real!

Healed Not Cured: OCD Remission & Relapses

I got an email this past weekend from a lovely blog reader who has found victory over obsessive-compulsive disorder through exposure therapy. It’s such a joy any time someone shares a story of freedom, and it does my heart so much good. It reminds me of the reason I preach the benefits of ERP therapy. It reminds me of when I first went into OCD remission back in 2008.

But I also find it important to mention that while the person with OCD has experienced healing, it does not mean that they are cured. In the vast majority of cases, OCD is never cured; it is treated and maintained. What does this mean?

First of all, it’s definitely something to celebrate. I revel in my remission, and in fact, after eight years of this freedom, sometimes I even find myself taking it for granted. It’s a victory to come out of exposure therapy with a new tolerance for uncertainty. It’s a joy and a relief and, for me, at least, a whole new life.

But it doesn’t mean that I don’t have OCD. 

not you again

There are days of intense stress where I buckle a bit and find myself having some obsessive thought patterns or even resorting to old compulsions. This disorder is mostly dormant in me … but it is still in me. And it can wake when I am stressed or fearful. Every once in a while, there is something that will trigger my OCD, and it’s like there’s a CLICK in the way my brain works, a little BLIP in the new system.

But, usually

  1. I recognize it for what it is. I am able to do this because of ERP.
  2. I do not beat myself up over it or assume “all is lost.” It’s merely a step back. I don’t have to start the race over.
  3. I refuse compulsions. (Notably, I allow myself to ask a group of people [usually my coworkers] ONE TIME for what they would deem the appropriate response, and then I DO IT, whatever they say. I know that when my OCD is triggered, I have a hard time understand what is or isn’t a valid response. So I give the decision to others.)
  4. If it’s particularly bad, I listen to my ERP audio track.
  5. I go to sleep, as early as I need to. It is–almost without fail–better in the morning.

I don’t mean this to be bad news–not at all; rather, it’s just something to take note of, something to have in the back of your mind for those stressful days, for those moments when your OCD wakes up and starts to whisper in your ear.

Here’s some anecdotal data about my remission and relapses:

  • In the first 1.5 years after completing ERP, I didn’t experience obsessions or practice compulsions at all.
  • In the years after that, I have had about 1-2 relapse incidents a year.
  • Each incident has lasted on average just a couple of hours. One lasted about two days.

This is nothing compared to my life before ERP. This is manageable. This is freedom. This is remission.

This is good news, people.

If you want to learn more about the exposure therapy that got me to this point, you might want to check out the following links:

jackieleasommers.com/OCD: a collection of my posts about all things OCD
jackieleasommers.com/OCD-help: a letter from me to OCD sufferers, along with a list of next steps
jackieleasommers.com/twin-cities-OCD: resources for OCD sufferers living in or around Minneapolis and St. Paul

The [Beautiful] Paradox of ERP

paradox of ERP2Exposure and response prevention therapy. ERP.

The hardest thing I have ever chosen to do in my life.

And one of the best.

But that’s not actually the paradox I’m talking about. The paradox of ERP that fascinates me most centers around uncertainty.

The whole point of ERP therapy is to teach someone to learn to live with, accept, even embrace uncertainty. ERP actually re-wires the brain to help the OCD sufferer with this. Before I went through ERP, I wanted to know everything with 100% certainty. Anything less would cause intense havoc in my mind, heart, and body. Because of this intense desire to know everything with certainty, I so often felt gobsmacked by uncertainty. I lived as if, without total certainty, I could barely know anything. Doubt pummeled me like a linebacker. My life was ravaged by uncertainty.

But once I went through ERP therapy and learned to accept uncertainty, the bizarre thing is that my confidence returned. I suddenly felt surety and certainty again– after I realized I didn’t need it.

When I demanded 100% certainty, what I ended up with was often something in the 25-40% range. Or lower.

When I abandoned the need for 100% certainty, I ended up in the 90-99% range. Sometimes less, but usually way, way up there.

That’s weird math. Backward logic. A paradox.

One I love.

99% sure,
Post-ERP Jackie

P.S. If the need to know for sure is ruining your life, you need ERP. Read more about it at jackieleasommers.com/OCD.

P.P.S. I’m a follower of Jesus Christ, and I can’t help but be struck by the similarity of this to “Lose your life to gain it.”

Image credit: Nicu Buculei, modified by me

OCD Scrupulosity: Is ERP Sinful?

is ERP sinfulSometimes people with religious scrupulosity fear that ERP therapy itself is sinful. It’s true that ERP therapy will definitely ask you to do things outside of your comfort zone, things that will probably make you sick. (This is how ERP works, and it is crafted specifically around your own deepest anxieties.)

But once embarked on this ERP journey, I think it’s unwise and counterproductive to try to convince yourself (or convince others … or let others convince you …) that your therapy is not sinful. (After all, the whole point of this therapy is to embrace the uncertainty!)

If you are a Christian and concerned about ERP therapy, I suggest you say a prayer like this then dive in headfirst:

Lord, I am terrified about what I am being asked to do through this therapy, and I worry that it might be sinful.  But there is at least some part of me that believes this is connected to OCD, so please cover over all I have to do with your grace. I am doing these things in the hopes of restoring my right and healthy relationship with you. Please be honored by my therapy and my choice to fight for my freedom (which you won on the cross) and my relationship with you (again, made possible by the cross). Be glorified in my therapy, and cover anything sinful with your incredible grace. Make me strong enough to complete my exposures. Provide the strength I need to press through this scary therapy, and let these hard exposures and choices (that may sometimes seem wrong to me) glorify you. Amen.

There were definitely times when I (and others– wow, that was hard!) wondered if I was doing something wrong with my ERP exposures, but in my heart of hearts, I knew that this was my last and best chance at freedom and health and hope. I held onto that and pressed through, and I will tell you this: every. single. thing. in my life is better post-ERP, in particular, my spiritual life is now thriving and healthy. I am growing in my faith. I have the joy of salvation. I trust Christ more.
And I believe that ERP was God’s tool to bring me into this way of life.
To learn more about OCD, ERP therapy, religious scrupulosity, go to jackieleasommers.com/OCD.
Image credit: Fernando Rodriguez

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