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.

Preparing for ERP Therapy

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?

comfort2