Stacy G. Smith, MS, LPC
OCD Treatment: ERP and Embracing Discomfort
After battling Obsessive Compulsive Disorder (OCD) for some time, you decide it's finally time to break the OCD cycle and relieve yourself of your compulsive behaviors. That's a big step! Here I describe an essential mindset you will want to adopt to make your treatment journey a success.
First, let's take a look at the function of your compulsive behaviors. Compulsions were created as an attempt to avoid discomfort. You might have started out with one or two behaviors (either mental, physical, or both), and most likely found relief. That's because compulsions initially work - they provide you with a sense of comfort, and are therefore reinforcing. However, as you've probably noticed over time, one compulsion quickly leads to two, three, four, and before you know it, you find yourself spiraling, spending countless hours, and much energy, trying to find that elusive sense of comfort. Therefore, the notion that compulsive behaviors are the key to relieving you of the distress caused by your obsessions is a lie, and the very idea Exposure and Response Prevention (ERP) seeks to target in treatment.
ERP is a structured treatment that requires you to face your obsessions head on, while removing any compulsions you feel compelled to perform. Understandably, this will elicit discomfort. The goal is to accept, allow, and ride out this discomfort, allowing your mind and body to learn that uncomfortable feelings can naturally dissipate on their own without any manipulation, control, and compulsions.
Starting ERP with the mentality that you can *hopefully* confront your intrusive thoughts and/or images with little to no discomfort, will only set you up for disappointment. The goal is to expect discomfort, embrace it, and welcome it in as a sign that you are reclaiming your life. The goal is not to enjoy this feeling, but to remember that your attempts to control and relieve yourself of this discomfort have only backfired, and have left you caught in a seemingly inescapable cycle.
While embracing discomfort, you will also be embracing uncertainty. OCD thrives off of trying to have you gain certainty over a particular situation - certainty that you won’t get sick, certainty that you haven’t harmed someone, that something bad won’t happen, or that something isn’t “just right.” Rituals are developed as a way to try and achieve certainty, and in return, relieve discomfort. If you enter treatment hoping to learn strategies to feel more certain in these areas, you are again setting yourself up for disappointment. ERP treatment also does not involve learning relaxation strategies - so there won't be any deep breathing, progressive muscle relaxation, meditation, or peaceful, relaxing visualization exercises. These strategies, when used during exposure exercises, are attempts to relieve discomfort, and as a result, can be considered compulsions. As a therapist, if I were to teach you these strategies as a way to cope with your obsessions, I would only be teaching you new compulsions, and helping to perpetuate the cycle.
Key questions to think about before starting ERP therapy include:
1.) Am I ready, and willing, to experience discomfort?
2.) Am I ready to allow and embrace this discomfort every day?
3.) Am I ready to learn to cope with feeling uncertain about situations that scare me?
Many individuals understandably want to jump right into ERP. After all, it’s the gold-standard treatment. However, if you find yourself unable to truthfully answer yes to the above three questions, the first part of therapy will involve working towards those “yes” responses. Why? Because if you find yourself fighting the discomfort, you will find your progress with ERP to be slow, frustrating, and unsuccessful. If you find yourself asking the following questions during an exposure exercise, you are unfortunately "fighting" your discomfort:
How much longer until this discomfort goes away?
How can I make myself feel better in this moment?
What can I distract myself with until this discomfort passes?
Once you're ready to surrender the quest for comfort and certainty, you are ready to begin ERP; and if your surrender is total and complete, you will quickly start seeing moments of success in your treatment, and feel motivated to continue.
I emphasized earlier the importance of embracing discomfort every day. Once you begin ERP, it is essential to engage in your planned exercises daily, and for a prolonged period of time. Due to the discomfort these exercises will elicit, it can feel tempting to only engage in them on certain days. Clients will often say they will pick "good" days during the week to do ERP - days when they're feeling relatively calm, and have little stress. Unfortunately, this does not work, and is a sign that your surrender to finding comfort is not total and complete. If you are currently in ERP treatment and can relate, you may notice that you're not as far along in your progress as you'd like to be. If that is the case, I encourage you to ask yourself if you can truthfully answer yes to the three key questions above. Chances are, there is still a piece of you looking for that elusive sense of comfort, as well as that dreaded certainty, which will only keep you tied to your OCD.
Remember that if your OCD symptoms are present, and interfere with your life, every day, you want to practice treating them every day - no excuses ;-)
ERP is certainly challenging. During the process, you may get emotional, and have moments when you think you can't push through the discomfort; but the truth is, you can. I know you can. I've seen countless individuals go through the fear, the discomfort, the uncertainty, and come out on the other side feeling more empowered than ever. With hard work and dedication, I know you can do it too!
DISCLAIMER: The blog posts shared on www.StacySmithCounseling.com contain the opinions of Stacy Smith, MS, LPC, and do not reflect the opinions of any organizations or affiliates. While Stacy is a licensed mental health professional, all blog posts on her site are for informational purposes only, and are never a substitute for professional advice catered to your individual needs. Stacy Smith is not liable for any diagnosis, treatment plans, or decisions made based on the information presented on this website.