3 Common Pitfalls in ERP Therapy Shared by an OCD Therapist in Los Angeles
Have you ever considered Exposure and Response Prevention (ERP) therapy for Obsessive-Compulsive Disorder (OCD)? If so, you could be a on a promising path to recovery. ERP can be a highly effective treatment for OCD, preferably with the help of a trained OCD specialist. But just like any therapeutic approach, sometimes we come across some snags in treatment. As an OCD therapist in Los Angeles, I’ve seen some common pitfalls that could get in the way of successful ERP therapy if they are not caught and addressed. Read on below to learn about 3 common pitfalls and what you could do about it.
Trying to get rid of anxiety
I know you’re probably thinking, “That’s the reason I’m seeking therapy – to get rid of my anxiety!” Hear me out for a minute, there is a good explanation for this. I do want to acknowledge that having your nervous system constantly activated can be tiresome and can negatively impact your quality of life. But we never want to get rid of anxiety. It’s our body’s natural alarm system. If we didn’t have a way of getting clued into danger, human beings would probably been extinct by now.
A common pitfall is clients going into ERP therapy with the intention of making their anxiety and discomfort go away.
Going in with the mindset of extinguishing and “getting rid of” gets us into battle mode – we want to duke it out with our feelings and control them. It can also create a lot of disappointment and frustration when those control tactics (i.e. compulsions, avoidance, etc.) don’t work. And it goes against the entire focus of treatment. It sends the message to our brain that anxiety and other uncomfortable emotions are bad, we must push them away, and they are not allowed. It creates an unhelpful relationship with some very normal human experiences.
The goal of ERP therapy is to learn to relate to our thoughts and feelings in a more adaptive way. By doing so, we shift our relationship with our feelings so that these uncomfortable experiences are not perceived as a constant threat. What we want to do is learn to accept anxiety’s presence without feeling the need to escape or control it. One way of doing this is by going in with the mindset of “I can handle challenging feelings” and accept the presence of some of these uncomfortable feelings. You don’t have to like it, but you can accept what is there without resisting it. Responding to yourself with some self-compassion during these moments can also yield better results. You’ll learn that you are way more capable of coping with anxiety or other uncomfortable feelings without needing to immediately act on them.
The good news is that a consequence of successful ERP treatment usually means that anxiety DOES become easier to manage. When we learn to accept discomfort, give it space to be there, and not get into a battle with it, we get so much better at coping with OCD…and other challenging things in life.
Overlooking mental compulsions
It can get tricky identifying OCD compulsions, especially when there are invisible ones in the mix. When people think of OCD, they often picture what has been commonly portrayed in the media - overt behaviors like handwashing, checking household appliances, or rearranging things until they are “just right”. However, mental compulsions are very common with OCD. As an OCD therapist in Los Angeles, I see mental compulsions showing up in more cases than not. Mental compulsions can be anything from mentally reviewing past events, neutralizing a “bad” thought with a “good” one, checking your feelings, or analyzing something over and over (and yes, rumination could become compulsive!)
A common pitfall is not realizing when mental compulsions are at play.
Self-monitoring is a great way to increase awareness around triggers, obsessions, and compulsions. Noticing how you respond to the anxiety/distress caused by your obsessions and keeping a log of the physical and mental compulsions you engage in can be helpful. By doing so, you keep these actions in the forefront of your mind and increase the likelihood of catching yourself in the act much earlier and interrupting/stopping the compulsive behavior. Mental compulsions can sometimes be sneaky and subtle and it’s important to know when and how they show up in order to target them effectively. That includes realizing when you are engaging in them during ERP exposure, after an exposure, or when you are naturally triggered in your day to day life.
Not addressing accommodation behaviors
OCD is not always an isolated matter, it can often involve family and friends. It’s not uncommon for family or friends to be involved in reinforcing an individual’s OCD without realizing it. This can happen when a family member or friend participates in compulsions as a way to ease an individual’s distress. They may go along with OCD’s rules or even engage in compulsions on behalf of the OCD sufferer. Like driving back at their loved one’s insistence to make sure that they didn’t accidentally run over anyone, or providing reassurance when their loved one asks the same question repeatedly. This is often well intentioned – no one really wants to see their loved one in distress. Or maybe it’s just easier to agree to OCD’s demands to keep things moving along and not have a tiff with someone you care about.
A common pitfall is not addressing accommodation behaviors with loved ones.
Any active participation in rituals or compulsions by friends or family members can and do reinforce the OCD cycle. So while it’s helpful for you to learn how to resist engaging in compulsions with ERP therapy, it’s just as important to tackle compulsions on side of your family/friends. Otherwise the cycle will continue to be strengthened in a different way.
The thought of no longer having family participation in rituals can feel scary, especially if you’ve been relying on it to get by. It can also cause a lot of discomfort for family members to see someone they care about in distress and not know how to support them. One helpful way to address this is by having your loved one(s) join one or more therapy sessions. Your OCD therapist can help you and your loved ones come up with a mutually agreed plan to address these behaviors together and in a gradual manner. While you focus on your compulsions, friends/family members can better understand how their behaviors are reinforcing OCD and how they could provide support in a way that is not feeding OCD. That could involve validating their feelings in a compassionate manner without providing reassurance. Tackling OCD as a team, from both ends, is the best way to help you get better quicker.
