5 ERP Therapy Strategies You Can Use Now: Shared by an OCD Therapist in Los Angeles
If you’ve been having a challenging time managing your Obsessive-Compulsive Disorder (OCD) and need a few tools to practice, you’ve come to the right place! OCD flare-ups can happen, even after a successful course of treatment. The good news is that once you’ve learned some effective tools, you have a greater likelihood of being able to nip any OCD lapses in the bud before they turn into a relapse.
Exposure and Response Prevention Therapy (ERP) is an effective evidence-based treatment for OCD. Sometimes engaging in OCD treatment to refresh the learning is the best option. And while working with a therapist is ideal, there are strategies you can do on your own to improve symptom management. As an OCD therapist in Los Angeles, I’ve seen how these techniques can empower individuals to break free from the cycle of obsessions and compulsions. Here are 5 practical ERP strategies that you can try right now.
1- Postponing compulsions
One of the most challenging parts of ERP is resisting compulsions. Some may find it daunting to begin resisting their compulsions all at once. A good “stepping stone” towards eventually fully resisting compulsions is delaying your compulsions. This allows you to experience the discomfort of an obsession without immediately acting on it. It can help you slow down and teach you that you don’t have to jump to doing anything as soon as you experience discomfort. You might even learn that if you wait long enough, you can get over the most difficult hump, which then makes it easier to resist the compulsion completely.
It’s important to try and keep the progress going by increasing the delay so that you don’t get stuck just postponing compulsions and never fully resisting them. Use a timer and set a small time goal (i.e., 2 minutes, 5 minutes, 10 minutes, or whatever feels like a good starting point that will push you out of your comfort zone.) Gradually increase the delay time and continue to live life as you postpone.
One potential downside to this strategy is that sometimes individuals never truly lean into the discomfort (“Just 5 more minutes and then I get to stop!”). They may end up white-knuckling during the delay as they wait for the opportunity to engage in the compulsion and soothe their distress. This defeats the purpose of the strategy (and you might as well not do it!) So, it’s important to note that this will only be effective if you stay and accept those challenging thoughts and emotions without pushing them away during that delay.
2- Non-engagement responses
A non-engagement response is a commonly used strategy with ERP. It is a phrase or statement that can be used in response to an obsession to help you pivot away from a compulsion. The intention is to keep you in an uncertain space (i.e., you’re not answering OCD demands or providing reassurance.) Non-engagement responses can also help you adopt a new attitude towards your OCD when obsessions show up. Maybe you can be sassy towards it, show it some indifference, be humorous, or acknowledge it without judgment- whatever works for you.
Some examples of non-engagement responses:
“I don’t need to answer that”
“Not gonna do it, it’s never been helpful”
“That’s an interesting thought”
“Moving right along…”
“Maybe, maybe not”
“That’s a possibility”
“Sure, whatever you say”
“Who knows?”
“I guess we’ll see”
“That would suck”
“Oh, cool”
“Let it gooo…let it gooo” (in a singing Elsa voice)
3- Cognitive defusion strategies
Cognitive defusion is a core principle of Acceptance and Commitment Therapy (ACT), and it is often used in conjunction with ERP treatment. This technique helps create distance between you and your thoughts so you don’t get tangled up in them.
Some cognitive defusion strategies might include:
Repeating a thought until it’s just a bunch of sounds that seem to have no meaning.
Singing a thought or saying it in a funny voice
Treating thoughts like background radio static noise, buzzing, etc.
Taking an observer role to your thoughts by objectively acknowledging what is happening in your mind with statements like, “I’m having the thought of…” or “I’m noticing my mind doing…”
Being aware of your thoughts without getting caught up in subjective interpretations. This sushi train video by Dr. Russ Harris is one of my favorites depicting this.
4- “Undoing” or “spoiling” compulsions
You’ve probably had many moments when you didn’t catch that urge to engage in the compulsion quickly enough. You realize that you performed the compulsion after you’ve already done it, acknowledge it as a missed opportunity, and leave it at that. Well, I’m going to encourage you to try something different. It’s not the end all be all after you’ve engaged in a compulsion. You can “undo” or “spoil” the compulsion by retriggering yourself and then working on resisting the compulsion the second (or third, or fourth) time around. Think of it as an opportunity to rewind that moment and give yourself a do-over.
Some examples of “undoing” or “spoiling” compulsions:
Let’s say you are struggling with Contamination OCD and catch yourself in the middle of your handwashing ritual after touching a dirty doorknob. You can “spoil” the ritual by messing it up (doing it the wrong way, leaving it incomplete.) Or you can reset the entire thing and “undo” it by touching the dirty doorknob again and resisting your handwashing ritual.
The same could be done with mental compulsions. Let’s say you’re struggling with Harm OCD, and one of your compulsions is to mentally review all the reasons why you’re a good person who would never spontaneously choke your wife when you get close to her. You can interrupt the mental compulsion with a statement that will bring you back into an uncertain space like, “Ok, but I can’t know for sure.” You can also engage in a values-based action to retrigger yourself (i.e., get close to your wife and hug her) and then practice resisting the mental compulsion.
5- Personifying OCD
It can be easy to overidentify with OCD when you’ve been struggling with it for a while. Personifying OCD, or treating it as a separate entity with its own qualities and personality, can be a helpful strategy. This helps to externalize OCD so that it does not feel like you are your OCD. It helps to create some separation so your identity doesn’t become fused with your OCD, and you can see your OCD as its own thing.
As an OCD therapist in Los Angeles, many of my clients have had great success with this strategy. It’s allowed them to get imaginative with thinking about how their OCD might look, sound, and behave. I’ve had clients come up with pop culture references or characters that seem to encompass their OCD’s personality. We’ve named their OCD and addressed it by its name anytime we refer to it, including during exposures:
“Karen is being very loud with her demands right now”
“Rumpelstiltskin is at it with his tricks again”
“Flounder was nervous and scared this weekend and bombarding me with a lot of questions”
“Drama Queen is trying to stir the pot in my mind and wants me to engage”
You can get super creative with this and come up with your own OCD character according to its unique traits. This creates some distance and can also add an element of humor during those difficult moments when OCD demands a compulsion.
By using some of these strategies, you may be able to loosen OCD’s grip on you. Give it a try and see which ones work for you!
An OCD specialist can provide further guidance so that you can benefit from the full range of ERP therapy. If you need this kind of help, reach out below!
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