Don’t Feed The Cycle
ERP Therapy Near Los Angeles, Orange County, CA, and Throughout California
What is Exposure and Response Prevention Therapy (ERP)?
Exposure and Response Prevention Therapy (ERP) is a form of Cognitive Behavioral Therapy (CBT). In this approach, there is a strong emphasis on the behavioral component (the ‘B’ in CBT). By making behavioral changes, we can accomplish cognitive changes. In other words, by acting differently, we allow ourselves to experience outcomes that lead us to think differently. Over time these new experiences and the learning that takes place help to rewire our brain. ERP is one of the most effective therapeutic approaches to treating obsessive-compulsive disorder (OCD). Since OCD and anxiety disorders are functionally very similar, ERP therapy can also be effective in treating other fear-based disorders such as generalized anxiety, social anxiety, panic disorder, phobias, and others.
ERP therapy is broken down into:
Exposure (the ‘E’): Confronting the triggers that provoke your obsessive thoughts.
Response Prevention or Ritual Prevention (the ‘RP’): Simultaneously learning to resist the compulsions or ‘safety’ behaviors that you typically engage in.
By repeatedly engaging in exposure exercises and resisting the urge to perform compulsions, you will learn to tolerate discomfort and reduce the power of your obsessions. This will happen at your pace and you will have input in developing exposure exercises. Keep reading for examples of what this might look like.
What can I expect when starting ERP for OCD in Orange County, CA?
Education
ERP therapy begins with some basic education that will help you gain insight into the OCD cycle and how it is maintained and reinforced. You will learn how ERP treatment helps to interrupt and weaken this cycle. You’ll receive information and resources to help you learn more about your diagnosis and treatment.
Awareness
An essential part of ERP therapy is increasing awareness of your specific symptoms, including your obsessions, triggers, fears, and compulsive behaviors. Some of your compulsions may have become so habitual that you may not even realize that you’re doing them. Or perhaps there is something that you have been doing that you didn’t know was a compulsion all along (this can be common with mental compulsions). You will be asked to self-monitor and record your observations in a log, a practice that will be important throughout ERP treatment.
Hierarchy
The self-monitoring will be useful for building your exposure hierarchy. This hierarchy consists of things, situations, places, or people you’ve been actively avoiding or confronting with distress because of your obsessions. These hierarchy items are ranked by you from least to most distressing. It is based on a scale, typically ranging from 0-10 or 0-100.
Exposure and Response Prevention
With your hierarchy, you will begin structured exposure exercises in a paced manner with the guidance of your therapist. These exercises are designed to confront these fears gradually while resisting compulsive behaviors.
As an example, let’s say you are a client who is having Pedophilia OCD obsessions. Maybe you have been avoiding being physically affectionate towards your child because your OCD keeps bombarding your mind with the doubt of ‘What if I become a pedophile?’ The anxiety and distress caused by these thoughts have caused you to repeatedly engage in mental rituals to convince yourself that you will never become a pedophile and abuse your child. This cycle happens daily and you avoid your children because you are afraid.
We may start ERP by having you engage in indirect contact, like looking at photos or watching videos of you and your child while learning to resist compulsions. We may then progress to activities with minimal contact, like being in the same room, eating together, or playing a board game. Once that feels more manageable, we may progress to exposures involving moderate contact, like holding your child’s hand, reading a book together, or brushing their hair. From there we may gradually move to more intimate contact like helping your child change into their pajamas, hugging them, or snuggling before bedtime. Throughout this process, you will actively work on resisting compulsions. The goal will be to have you get back to interacting with your child as you did before.
Throughout ERP treatment, you’ll practice facing your fears without resorting to compulsions and develop a new way of responding to your thoughts/obsessions. Your hierarchy will continuously evolve as you complete exercises and add new ones. Exposure practice is done in therapy sessions and on your own in between sessions. You spend more time on your own than in therapy sessions, so practice in between sessions will be extremely important to help reinforce new skills and learning. You won’t be alone during this process, your therapist will provide support and guidance along the way!
If Exposure and Response Prevention Therapy is what you need, you don’t have to wait any longer.
Let’s put an end to the suffering that OCD has been causing. ERP therapy near Los Angeles, CA and throughout California is available.
Will Exposure and Response Prevention Therapy get rid of my OCD obsessions?
ERP treatment does not focus on eliminating or challenging OCD obsessions (attempting to do so can make OCD worse). The truth is that we have little control over the thoughts that enter our minds. However, we DO have control over how we respond to these thoughts when they show up. Our response to obsessions plays a huge role in the reinforcement of the OCD cycle. OCD causes you to get entangled in your thoughts, attach significance to them, and take them as facts. ERP therapy teaches you how to handle difficult thoughts and feelings more effectively. By shifting your response to them, you will no longer perceive them as threatening and scary.
According to the ERP model, the OCD cycle breaks down with the elimination of the compulsions. As the cycle weakens, the obsessions no longer have the same power that they once did. You’ll begin to realize that you have a choice in your response and feel more autonomous in your life again. Obsessions will naturally decrease as the cycle breaks down, but they may not always be completely gone. But this will be much more manageable because you’ll no longer live in constant fear. You’ll be able to turn towards the things that are meaningful to you again and OCD will no longer have a tight grip on you.
Exposure and Response Prevention Therapy sounds scary. Why would I want to trigger myself on purpose?
If you’re feeling this way, you’re not alone. ERP therapy is challenging and can definitely feel scary. But one thing I remind my clients is that what you’re already enduring in your day to day life with unmanaged OCD and anxiety is just as scary- and with no end in sight. ERP therapy does bring up distress, but it is with the intention of learning new skills and creating opportunities for change and long-term relief. ERP treatment is purposeful and done gradually so you build confidence as you learn these skills. You’ll start by dipping your toes in the water and working your way in, not getting thrown into the deep end on the first day. Over time, you’ll experience relief from symptoms that once felt unmanageable. And that’s empowering!
You’re tired of being stuck in a cycle of doubt. It doesn’t have to be that way, ERP for OCD could help.
Connect with ERP Therapy near Orange County, CA, Los Angeles, or anywhere in California. Click below to get started.
How does Exposure and Response Prevention Therapy work? What are habituation and inhibitory learning?
Two learning mechanisms are at play with Exposure and Response Prevention therapy: habituation and inhibitory learning. Both work together and play an important role in OCD treatment. It is important to look at ERP treatment through the lens of both of these learning processes.
Habituation
According to the habituation model, consistent and repeated exposure to a feared stimulus will naturally cause anxiety and distress to go down. ERP therapy works because one essentially becomes desensitized to that feared stimulus so that it no longer feels distressing. Think of it like a horror movie that is very frightening the first time you watch it. But after the second, third, fourth…or tenth time, it gets easier to watch and no longer has the same effect on you. Maybe now it’s even gotten a little boring after watching it so many times. According to this model, old learning is being ‘undone’ and anxiety diminishes.
How does this translate to OCD? Let’s say that you are a client with Harm OCD and you are fearful of losing control and stabbing your spouse while chopping vegetables around them. The anxiety will probably be high when you start engaging in this activity. But after doing it over and over, the distress will gradually decrease. Reduction in anxiety/distress is the main focus of the habituation model. For a long time, the presence of habituation was what clinicians relied on as the only indicator that ERP treatment was working.
Inhibitory Learning
Through continued research, we know that there is more than just habituation taking place with ERP treatment. This brings us to the inhibitory learning model. The principle behind this theory is that new learning takes place during ERP therapy and becoming stronger than the old learning. Through exposure work, the brain starts to create and reinforce new associations by disconfirming previously held beliefs. Anxiety reduction does not necessarily need to be present while this learning process is taking place. Therefore, OCD could still be getting better even if habituation is not occurring.
Let’s go back to you as the client with Harm OCD. By repeatedly chopping vegetables with your spouse, you begin to see that you aren’t losing control or stabbing your spouse. You learn that your feared outcome is less probable than what OCD convinced you (OCD is known to exaggerate.) You learn that you’re more capable than you initially thought in coping with the distress that the activity brings. Perhaps you might still feel some anxiety cooking with your spouse, but you no longer feel the need to avoid the activity or engage in compulsions. You learn that these feelings are not dangerous to have. This leads to greater confidence and trust in yourself and keeps OCD from dictating your life.
According to the inhibitory learning model, new learning ‘competes’ with old learning. The more these new learning pathways get reinforced through ERP, the more dominant they become. So while old learning might still be present, it gets inhibited, or blocked from getting stronger.
Where can I learn more about Exposure and Response Prevention Therapy?
Below are some information sources along with articles that could be helpful about ERP Therapy:
International OCD Foundation (IOCDF): Exposure and Response Prevention (ERP)
McClean Hospital: Everything you need to know about Exposure and Response Prevention
I’m ready to seek Exposure and Response Prevention Therapy. How do I find an ERP therapist near me?
I’m an ERP therapist near Los Angeles and Orange County, CA, and I'm happy to help! One of the services I provide in my online therapy practice is ERP therapy to adult clients throughout California, including San Diego, San Francisco/Bay Area, Sacramento, San Jose, or anywhere within the state. I also offer online ERP therapy to clients in New York, including Manhattan, Brooklyn, the entire NYC metro area, Westchester, Long Island, or anywhere within the state. One of the benefits of online therapy is being able to reach and help clients who are miles and miles away.
If you are outside of California and New York, or looking for an in-person therapist, the IOCDF has a great directory of OCD therapists worldwide.