Am I doing ERP correctly? This is a common roadblock I see every week in my private practice. I think it is a common struggle for people with anxiety and OCD. Today, we will talk about the three common OCD traps people fall into and how you can actually outsmart your OCD and overcome it.
Now, when we're talking about Expsoure & response prevention ERP, we must go over the basics of ERP therapy, so let's talk about what that means before we talk about the specific traps that we can fall into.
ERP is exposure and response prevention. It's a specific type of cognitive behavioral therapy and is the gold standard treatment for OCD to date.
And it's a detailed process, right? It's something that we [00:01:00] have to go through slowly. It's a detailed process where we first identify OCD obsessions and OCD intrusive thoughts. So, you'll identify precisely the repetitive, intrusive, and distressing things for you. Once we have a good inventory of your OCD obsessions, we then identify what specific OCD compulsions you are doing now. A compulsion is a behavior that you do to reduce or remove your anxiety, uncertainty, or doubt, or any kind of discomfort that you may be experiencing.
And once we do that, then we can move towards exposing you to your fears. Exposure therapy for OCD involves exposing yourself to those specific obsessions. And then engaging in [00:02:00] response prevention, which is the reduction of using those compulsive safety behaviors. Now, common OCD response prevention will involve reducing physical behaviors, reducing avoidant behaviors, or reducing thought suppression. It's reducing reassurance, seeking, reducing mental compulsions, and in reducing any kind of self-punishment that you're engaging in to beat yourself up for the obsessions that you're having. Then we get you engaged back into doing the things you love to do; getting you back to engaging in your daily life, your daily functioning, the things that you find pleasurable, and your hobbies as soon as possible.
That's the whole goal of ERP. Right?
The important thing to remember here is that ERP therapy for OCD is greatly improved by adding in [00:03:00] other treatment modalities, such as acceptance and commitment therapy or mindfulness-based cognitive therapy, DBT, and medication.
I should have mentioned medication first because most of the science shows that that's one of the most helpful to really augment ERP therapy for OCD. If you want to go deeper into that, I strongly encourage you to check out Exposure and Response Prevention School. I'll show you how to do all of those steps in ERP school, our online course for OCD.
You must know how to do those steps and that you're doing them in a way that's careful and planned so that we're not overwhelming you and throwing you in a direction that you're not quite prepared for; you don't have the tools for yet. And so today, I wanted to discuss three questions that come directly from people who've taken ERP school [00:04:00], and they're really trying to troubleshoot these three common OCD traps that OCD gets them stuck into.
So, let's get to the good stuff now.
What if I don't engage with an obsession? Am I thought suppressing? One of our listeners said, “I know what you resist persists. We talk about that in ERP school, but I also know that obsessive thinking and worrying can become compulsive. Is it possible I could be caught in both situations, and how common is this?”
So I want to really be clear here in what we're saying when we say to practice ERP. So when you have an obsession or the onset of an intrusive thought or intrusive feeling, sensation, urge, it could also be an image.
When you have that,[00:05:00] you're old way of dealing may have been to try and push that thought away with some urgency and aggression. We call that thought suppression and that's an avoidant compulsion, so yes. This student of mine is correct. That becomes compulsive, right? But we also know if we go into the obsession, try and figure the obsession out, give it too much of our attention.
We're also engaging too much with it in terms of using mental compulsions. That too is a compulsion. So we want to see that these two things can happen. But when we have the thought, and we observe that it's there the obsession, we've noticed it's there. Right? We talked about this in previous episodes of your Anxiety Toolkit podcast.
When you identify it's there and then you say, I am gonna let it be there and still move on. To what you love to do, [00:06:00] what you value that is not resisting it, that is engaging back into what you find important and effective, and valuable for your life. It's not avoidance, it's not thought suppression. Now, if you do that in a way where you're like, oh, I don't want that thought.
I want to engage in what I'm doing. Now you're crossing into that reaction being with . Urgency and resistance, and anytime we're doing anything in a sense of urgency and resistance, well, yes, it may be becoming a compulsion, right? And what we're talking about here, the way to manage this trap, right, is to find middle ground, and it often involves slowing.
Down being a little more thoughtful in how you respond, and that's often using mindfulness. We talk a lot about mindfulness here in your, your anxiety toolkit [00:07:00] in observing, okay, this is happening. I. I'm going to respond in a way without urgency, and I'm going to come back to what I'm practicing. That isn't thought suppression.
It's also not avoidance. It's also not doing a mental compulsion or ruminating. It's what we call occupation. You're engaging back into what you need to be doing. Right, which brings me right to trap number two, which is did I expose myself to the thought enough?
The fear, “Did I expose myself enough to my fear?” and, “if I dont engage with an obsession, am I thought suppressing? These are two very close obsessions. But, there's a nuance difference that I want to ensure we address here.
So the student says, right now when anxiety sets in, I divert my attention to something else to focus on my values. Beautiful. Right? Then usually anxiety will wear off pretty quickly and I choose to move on. The problem is what happens next? So, so far this is beautiful. [00:08:00] Just like what we said they go on to say, my mind immediately points out the fact that I didn't quote, unquote, savor the anxiety or look it in the eye, right?
And that they're doing that to prove they're not scared of it. Or that they can they can tolerate it, right? And so they go on to say, “OCD accuses that my diversion wasn't in fact occupation or being functional and effective, that it was avoidance and, and that I'm avoiding to deal the anxiety feeling that I have. And they then go on to say, this makes me more scared of the intrusive thoughts in the long run.”
So, if we were to break this down, this person had a thought, they responded really effectively. But then, this is the trap. OCD will usually tell you there's a way you're doing this wrong or there's a way that there's an additional thing you haven't addressed yet.
It usually [00:09:00] is like you who I have more to say, have you thought about this? Like it's saying, you know, there's other things you should be worried about. And in this case, they have dealt with it really beautifully. But then OCDs come in and said, no, you didn't look at it long enough. You didn't face it enough.
If you don't face it enough, well then you're gonna keep having this anxious feeling in the long run. And really in that situation, all we need to do, I. Is practice exactly the same tools we use with the first obsession, which is to go maybe, maybe not, but I'm not tending to you. I'm not trying to make this perfect.
I'm going to move forward with what I am going to do and allow the uncertainty that I may or may not have anxiety about this in the future, or I may or may not have looked my fear in the face enough, right? Remember here that O C D. Is always going to try and bring you back into doing [00:10:00] a compulsion to try and get that uncertainty.
And your job is to catch the many ways OCD consistently pulls you out of using effective behaviors and tries to get you to use compulsions. If you can find those trends, you can identify them as, okay, we know what to do when they come.
When it tells me I'm not doing it enough, or I'm not looking at my fear enough, or I'm avoiding it, or whatever, you can go, I'm not tending to that. I'm moving back to my values. Right. Which beautifully now brings us onto the final trap, trap number three, which is, how do I know I'm doing ERP correctly?
People often ask, “How do I know if I am doing ERP correctly?” This is a very common one. In fact, I have consulted with dozens of different OCD therapists, including the ones in my private practice. For those of you [00:11:00] who don't know, I have a private practice in Calabasas. We have eight incredible licensed OCD therapists. We are constantly consulting on this kind of question or these traps in particular, and it's often around, how do I know I'm doing this right?
And it makes sense, right? If you're doing ERP therapy, you want to get better, you're here to get the job done, and you want your life back. You're not putting in all this time and paying all this money and investing your valuable resources, um, to just . Have a good time and waste it, right? You're here to get better.
And so it makes sense that you're going to have some anxiety about how well you're doing it, and you're obviously wanting to do it well, like you're someone who is thorough and is invested, so it makes sense that you're going to have this fear. But this is the thing to remember. This is another trap of OCD to try and get you to go back to rumination, right?
To try and figure something out. [00:12:00] Here is the facts. No one does ERP correctly. You are going to do ERP, and you are going to fall and you're going to try again, and you're going to fail again, and you're going to try again, and you may fail again. That is a normal progression of ERP. I tell my patients all the time, you're not backsliding.
Nothing is particularly wrong right now. This is just the normal progression that we get better over time. Just like when we're learning to walk. You stand up, you fall down. It's not like you say, I'm not able to walk, I'll never be able to do it. You get back up, you walk three steps, you fall down, then you get back up, you walk five steps, you fall down.
That's normal, right? We are not going to say to a young baby like, oh, you're not walking correctly. You know, this is bad. You're never gonna be able to walk because you're not walking correctly. No, we're going to say to them, keep going, keep trying. Just keep trying. And with time, those muscles will strengthen.
And you'll be able to stand up and do this work a little longer each time, but do not fall into the trap [00:13:00] of O C D telling you it has to be done perfectly and you have to do mindfulness correctly, and you have to do response prevention correctly, and you can't do any thought suppression or you'll never get better.
That is another trap, and your job is to say, good one, OCD. Thank you for your input, but I'm still over here with the focus of not trying to engage in rumination and trying to get certainty, but to, to move towards my values, to allow fear to be there imperfectly, right imperfectly, knowing that it won't be perfect every time.
You may engage in some compulsions. I'm going to keep saying that that is not particularly a problem. Right. Especially if as you're doing it, you're using your tools and you're doing the best you can, try to just focus on doing one minute at a time and doing it as you can. And we're not here to do it perfectly.
Right? And at the end of the day, if you're someone who struggles [00:14:00] with this thought, like, am I doing it correctly or am I doing it perfectly? You can just say, “Maybe I am. Maybe I'm not. I'm also not getting caught in that trap.”
So I hope that that has been helpful to really get to know these traps.
And for you, it mightn't be specifically these three common traps. It may be something a little different. That's okay. Your job is to catch these trends, the things that keep pulling you back into rumination, pulling you back into avoidance, pulling you back into reassurance-seeking, and identify them. Come up with another plan.
Again, if you need more help with this, you can use E R P school. It's an online course. It's on demand. You can listen to it and watch it as many times as you want in your PJs. It's there for you to troubleshoot these issues. We have a whole bunch of modules talking about how to troubleshoot these issues, but I wanted to do this publicly because I knew
A lot [00:15:00] of you who don't have access to care are probably struggling with the same thing. So that's it for me today. Thank you so much for being here. I love talking with you about the nitty gritty of how this can, you know the real hard stuff and I hope it's been helpful for you. Please do remember, and I say this at the end of every podcast episode, you know I'm gonna say it.
It is a beautiful day to do hard things.
Do not let society tell you that you're weak or that you're not supposed to. And it should be easy because that's not real life. I know it's hard to accept that, but we can shift this narrative to a narrative where we can do hard things. We can see ourselves as strong.
We can see ourselves as courageous, and we will do the hard thing because in the long run, we build resilience and freedom that way. Have a wonderful day, everybody, and I can't wait to see you next week.[00:16:00]