My OCD Treatment Is Absolutely Brutal, But It Does Help
· Vice
If you have obsessive-compulsive disorder (OCD), you might be familiar with the concept of Exposure and Response Prevention (ERP) Therapy. This form of cognitive behavioral therapy is considered the “gold standard” for OCD treatment.
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As its name suggests, ERP involves two components: exposure to an irrational fear/intrusive thought and the prevention of compulsive behavior.
“The exposure component of ERP refers to practicing confronting the thoughts, images, objects, and situations that make you anxious and/or provoke your obsessions,” the International OCD Foundation explains on its website. “The response prevention part of ERP refers to making a choice not to do a compulsive behavior once the anxiety or obsessions have been ‘triggered.’ All of this is done under the guidance of a therapist at the beginning—though you will eventually learn to do your own ERP exercises to help manage your symptoms. Over time, the treatment will ‘retrain your brain’ to no longer see the object of the obsession as a threat.”
Before I get into sharing my own ERP tips with you, I’d like to preface by saying that I’m not a professional—just someone who’s struggled with OCD since she was a child. It’s always important to discuss your treatment with a therapist to understand the best approach for your specific condition/mental health needs, especially since some conditions can overlap.
That being said, through the years of ERP therapy I’ve endured, I’ve learned that one of the most effective ERP tactics for me is “scripting.” This essentially entails writing down your intrusive thoughts/fears as though they are true (or using “maybe” statements), exposing yourself to the idea by recording it on paper or in a journal. The trick is to let yourself sit with the anxiety, uncertainty, and “what if?” thoughts without feeling the need to do compulsions (e.g., rumination, seeking reassurance, researching, etc.)
Interested in this ERP technique? Here’s how I write ERP scripts for my OCD.
1. I Write My Intrusive Thoughts As ‘Maybe’ Statements
I think many people with moral scrupulosity can relate to feeling like a bad person all the time. This is one of my worst OCD fears, so when it comes to ERP, I center my scripts around the idea of being “morally” bad.
To start my script, I might write something like…
“Maybe I really am a bad person. I might have bad intentions that hurt the people around me. I might be selfish, manipulative, or controlling in my closest relationships.”
Of course, this isn’t enjoyable to write or read back. In fact, it’s basically affirming my worst fear. But if you can get your most unfiltered thoughts onto paper, you might start to desensitize yourself to them. This strips your intrusive thoughts of power.
2. I Include as Many Details as Possible
OCD loves to find loopholes and pull from other experiences or sources for inspiration. It’s quite the creative monster. That being said, if OCD adds more context as I’m jotting down my script, I’ll include it without second-guessing.
For example, I recently wrote a script that addressed my relationship-OCD. At first, it centered around my fear of not being a good partner. As I was writing, OCD continued to chime in with more bullying statements, like “Your boyfriend would probably prefer to be with someone else” and “You’re not as attractive as other women.” So, I added them right along in the script. It ended up sounding something like…
“Maybe I really am a bad partner. In fact, maybe my boyfriend would prefer to be with someone else. I might not be as attractive as his female friends. Maybe he’ll meet someone who is kinder, prettier, and better-suited for him. He might decide I wasn’t the one and might walk away.”
I know, I know…it sounds brutal, but think of it like this: The ERP is being brutal on the OCD, not on you as a person. It is meant to strengthen your resilience and desensitize you to OCD’s desperate attempts at scaring and controlling you.
3. I Add a ‘Resource’ Line for Encouragement
Because ERP can be incredibly triggering for OCD sufferers, it helps to add just one “resource” line to support you through the exercise. This is not the same as reassuring yourself or doing compulsions. Think of it as a small token of encouragement and empowerment.
My go-to resource line, which I include at the end of every script, is: “I choose to be present and loving despite my uncertainty and fear.” This helps me move forward from the exercise rather than simmer in the shame or anxiety it might trigger.
Living with OCD can feel like the most disempowering experience, but it doesn’t have to control you or your life. As impossible as it might seem, you can still choose presence and love over uncertainty and fear. It will get easier in time, especially as you continue your ERP practices.
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