Overcoming OCD: Exposure and Response Prevention (ERP)

Overcoming OCD: Exposure and Response Prevention (ERP)

Obsessive compulsive disorder (OCD) is an anxiety disorder whereby a person engages in obsessive thoughts and compulsive rituals that he or she feels unable to stop

Common rituals include compulsive hand washing, checking things are off (such as switches, lights, ovens) or locked up - however the checking and washing goes beyond normal health and safety limits. People suffering from OCD may feel the need to wash their hands repeatedly for 10 minutes at a time. With all the checking and other OCD rituals that the person feels they need to do, leaving the house to go out can be a nightmare.

The theory is that by engaging in such obsessions and compulsions the person is taking their mind off of underlying things that they are anxious about. Therapy involves three major tasks: stopping the obsessions and compulsions and developing mental discipline and will power to do so; finding alternative relaxation exercises; working through and resolving any underlying source issues the person has otherwise been evading through the OCD.

Medication can also be helpful in some cases - particularly an SSRI antidepressant known as fluvoxamine ('Luvox'); but other SSRIs can also be effective. Anti-anxiety medications can also reduce the tension that leads to OCD behaviour, such as Alprazolam (and other valium type drugs). However, these medications will not deal directly with the disorder; they just masks the symptoms. Here is a clinically proven and effective method for overcoming OCD: exposure and response prevention (ERP):

People with OCD typically know that they are being irrational, just as a cigarette smoker knows the cigarettes are dangerous to health. A good way to understand OCD is that it works like an addiction. The person is addicted to OCD behaviours and thought patterns. The brain is an efficiency machine and makes it easier to do whatever we do a lot of. The brain works in terms of patterns and sets up holding patterns to make things more efficient and automatic. Therefore if you change a pattern things become more difficult until a new neuro-network overshadows the old one. So if you start engaging in OCD type rituals you can become addicted to them. Stopping OCD rituals will involve will power and also the tolerance of withdrawals until the brain recalibrates, as with any addictive behaviour.

ERP involves exposing yourself to a situation where an OCD type behaviour would usually occur but not following through with the OCD ritual. If it involves repeated OCD checking, resist the urge to check and walk away. OCD is like an addiction to cigarettes. When you stop smoking you experience withdrawals. It is only by tolerating the withdrawals and enduring the tension that makes it go away over time. If you halt the withdrawals by relapsing into the addiction you are feeding the addiction and making it worse. You need to practice mental discipline exercises and meditation in order to strengthen your mental muscle.

Brain scans such as FMRI show that the OCD brain functions differently, particularly with excessive frontal lobe activity. With meditation and exposure and response prevention the brain can change such that the person can overcome OCD.

If you choose to quit OCD, you need to make a commitment to change. Be honest with yourself and write down your OCD ritual behaviours in the table below. Then expose yourself to the trigger where the OCD occurs but don’t go through with the OCD. As the brain is all about setting patterns, you will create a new OCD-free pattern that will start to overshadow the old OCD pattern.

The withdrawals go away over time and you are now free of OCD. Withdrawals are like waves: they build up, crash, then recede. When the set of waves passes the ocean is again tranquil. Realize the tension will not stay forever and hold on to yourself in the mean time. Distract yourself by doing something else instead, by simply getting on with your day or by practicing relaxation. If underlying anxiety comes up (real concerns beneath the OCD), discuss it with your counsellor or with a supportive friend or loved one.

Tell yourself: “I DON’T NEED TO CHECK THIS AGAIN. EVERYTHING WILL BE OKAY. I WILL OVERCOME OCD. THE WITHDRAWALS WILL PASS LIKE WAVES”. Then think about something else to take your mind off the OCD.

For OCD worry - practice the following steps of APPP:

Anticipate a bad thing happening - > evaluate the risk Probability -> Plan responses - > Prepare for it now.

This will follow through from worry to constructive action about what is within your power to change; as well as accepting what you cannot change. Tell yourself: “If something bad might happen – I will deal with it there and then. Issues and accidents occur all the time; we can reduce the risk as much as possible but they can still go wrong. If I check something once, it’s like I’ve checked a thousand times. There’s nothing else I can do. It’s in the hands of God / the universe.”

For compulsive repeat checking, practice checking something once if it is important and healthy to do so (E.g. that your park brake is on if you park on a hill) – but only check it once. If it is an OCD checking behaviour, do not check at all, e.g. if you turn off a light you do not need to check that it is off, as you know, the light being off is evidence enough that it is off. If you turn off a hot plate, just looking at the switch once to see that it is off is enough to be safe. Anything else is OCD. In the following table list your OCDs, and take a record of all the time you expose yourself to the situation but prevent the OCD response (exposure and response prevention or ERP). Just mark the column with a score mark as you go, eg. IIIII

OCD  Behaviour                                                                     EPR  Trials

e.g. Washing hands                                                              Limiting to 20 seconds only.

e.g. Compulsive checking                                                 Only checking once if it's a healthy behaviour,
such as checking a vehicle's park brake.

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