What Exposure and Response Prevention Therapy for OCD Is Really Like
Exposure and response prevention therapy (ERP) is considered a crucial part of treatment for obsessive-compulsive disorder (OCD). It involves exposing the patient to their worst fears and letting them habituate the anxiety without letting them give in to their compulsions. But while the concept may sound simple, it is really as complicated as the disorder it is designed to treat. And just like most medical websites only explain OCD in technical terms, without really expressing what it is like to have the illness, even fewer go into detail to explain what ERP is really like.
OCD is an extremely misunderstood illness, not only because most information you will find gives you only the driest, simplest definition, but because it is so hard to put into words the torture it puts a person through. It is constant, consuming paranoia that clouds your mind and makes you afraid of yourself, the world and everything in it. It is irrational, and sometimes flat-out ridiculous, but it grips you with so much power that you can’t help but believe it. It is so manipulative it almost seems like a supernatural force that is constantly studying you, finding your worst fears and weaknesses, and using them to control you. But what’s even worse is that it convinces you it’s helping, it’s keeping you safe and that you need it.
So how do you overcome this monster? How do you fight back against a disorder that seems impossible to defeat? ERP is the answer. It is the most tried and true method, and I can confirm from personal experience that it does wonders, but it does not come without its challenges. It is a lengthy and straining process that requires an unimaginable amount of strength and patience. It’s often extremely painful. But it’s necessary, and it works.
I began intensive treatment for OCD more than a year ago. I did an outpatient program that was three weeks long, for three hours a day, five days a week. It was almost like school, but for ERP. It was both the best and worst three weeks of my life.
I remember walking into the office to meet my therapist. He noticed right away how tense I became when I had to shake his hand. He has also fought a long battle against OCD. It doesn’t affect him anymore because of the decades of work he has put in, but he had been in the same place I was and he knew exactly how I felt. He assured me that the therapy would go at a gradual pace, we would not be going dumpster diving, and he would not make me do anything he would not do himself. Of course, I soon learned that he is now pretty fearless when it comes to contamination, even though he wasn’t always.
And so I had to put a great deal of trust into this person I had only just met, as much trust as I had in OCD, which had been with me my whole life. It wasn’t hard at first because I wanted to get better, and I didn’t want to be controlled by OCD anymore, but it became harder as my treatment progressed. Since OCD is such a powerful illness, treatment has to be even more powerful. That’s why I was kept on such a long and strict regimen.
The first thing we did was build my hierarchy of fears, and then we tackled the ones lowest on the list. For me, this included numbers and “just right” OCD. And so I wrote down odd numbers and placed objects around haphazardly. It was fairly easy. And so next we tackled my intrusive thoughts. These included gripping, intense visions of fires and break-ins, basically anything horrible that could happen to my home. I wrote narratives about these things and read them over and over, imagining them actually happening, and accepting that this was a very real possibility. I learned not to be afraid of those thoughts, and that obsessing over them wouldn’t make those things real. At this point, therapy was kind of fun. It was a healthy challenge. I could see my improvement and was eager to do more. This didn’t really last.
Highest on my list were my contamination fears. These would be the very hardest to fight. Things like going out to public places and touching things scared me half to death. I had to eat at a buffet, and sit in the waiting room at urgent care. But the actual things I did don’t matter so much. It was how they made me feel that does.
For most people, their greatest fear is a little thought in the back of their mind, something that pops up in nightmares, but not something they will ever likely face. For most people, their greatest fear does not prevent them from functioning from day to day. For people with OCD, their worst fear is constantly at the front of their thoughts, controlling them in everything they do. And it makes simple everyday things feel like torture. I managed to power through and force myself to do my contamination exposures. I managed to ride out the fear. The point of exposures isn’t to get rid of the fear, it is just to face it and live through it. And so I did. I did things I was convinced would harm me. And I could never be told they wouldn’t. I touched the doorknob fully believing it would make me seriously ill, and not being told anything different. It was a surprise and a relief to wake up the next morning and discover I was perfectly fine. I was consumed with anxiety throughout therapy. I broke down in tears once or twice. But no matter how torturous the intensive therapy was, it wasn’t any more so than years of having OCD.
And it made me better. The next day, after doing my hardest exposure, I could do it again and tolerate it. Then I could do it again and feel OK. I felt freedom for the first time. I could rebel against OCD and prove it wrong. It was an empowering feeling, that I could do the things that scared me the most, and I could feel the fear at full force and be OK. I had never imagined before what it would be like to be free from OCD, but now I could feel it. I could taste the freedom, and I wanted more.
It took more than those three weeks to get to the point where I could say I’m recovering. In fact, I don’t think I’ll ever be fully recovered. There is no magic cure for OCD, and it’s a lifelong battle that can be made easier through lots of work, but is almost never fully won. I still feel the same fears, though they’re not nearly as strong. I still have to actively fight them, and sometimes it’s just so much easier to give in to them. I’ll admit I should be putting in more effort, but I’m now in a pretty good place. I feel stronger than I ever did now that I’ve been through intensive treatment. ERP can seem like torture sometimes, and it takes effort, and sometimes it can seem impossible to do. Sometimes you’ll feel like it’s not even worth it. I can assure you that it is. It’s more than a challenge, it’s a struggle, and sometimes you’ll feel like you don’t have it in you to keep going. But if I could do it, anyone can. ERP is painful, but it’s also empowering. It makes you aware of strength you could never have imagined you had. And the freedom it brings you is worth everything.
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