Anxious Parenting Practicalities Part 2/10: Top 5 Lessons I Learned About ERP
Updated: Feb 2, 2022
In my #OCD therapy journey, I conducted a lot of #ERP exercises. I started out under the guidance of my wonderful group therapist, and later progressed to trying some on my own. As my group and I learned and progressed, we collected questions about the 'how', 'what' and 'why' of ERP. I've summarized some of our key findings here in the form a question-answer article in the hope that others might recognize the same question in their own journey and find some helpful thoughts (not to be confused with actual therapeutic counsel...because, you know, I'm not a therapist). Alright, onward!
Question #1: How Do I Actually Do an Exposure? It all depends on the goal of the exposure. The point of exposures, regardless of content, is to develop a healthy, rational response to some- thing that triggers your obsessions and compulsions. Sometimes, all it takes to do that is exposing yourself to a trigger and sitting with the discomfort you feel until it goes away (which it will). A good analogy here is stretching a muscle. At first, the muscle will respond to the stretch with tension and pain, but if you sit in the stretch long enough, the muscle will relax and lengthen. Exposures are a lot like that.
Other times, the goal of an exposure may be to experience dis- comfort and then resist a compulsion. For example, if you have a fear of contamination from public doorknobs, you might touch a public doorknob, find a bench to sit on, and just sit with your thoughts while resisting the urge to go wash your hands. Or, if you have a fear of the number six, you might start by writing the number six on a piece of paper and just practise looking at it without erasing it. The point is not to fight your feelings, it’s to sit with your reactions and watch them fade away. It’s hard to do at first, but it gets easier with time and practice. Question #2: Are There Any Rules on What Exposures Should or Shouldn’t Look Like? Your exposures should never, under any circumstance, pose a threat to your safety, employment, or well-being (or anyone else’s, for that matter). In my experience, there’s really no need for grandiose risk of any kind – physical, emotional, financial, social or otherwise. Exposures should help you push through your discomforts, but they should be controlled, safe and manageable. Other than that, there aren’t a lot of restrictions. The most important thing is that your exposures should reflect you and what you want to accomplish. If you’re unsure of what that looks like for you, professional help and resources like the ones in the Resources section of this book might be helpful. If you’re ever unsure whether an exposure is safe, my advice is to hold off on per- forming it, and make sure you talk to a professional.
Question #3: How Much Time Should I Spend on This? Exposures are meant to be conducted regularly, but not so much that you’re constantly in exposure-mode. I found working out to be a helpful analogy: I started with a regular schedule that I could handle, and as my ‘exposure fitness’ increased, I was able to build in higher- intensity exposures for longer periods of time. When I first started, I was doing two exposures per week, and then in my most intense treatment periods, I increased my frequency to six times per week. These days, I only conduct occasional exposures for maintenance and stress-management purposes. I should also note that I came to those numbers through a bit of trial and error, and they evolved from week to week based on my progress and the demands of my work and family. Life made it hard to keep perfect habits, but eventually I learned to focus on a flexible routine rather than a rigid schedule.
Question #4: How Long Should Each Exposure Take? The length of my exposures varied based on the severity of the trigger I chose. If an exposure led to signs of panic (physical pain, increased heart rate, light-headedness, severe anxiety), that meant it was time to stop, even if I was only in the exposure for ten seconds. Other times, I found myself in that ‘just right’ state where I was uncomfortable, but not overwhelmed, and in those cases, I tried to stay in the expo- sure for as long as I could, or until I felt relaxed, bored, or distracted. Sometimes that meant ten minutes; other times it meant up to half an hour. Over time, I noticed my mind getting used to the discomfort of exposures. It was almost as if it was learning to say, ‘Right, here comes this feeling again. It’s not new anymore, and it’s not that bad. Let’s just get through this.’ Once that started happening, most of my exposures only required ten to twenty minutes.
Question #5: What If My Exposures Don’t Work? Generally, if an exposure didn’t help me at all, it’s because it was either too hard, too easy, or not performed regularly. Occasionally, I also lost progress because I set unrealistic expectations for myself. Think back to my attempts at getting over my fear of heights; zip-lining, for example, didn’t work because I only did it once, which is completely insufficient for building new neurological pathways. You could argue that I should’ve gone zip-lining more often, but that was an unsustainable solution for several reasons. First, I didn’t have the time and money to take zip-lining excursions on a regular basis. Second, zip-lining was too stressful for me to want to do it every day. If you’ve only ever run five kilometres, and you start trying to run weekly marathons, you’ll get injured. The same rule applies with exposures. If you don’t get the results you want, go back to your research, talk to experts, remake your plan, and try again. You’ll get there.
Occasionally, I also get asked what to do if you can't think of any exposures to try. My suggestions are simple: research examples that others have done if you want, but ideally, go to a trained therapist for advice.
Now, you might notice that I didn’t suggest asking friends or loved ones to help with creating exposures. I would never presume to tell families how to care for each other; I just think that an exposure ladder created by someone else (anyone else) doesn’t require you to go through the hard work of analyzing and managing your own thoughts. Therapy is highly personal, and if you’re feeling stuck with your exposures, my opinion is that experts and reputable resources are the best way to find solutions that work – for you and by you.