Exposure Response Prevention (ERP)
My Experience with Exposure Response Prevention (ERP) I can remember vividly. My body was frozen except for the trembles. I was next to the bedroom door, eyes glued to the light switch. It was the usual kind. One for the lights the other for the fan. Most people glance quickly at the switch, turn off the lights, and settle down for the evening. For me it was taking considerably longer. You see, I hadn’t dusted my fan blades in a while… and if I happened to mistakenly tap the fan’s switch when I went to hit the lights my whole room would rain dust…who knows how long it would take to clean all that up…and I’m allergic to dust! Plus, panic attacks cause mind fog making me even less sure of my actions. My rational brain is deadpan, telling me I just have to stay mindful and I’ll be fine. Of course I would notice if I did anything wrong. But my panic brain is making excuses, any excuse to linger paralyzed and worry about how I might bungle things up when I do this menial task. It was around the fourth minute of standing there that I remembered, Oh that’s right…I have obsessive compulsive disorder! Pull it together man and do that ERP… I gave myself a split second to look at the switch - surely enough time for any able person to see the fan was off - reached out, flicked off the light, and walked to my desk chair. I was covered in sweat. I kept worrying that the fan would somehow turn on. The irrational thought flashed in my mind: maybe I couldn’t tell if it was somehow on already. I wanted to go back and make sure it was off. I wanted to keep staring at the fan blades. Instead, I steadied my hand and clicked on a funny YouTube video. The one I meant to watch 15 minutes ago. Since obsessive compulsive disorder (OCD) plagues its sufferers with fear of what could happen in the future, sitting with uncertainty is the most painful yet necessary step towards healing. The most proven and effective OCD treatment is “ERP” or exposure response prevention. ERP is essentially what it sounds like. For example if an OCD patient is afraid of contamination by dirty objects, they’re exposed to what they fear (e.g. touch the handle on a toilet, touch an oft-used doorknob, etc.) but refrain from compulsions to ease their distress (e.g. washing hands, taking a shower, etc.) The practice re-conditions the brain. What once caused great anxiety is now calmly accepted with no compulsive reaction. They are encouraged to repeat the worst case scenario in their mind so they become desensitized to the very idea of it (“Now I definitely have contamination on my hand,” “I no doubt turned the fan on by mistake and now my room is getting dusty.”) For sufferers this is initially quite uncomfortable but the payoff is immense. The worries won’t carry the weight they once did. This is called habituation. It was almost 9 years ago when I started ERP. I had practiced it as a teenager but I was never as serious as I was now. My OCD was so bad scenes like the one described above were commonplace. I wasted valuable hours with useless compulsions and my patience had finally worn out. I found a psychologist I was comfortable with and discussed options. ERP sounded grueling but my new doctor assured me it was the most effective treatment. In my room, the fan almost seemed to whisper behind my back. Urges to stand up and check kept flashing into my mind every few seconds. Each time I was about to give in, I remembered my therapist’s directions. No matter how bad it gets, DON’T DO IT! Her strictness was necessary - without those rigid guidelines I would surely have faltered in my treatment. Years ago I held back during therapy because of embarrassment and anxiety. Now I was older and willing to dive into treatment. This meant being honest, open, and taking what she said seriously. It took a long course of ERP treatment but played an irreplaceable part in my recovery. A year went by before I felt like myself again. At first it was excruciating yet I persevered. Support from my therapist, family, and friends kept me on the road to recovery. It gradually got easier until my obsessions and compulsions were almost extinct, but OCD is a chronic condition. Every now and again when it reappears I’ll restart my ERP and it still works like it did then. I’ll always be thankful for discovering this treatment and the people who helped me through it.