How ERP therapy is helping me confront the uncomfortable
“Place your hand on the doorknob.”
“Okay, now the soap dispenser.”
I do as she says. Though I’m hesitant and somewhat fearful of what could come next.
It’s my fifth session of ERP therapy, which stands for exposure response and prevention. For the last four weeks, I’ve met with my therapist for an hour over Zoom. Each time, she asks me how I’m doing. If there’s been any changes since we last talked. And then we get to work.
By this, I mean that each session consists of a series of exercises designed to help me, someone with obsessive compulsive disorder (OCD), confront triggering situations or objects. Rather than engage in the compulsive acts I usually perform to alleviate my distress, I’m encouraged to sit with the discomfort and accept uncertainty. The idea is that by exposing myself to triggers, my anxiety level will decrease overtime.
In essence, ERP is a form of cognitive behavioral therapy that helps to treat the symptoms of OCD, as well as other psychological disorders. Another way to think about it is that ERP therapy is designed not to help you overcome your fears, but rather to address them head-on. It’s looking the bull in the eyes and saying I’m not afraid of you. Or in my case, it’s touching the doorknob I believe is covered in germs and resisting the urge to wash my hands.
In practice, ERP therapy looks and feels a lot like Simon Says. You know, the game you played as a kid where “Simon” said to touch your elbow. But if your sort-of-bossy friend didn’t actually say “Simon says” and you touched your elbow anyway, well, then you lost.
The ERP version of this is that my therapist will give me a series of instructions which I’m to follow. I’m often hesitant and sometimes I try to negotiate, which is only effective about a quarter of the time, but eventually I will give in. After all, I did sign up for this.
For example, let’s say you’re doing ERP therapy. And for fun, let’s say your therapist’s name is Beyoncé. Because if the real Beyoncé calls you or shows up at your home and starts giving out instructions, you’re going to do what she says, right? Are you really going to tell Beyoncé no? I didn’t think so.
So, Beyoncé will say something like, “Go touch the faucet.” And so, you do.
“Now go open your refrigerator and touch a few things there.” You walk to the fridge and move around the milk, then the eggs, then the cream cheese and so forth.
“Now go into your bedroom. Touch your phone. Your dresser. Your sweatshirt.”
“Okay, now can you place your hand on your pillow?”
You pause. Because, if you’re me in this situation, you would have typically washed your hands after touching the doorknob. And after touching the food in the fridge. And it’s already bad enough that all those germs are on your phone and around your bedroom, but now Beyoncé wants you to put them on the pillow where you sleep!
“Do I have to?” You ask and Beyoncé replies with, “You don’t have to,” which feels like the equivalent of I’m not mad. I’m just disappointed.
You sigh and reluctantly place the palm of your right hand on your pillow. You’re already thinking about changing your pillowcase afterwards. But Beyoncé says to keep your hand there and so you do. A few seconds go by, and she asks how you’re feeling. Now you’ve reached a minute and again, she asks how you feel. You realize that your discomfort, though still present, has decreased. Touching the pillow isn’t quite as bad as you thought it would be. Your mind has even wondered off in thought about something else.
“Okay, you can take your hand off now,” Beyoncé says.
I’ll admit that I didn’t fully know what I was getting myself into when I began ERP therapy. For starters, I think I underestimated how challenging it would be for me to participate in certain exposure exercises. And on the other hand, sometimes I wondered if parts of the therapy were too easy. Should I feel worse about this? Should this be harder? I found myself wondering.
But what I’ve learned is that not every exposure sends me into a panic. It’s more of just a feeling that something isn’t right, a feeling I experience often in my day-to-day life. I can’t always pinpoint where this comes from. But OCD hates this feeling and the uncertainty it brings. My OCD tells me all the worst possible outcomes that may result and says I must perform my compulsions to ward off even the most unrealistic of circumstances.
It’s in these moments where I’ve started to see how ERP is helping me to quiet this voice. There are still times where I give in. Afterall, I’m human. But doing ERP therapy has given me permission to resist. Whereas before, if I exposed myself to a trigger, I would hear OCD say, “Why would you do this? This is your fault.” This became the most challenging internal monologue to quiet of all. Because it not only made me feel weak, but also angry and resentful towards myself for causing pain that OCD said I should have known better to avoid.
In truth, I have a lot more work to do and am still figuring out how I feel about ERP. It’s been difficult to put exercises into practice without my therapist present. But so far, ERP therapy has given me a better understanding of OCD and myself. It has helped me to realize that I am not powerless against OCD. Rather, I can reclaim my agency. And while my obsessions and compulsions are still part of my daily life, if I face my fears and sit with the discomfort that they bring, even if only for a minute, that alone is a small victory worth celebrating for now.
Disclaimer: This article is a reflection of my personal experience and not based on clinical expertise. For more information about OCD and ERP therapy visit iocdf.org.