ERP

Exposure and Response Prevention (ERP) isn't always easy, but as one of the most effective treatments for OCD, it's worth it. If you've started ERP, what has been the biggest surprise you've experienced in learning to resist compulsions? If you haven't started ERP yet, what is holding you back from starting?

I had just posted a summary of ERP for a group member, and I thought it might be useful for everybody. Here it is below (with a little extra added)…. ERP therapy is researched-based. Most other therapies don’t work. There have been people who have been literally stuck in their houses (from their OCD) who gained their lives back through ERP therapy. NOCD does ERP therapy exclusively. You can find it in other places too, but you have to ask around. There are two tenants of ERP therapy: The first one has to do with the repetitive thoughts inside our heads. These thoughts are actually defined as “obsessions”. You are not supposed to do anything with the obsessions. You are supposed to let them run through your head freely, without trying to fix them or stop them. Imagine a tree planted by a river. The leaves fall off and float down the river. You can see the leaves falling, but you don’t try to stop them or pick them up. You don’t try to fix them. You just let them float away. This is really important to do with your obsessive thoughts. The more you try to fight them off, the worse they get. I used to have blasphemous sentences running in my head 24/7. I felt like I had to put a “not” next to each sentence in order to “fix” it. But this just took hours of my time every day, and it was very scary, because I was worried that if I messed up, that I would go to hell. It was very freeing to learn later that I could just let those sentences run freely through my head without trying to fix them. The second part of ERP therapy is all about “denying your compulsions.” Every time OCD tells you that if you don’t do things a certain way that something really bad will happen, that is a compulsion. Once you recognize what your compulsions are, ERP therapy will have you practice stopping doing all of those things. For some people, that will mean stopping washing their hands or touching lights switches or, in my case, putting “fixing” words in their head. Compulsions are safety behaviors. During ERP therapy, you will practice stopping engaging with safety behaviors. All this is very hard to do and scary, so during therapy you will be given tools to help you deal with the fear. Often ERP therapy will take people from being non-functional to functional. I highly recommend it. ————————————————- PITFALL #1: After you have been doing ERP for a while and become somewhat successful, the OCD will try subtle little tricks to bring you down again. The first one is to tell you that your thoughts are REAL and not OCD, and therefore you can’t apply ERP therapy. Don’t fall for this trick! All thoughts are just thoughts. They are all meaningless. Don’t try to figure out what is real and what is OCD. Just treat all thoughts with ERP therapy. PITFALL #2: The second pitfall is that OCD will tell you that you can’t move forward unless you have absolute certainty that you will be safe. Hate to tell you this, folks, but there is no certainty in life. You will never know for SURE that you or your loved ones will be “safe” from the OCD rules. Therefore, you have to move forward in the uncertainty. It’s hard, but it gets easier with time and practice. We got this, guys !!!!!!

I have, alongside my other OCD themes, an intense fear of insomnia. Although this has been improving somewhat — partly thanks to medication and The sleep school on YouTube — I still find myself ruminating about it throughout the day when I have something important the next day, I get stuck in the fear that everything will be ruined — for both myself and others — because my mind is so preoccupied with sleep. + a fear of depression coming back. It honestly feels like a form of sleep OCD. I'm not sure if that’s an official thing, but that’s how it feels to me. A form of erp is the idea of befriending wakefulness. That works great tbh. Things like sleep hygiene, meditation, etc. — tend to backfire because my OCD latches onto them and becomes too obsessive about “doing them right.” I’m genuinely wondering whether ERP — for example in the form of a worst-case-scenario audio loop (imaginal exposure) — could be helpful in this case. I’m hesitant to start unless I know it can actually help. Is there anyone who has experience with this or thoughts about it? I’m not looking for reassurance or tips to fall asleep — only for ideas on how ERP might be applied in this situation.