Common ERP MistakesDec 30, 2022
ERP, or exposure and response prevention, is the gold standard (and only evidence-based) treatment for OCD and worked wonders with me and has with all of my clients who use these skills consistently. Unfortunately, I often work with people who have either tried to do ERP on their own, or gone to someone who isn't properly trained, and therefore only lose faith in the treatment itself.
The good news is...ERP DOES work when done effectively, every...single...time! Below, I will explain some common mistakes I see in the process and how to work through them.
Doing the Exposure Exercise With the Intention of Getting Rid of the Discomfort/Thoughts
Compulsions are tricky, and almost ANYTHING can become a compulsion, even exposures! So it's not uncommon for me to uncover that after a week or two, a client starts to use the exposure responses to "get rid of the thoughts or discomfort." The exposure can quickly turn into a compulsion - any response you feel compelled to do to ease or get rid of the discomfort.
Effective exposure is when we lean into or expose ourselves to the feared object or situation, either mentally or physically. It's going to be uncomfortable because it's the opposite of what you've been doing, the opposite of what this part of your brain is telling you to do, but it works. Recovery comes when we accept the imperfections and uncertainty, not pushing it away. Being upset that it's there is also a subtle form of pushing it away. It's all about the intention in that moment. When fear is present, lean in!
Your Expectations Are Unrealistic
Many of those with OCD struggle with perfectionistic tendencies, whether it's from themselves, others, or from life in general. High expectations of oneself is a common theme when working with new clients, as is feelings of guilt and shame. One of the expectations that rings true for almost everyone is the expectation that the process be smooth and linear, and this isn't how healing typically works.
A big part of the recovery process includes learning about one's own OCD tendencies, as well as ERP itself. This entails mistakes and and struggling at times. Without these, we wouldn't feel the pride and joy on the other side of recovery! So when doing ERP treatment, you should expect progress and growth, even from the first session or two, but also expect steps back that will help you take several steps forward.
You Quit Too Soon
The process of exposing ourselves to our fears works when we put in enough effort to allow it to work, meaning when we sit with the fear long enough to let our brain habituate (or get used to) it. This process will bring down the physical and psychological anxiety or discomfort that's attached.
How long is that? Until it's at ZERO. Yes, zero! Many ERP Specialists will tell you to do the exposure for a certain amount of time, say 2 minutes, until you feel the discomfort lower. Some teach you to keep going until the discomfort drops in half.
About 5 years into my own recovery process, and 2 years into coaching, I started to wonder why I was having someone stop when they still had discomfort. So, I started having them go to zero, and I had them continue practicing ERP until the level of discomfort with that particular thought was not bothering the AT ALL. Guess what happened? They got better results, and so did I! This is one reason I stay in the recovery stage!
Not Identifying and Stopping ALL Compulsions
This was a huge missing piece in my beginning recovery work with ERP therapists. Yes, I learned some good exposure exercises, and I learned a little bit about compulsions, but it wasn't until my 3rd Specialist that I was told that all of my compulsions need to be at zero to be in the recovery stage. Not only that, no one ever helped me identify ALL of my compulsions so I could stop doing them. Unfortunately, I had to learn the hard way, but I don't want that for my clients so I help them identify their compulsions up front so they don't have to learn by trial and error.
I didn't believe it either at the beginning, but it's not the thoughts or situations that are causing your suffering, it's what you're doing in response to it - the compulsions! Get your compulsions to zero, and you won't feel like OCD bothers you at all.
Rushing or Distracting While Doing Exposures
Again, your OCD won't want to go away without a fight, and one way it'll try to interfere with your exposures (especially imaginal exposures) is to try and distract you with essentially ANYTHING. The noise over there, the things you need to get done that day, or just more thoughts. Additionally, it can cause you to rush through the exercise, pulling you further away from being fully present. It's important for the exposure to work effectively to stay as present and engaged as possible.
Expecting Negative Thoughts to Go Away Forever
While your OCD themes can go away completely with enough time and responding with consistent (an immediate) ERP to your intrusive thoughts, negative thoughts, uncertainty, imperfection, and discomfort are parts of life. If you are a human being these will always exist. Remember, OCD wants perfection, but it doesn't exist.
Once you accept that uncertainty is a part of life, that intrusive thoughts are normal, they will no longer bother you like they do today, because they won't have so much meaning. You'll know what to do with discomfort and it'll quickly fade away.
Not Practicing Exposure Enough
Let's say you want to learn to run, but you've never been in good shape and even walking long distances is difficult for you. You're not going to meet this goal by walking a short distance a few times a week or not pushing yourself physically, right?
The same is true with ERP treatment. Only doing "a little" exposure here and there or not pushing yourself past your comfort zone is only going to lead to minimal progress. It's important to practice exposures regularly (daily if possible) and really get out of your comfort zone! You can really tackle OCD by doing those things that scare you the most. Don't let the OCD voice tell you that you can't, don't let OCD win.
Using Exposure Exercises on Depressive Thoughts
Part of what a great OCD specialist will teach you is to differentiate between which thoughts are coming from OCD and which might be coming from other mental health disorders such as depression. Using exposure on thoughts that cause sadness or hopelessness (common with depression) will actually exacerbate those depressive feelings, so it's important to know the difference and use exposure only on thoughts coming from OCD (resulting in anxiety, discomfort doubt or avoidance). Otherwise, you may end up making any lingering depression worse, therefore hindering your mental health further.
If you are experiencing depression, which is common for those struggling with OCD due to the fact that the disorder can easily affect all aspects of life when it goes untreated, make sure you're working with a coach or therapist who understands the difference and can help you navigate both effectively.
Trying to Do ERP on Your Own
Unfortunately, it isn't always easy to find an OCD/ERP Coach or Therapist to help you get to (and stay in) the recovery stage. Being a part of many OCD support groups online, I often see people trying to "white knuckle it" or practice acceptance and exposure on their own. While this is very commendable, there's nothing that replaces the guidance of a specialist who can help you navigate the pitfalls.
One, it's very common for my clients to come to me thinking that they know all of their compulsions, so when we talk about the need to get them to zero by the time we're done working together, they say no problem! But, I almost always uncover more compulsions that they weren't aware were compulsions. Stopping your compulsions is essential to full recovery from OCD.
Second, exposure exercises need to be done systematically and properly. They are created based on your personal intrusive thoughts and fears, so without the knowledge of both how to do exposures effectively, and the exact thought/fear (specific wording is important here), they likely won't be as effective in the long run.
Additionally, having someone who understands the tricks that OCD can play as it tries to stay in the driver's seat, will help you win the battle against your OCD.
Ready to Recover & Get Freedom from OCD?
If you're ready to finally recover from OCD, anxiety or depression, just know that full recovery is very possible! It requires the proper education on your particular fears, beliefs & themes, effective exposure exercises specific to your intrusive thoughts, and guidance to get you to recognize and eliminate ALL compulsions. To learn more about how I can help, visit the links at the top of this page.
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