When people first hear the words "exposure therapy," I imagine they immediately think of being forced to face their worst nightmare. White knuckles and gritted teeth. I completely understand that worry, and I want to take some time here to offer a different way of looking at exposure therapy.
Exposure and Response Prevention, or ERP, is the most researched and most effective treatment for working with obsessive compulsive disorder. When it is offered with attunement, consent, and compassion, it is also one of the most hopeful things I get to witness in my work.
The cycle ERP interrupts
OCD tends to run on a loop. An intrusive thought or fear arises (this is the obsession). Anxiety increases in the mind and the body, and then we try to get safe or find certainty with a compulsion: checking, washing, counting, repeating, mentally reviewing, asking for reassurance, or avoiding altogether. The compulsion brings some temporary relief, and the relief is where we tend to get hooked. This cycle then reinforces in your brain that the fear was something to be avoided/fixed and the ritual saves you temporarily from that fear. So the loop tightens.
ERP works by loosening that loop from both ends. Together, and always at a pace that feels appropriate for you, we practice approaching the thoughts and situations that create fear (exposure), while gently, mindfully (together- you are not alone) choosing not to perform the ritual, and replacing it with another more skillful response (response prevention), and noticing with compassion what happens. Over time, your nervous system learns something it could not learn while the compulsions were in charge: that anxiety rises, it crests, and then it passes on its own. And you might start to experience a different kind of safety, a safety that does not need everything to be perfect or right before you can truly live your life.
Compassion in Action
“Be gentle with yourself
Be kind to yourself
You may not be perfect
but you are all you've got to work with….”
- Bhante Gunaratana
This is what makes my approach to ERP nuanced. Compassion is at the heart of this work for me, and I make it a priority to centre our work in curiosity and kindness. I understand the fear and shame that can accompany OCD and intrusive thoughts, and I believe it is incredibly important that, first and foremost, we approach this work with gentleness and a willingness to get to know ourselves just as we are. In time, and at our own pace, we can begin to make friends with the parts of ourselves we may have been denying, fearing, or struggling to understand.
What ERP looks like in my practice
I am trained in ERP through the International OCD Foundation's Training Institute,(IOCDF) as well I have specific training with Kimberly Quinlan who is an OCD specialist through CBT School.
We always begin slowly, and at a pace that works for you. Together, we will take some time to map out how OCD has showed up in your life, and without judgment, we build a ladder together. You choose the steps we take, and nothing happens without your full presence and agreement.
As a mindfulness teacher with a long personal meditation practice, I weave in skills for staying present with discomfort and meeting yourself kindly when the work is hard. ERP asks you to have courage, but it will never ask you to be cruel or cross your own boundaries.
As well, we always connect the work we are doing together to your values, and what matters to you. The hard work we might do together is not about needlessly suffering, it’s about reclaiming the life OCD has taken from you: the drive you stopped taking, the kitchen you stopped using, the people you stopped hugging, etc.
Does it work online?
Yes, and often I find ERP to be quite successful online because we get the opportunity to be in your real environment. Practicing ERP over Zoom from your own home can make the work more relevant. I offer ERP online across BC and in person in Nanaimo, for teens 13 and up and for adults.
Is ERP right for you?
If intrusive thoughts and rituals are taking up most of your time, your energy, or negatively impacting your relationships, ERP is worth a conversation. I offer a free 20 minute consultation, which is a relaxed, no-pressure chat about what is going on and whether we might be a good fit.
There might be a version of your life where your mind can be loud without taking over your whole life. Exposure and Response Prevention (ERP) therapy is one well-worn path there, and you do not have to walk it alone.
