Exposure and Response Prevention

I’ve completed my ERP therapy. Thanks to both medication and ERP I’m in a “complete” remission of symptoms. I can truly tell you I hope to never go through that again, but I do not regret doing so [ERP] (and would do it again if needed to). I feel peace and am relatively anxiety free. Results may vary from individual to individual, but for the most part a significant decrease in symptoms is expected should one complete therapy.

So, what is ERP and how/why it works. The basic idea is actually deceptively simple. That doesn’t mean it is easy. Let’s take the example of someone who is afraid of heights. This fear of heights triggers an uncomfortable amount of anxiety at a certain level. We start with a scale from 1 to 10 (or 1 to 100). This scale is known as subjective units of distress (aka SUDS). This person who is afraid of heights would  back away from the balcony (avoidance/escape response) if on say, the tenth floor. By assigning a SUDS number to a floor level, therapy can be tailored empirically to ones experience. At around 6+ we start to initiate an avoidance response. This person should have a reduced level of anxiety on floor one, but still have some anxiety. The person would deliberately stay on a balcony (exposure) on floor one until their anxiety level reduces on its own (habituation). The person eventually makes it to the tenth floor.

The same basic principle is at work with OCD. Whatever triggers the anxiety (obsessions) is scaled, using SUDS, to create an exposure ladder. One is then exposed to the obsession in a deliberate manner without implementing any escape strategies (compulsions) until the anxiety level decreases. This technique combined the exposure treatments used for phobias and the prevention of coping strategies (washing, checking, praying, thought neutralizing, avoiding people or situations etc…). This treatment came in to existence in 1966 by English psychologist Victor Meyer. The actual experiment is pretty awesome. One would aim at an exposure exercise that elicits 4-5 on the SUDS scale and work one’s way up the ladder. The most important thing to remember about ERP is that it is about achieving a goal as opposed to “feeling good.” It’s undergoing short-term anxiety for long term results.

In my case, I had thoughts that I would try to suppress (avoidance). The specific thoughts were blasphemies against the holy spirit such as “F*@k the Holy Spirit” or some other variation of that. These thoughts were unwanted thoughts. Even though I consider myself an atheist, I’m not explicitly against any particular deity. I just don’t know if any exist, but I personally am no longer Christian. As someone who suffers OCD I can say that I have an excessive need to feel safe. These thoughts made me feel as if I was possibly damned, even though I don’t believe in heaven or hell. To an outsider this would seem absurd and I would agree, but if OCD was something one could reason their way out of, than no one would have it. There are many variations of this type of scrupulosity. There are people who have experienced scruples despite not being raised in the particular religion the scruple belongs to (such is my case). My exercises included reading the scripture that made me anxious, think the obsession 10x a day, verbalize the obsessive thought. I had to do this with God, Jesus, The Holy Spirit, Zeus, Thor, and some other deities as well. Believe it or not I just don’t like telling “divine beings” to f*@k off regardless of whether they are real or not. Just not my style.

I truly hope that if you suffer from OCD that you consider ERP as a treatment. It will require some courage and patience, but the results are somewhat amazing. For the scrupulous, some of this stuff will seem counter to one’s morality. Cursing at God may very well be out-of-bounds for many, but a good therapist should be able to help one get at the obsession without violating one’s morals. One must also change a little bit about what one thinks regarding God. I would urge you to trust that God (or whatever it may be) has the insight to know that you have a bonafide mental condition and, under the advice of a therapist, you are trying to reclaim a life worth living. On some level, OCD sufferers know that the anguish one undergoes is not healthy or normal. To go through treatment is to risk “being as evil as the rest of us” and knowing that God (or whatever) loves you no matter what. To atheists suffering from scrupulosity, I have found it helpful to conclude that if a God should exist, it would be far more rational than me.

Best of luck

TSA