I distinctly remember studying mental health in my 8th grade Health class, and watching a video on a form of Cognitive Behavioral Therapy (CBT) known as Exposure and Response Prevention (ERP). I was transfixed by the intensity and bravery that the therapy required. I remember watching the therapist walk a client through an exposure regarding harm obsessions, specifically revolving around knives. The client held the knife even though she was terrified that she would use it to hurt herself or someone else. By leaning into this fear-inducing behavior, she proved to herself that she was not actually a danger. While I was not acutely dealing with OCD at that point, that video clip remained seared in my mind.
Fast forward 15 years, and after a painful and debilitating six-year battle with what I soon learned was OCD, I found that I too would be partaking in Cognitive Behavioral Therapy, and, more specifically, ERP. Flashes of those video clips reeled through my mind, and I was terrified. My obsessions were already scary enough; the last thing I wanted to do was face them head on via ERP. Even so, OCD was taking over my mind, and in doing so, taking over my life. I knew that something needed to change, and if ERP could help me make that change, I was in.
Fast forward nine months, and I’m now six months out from completing intensive ERP, and for the first time in years, I truly feel that I have my life back. That said, getting here was difficult, and it required some serious work. For those of you that are either considering or just beginning ERP, here are four things I wish I had known before I started:
1 – Things may get worse before they get better.
Let me repeat: things may get worse before they get better. Your therapist might even tell you this. Mine did, and I frankly didn’t want to listen. Instead, I disregarded it and ignored the warning. Sure enough, things did get worse before they were better (reminder – they did get better in the end!). The thing is, ERP aims to desensitize the participant to their intrusive thoughts by focusing on response prevention. In other words, ERP will trigger the obsessions (i.e. intrusive thoughts). The progress comes from allowing the intrusive thoughts to sit there and not respond with a compulsion. However as much I didn’t want to admit it, this process is hard. It’s triggering. All of that “work” that I was doing to suppress my thoughts came tumbling down after my first ERP session, and I found myself in a very difficult spot. While trying to resist my compulsions, my intrusive thoughts increased to the point that I could barely focus on what was right in front of me, and my anxiety increased exponentially. I threw up my hands and said, “this will never work for me!” and nearly gave up. Thankfully, my therapist talked to me about the importance of staying and seeing it through.
2 – Do the work. The work works.
By staying, I learned that I had to do the work. Before things got worse, I entered ERP with one foot in and one foot out. I didn’t want to commit. I didn’t want to admit how deeply rooted my obsessions and compulsions were. I didn’t want to admit how hard I had to work to usher in my own healing. However, when I hit my lowest point after beginning ERP, it became clear that I had to work to achieve the result I so desperately desired. I couldn’t simply go to my counseling sessions, do ERP in the office, and then go back to the usual mind games that my OCD fed me after therapy sessions ended.
I began to take my therapist’s advice, and started doing my ERP exercises every single day. I would listen to tapes of myself saying my intrusive thoughts over and over again – until I was sufficiently triggered – and then I would sit on my couch for hours listening to my coping script until my anxiety finally came down. At first it was absolutely excruciating, but over time, I began to experience a breakthrough. One night, after sitting with my coping script for an hour and a half, I realized that my anxiety had significantly dropped. I turned off my coping script, hopped off the couch, and made myself a nice dinner. That would have been unthinkable even a month before. It was in that moment that I realized that I needed to commit to doing the work, because the work works.
3 – ERP is hard.
Yes, ERP is hard. I wrote down my deepest, darkest, scariest fears on a white board. I recorded them in my own voice and listened to them over and over again – walking to work, in my home, sitting at my desk, etc. I basically bathed in my fears, and I paid someone to help me do it. It was very scary and unpleasant. I admit that.
However, the good news is that with patience and perseverance ERP delivers results. Starting the journey was challenging, but with each ERP session I began to feel my compulsions lift. Slowly, my obsessions followed suit, and I began to encounter a newfound mental freedom I hadn’t experienced in years.
4 – While ERP is hard, living with untreated OCD is much harder.
Before embarking on ERP, my intrusive thoughts nearly ruled my mind. They would pop into my head out of nowhere, and once they were there, I was a slave to them. After ERP, I am empowered to usher in my own healing. I now know what it takes to conquer my fears. I won’t say that every single intrusive thought is gone (though they have greatly decreased) but those thoughts don’t get to run the show. The truth is, I do. I get to make the decisions from now on, and that feels really, really good.
If you’re just beginning ERP or if you’re on the fence regarding whether you should start, my encouragement is YES. Do it. Yes, things may get worse before they get better, and ERP is hard, but living with untreated OCD is harder. Commit to doing the work, because the work works. You can do it!
Wishing you endless amounts of bravery, courage, and self-compassion. Your journey is just beginning!