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ERP Tip of the Day #2

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It’s ERP tip time. This series of posts focuses on tips to enhance the effectiveness of your exposure and response prevention (ERP). If you’re interested in more ERP tips, click the following link for all the posts in this series. Exposure and Response Prevention (ERP) Tips for OCD Without further ado, here’s another ERP tip to consider when designing your next exposure. ERP Tip #2 When completing your next exposure, avoid rules that dictate what you’re allowed to think during the exposure. If you try to complete an exposure without having a certain bad thought, chances are that you’re setting yourself up to think that very thought. Instead, design your exposure around having that very same unwanted thought. I love it when people with OCD do exposure, but I don’t love it when they have a long list of...

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ERP Tip of the Day #1

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Starting today, I am going to start posting random ERP tips as they occur to me, as there are certain roadblocks that many of my OCD patients tend to encounter. If it’s helpful for my patients, maybe it’s helpful for you. If you’re interested in more ERP tips, click the following link for all the posts in this series. Exposure and Response Prevention (ERP) Tips for OCD These posts will probably be a bit shorter unless the concept requires a more thorough discussion. Please feel free to leave comments below, if you need more information. Today’s tip is… ERP Tip #1 Do not label your rituals as ERP. Instead embrace openness, defenselessness, and vulnerability. You might think that you never do this, but it happens more often than you think. Some people that I know will encounter triggers for...

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Imaginal Exposure vs. In Vivo Exposure for OCD

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As I’ve talked about in numerous posts, overcoming OCD involves learning to co-exist with doubt and uncertainty. This idea can be a bit counter-intuitive at first, as many people initially expect OCD treatment to reduce uncertainty. One therapeutic approach that helps with this process is exposure and response prevention (ERP) for OCD. Not surprisingly, ERP consists of two parts: 1) exposure, and 2) response prevention. An exposure is when you do something on purpose to provoke an anxiety spike. By definition, exposures are not accidental; rather, they are pre-planned, deliberate offensive strikes against your OCD. Exposures are designed to help you build up your tolerance to fear-producing situations. Exposures are often completed according to an exposure hierarchy, meaning that people typically complete lower level exposures (i.e., less distressing exposures) before gradually working up to higher level ones. Response prevention...

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OCD & Checking: Part 2 (Mental Checking)

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Behavioral Checking (Overt Checking) Many examples of compulsive checking rituals in OCD involve direct inspection of a target stimulus by sight, sound, or feel. Common OCD checking behaviors include relocking doors, visually examining the position of one’s parking brake, or holding one’s hands above stove burners in order to detect warmth. Behavioral checking is often accompanied by the thought, “Did I do it the right way?” These checking behaviors are often referred to as behavioral checks, manual checks, or overt checks. Overt rituals (by definition) are visible behaviors that can be perceived by external observers. However, in some cases, overt rituals may be subtle or purposefully hidden in order to avoid embarrassment. Mental Checking (Covert Checking) In contrast, other compulsive checking rituals can only be perceived by the individual engaging in the behavior. These types of OCD rituals are...

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Checking & OCD: Part 1 (Checking for Safety)

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Compulsive checking often begins innocently enough. One check here, two checks there… But OCD’s greed knows no bounds. What starts out as a simple check “just to make sure” eventually spirals into disabling OCD doubt that can come to predominate innumerable situations and scenarios. Checking behaviors often emerge in situations in which “being irresponsible” might result in catastrophic outcomes, guilt, anxiety, or regret. OCD-related checking is usually driven by a need to obtain absolute certainty that nothing bad will happen. Compulsive checking is typically harder to control in “high stakes” scenarios and in situations in which you perceive that you have personal responsibility for the outcome. Unfortunately, at least some degree of personal responsibility is present in most situations. Moreover, many people with OCD often feel that safety is tenuous or that disasters are lurking just one mistake away....

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Hit-and-Run OCD

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“Hit and run” OCD involves the fear of accidentally hitting a pedestrian while driving.  In most cases of hit-and-run obsessive-compulsive disorder, fears focus on unintentionally killing, injuring, or maiming a victim.  Other individuals worry about causing car accidents or causing other vehicles to swerve and hit pedestrians. Fear of Driving Hit-and-run OCD, or motor vehicle accident OCD, is distinct from other syndromes that involve anxiety about driving or the fear of car accidents. Hit and run OCD differs from panic– or agoraphobia-related driving avoidance, in which individuals fear driving due to the possibility of having a panic attack while in the car. Diagnosis of hit and run OCD is slightly more complicated in cases in which one fears “losing control” while driving, as this symptom can reflect either panic or OCD. In the case of panic, this fear is...

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