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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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Common Misconceptions About Anxiety & OCD Treatment

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People new to OCD treatment often walk through the door with more than a few misconceptions. Here are some common ones: Misconception 1: Anxiety is bad. Actually, anxiety is a normal, functional, biologically-based phenomenon that every person is capable of experiencing. The only people who are truly anxiety-free are dead people. The rest of us (the living ones, at least) will find that anxiety will be a part of our lives, at least to some extent. Some anxiety is good and can be helpful. For example, it’s probably good to have some anxiety when you’re studying for a test. This anxiety can help motivate you to prepare sufficiently. Similarly, it’s probably good to have some anxiety about doing dangerous things, such as driving too fast — this anxiety might just save your life. Of course, not all anxiety is...

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OCD Treatment Group Using ERP

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OCD Treatment Group! I am pleased to announce the availability of our new exposure and response prevention (ERP)-based treatment group.  The intent of this group is to provide a supportive environment for completing ERPs. Participants wishing to attend are required to register using the links at the bottom of this post. This group will first meet on Saturday (8/10/13), 1pm-3pm.  The fees for attending this group are $75/session or $50/session if you pay in advance and commit to a 4-week group treatment sequence.  Insurance will not be accepted; however, if you have out-of-network benefits, you may be eligible to submit your bill for reimbursement by your insurance company.  Subsequent 2-hour sessions will be held on 8/17, 8/24, and 8/31 @ 1pm. You are free to participate in any or all of these sessions; however, individuals are most likely to...

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Worry & “What If” Questions

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Anxiety, Worry, & What If Questions If you have anxiety, it’s likely that you wrestle with worry and “what if” questions. Many what if questions are easily recognizable and start with the obvious, “What if…?” Others are more subtle and begin with phrases like “How am I ever going to…?” By definition, what if questions prompt us to solve problems that haven’t actually happened yet. The possibilities are truly endless. These worries may involve fears about current situations or about situations set far in the future. What if questions are often difficult to resist because by answering them, we often feel that we become more mentally “prepared” or “ready” to deal with life’s uncertainties. In fact, many individuals feel stressed out if they ignore their worries. They think that because what ifs involve potentially dangerous situations, it’s irresponsible or...

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Scrupulosity & OCD: Religious/Moral Symptoms

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Question: I have scrupulosity (religious/moral obsessive-compulsive disorder), and I am triggered by religious posts on Facebook. When I see a religious post, I feel like I have to repost it or God will be mad at me. I also worry about what other people think about these reposts, which then leads me to fear that God will judge me for worrying. Any suggestions for treating scrupulosity (religious OCD)? Religious Scrupulosity/OCD For many people with OCD/scrupulosity, treatment can be especially confusing at first. Every action or inaction can feel potentially dangerous, which is why scrupulosity often goes untreated for so long. The very fact that you recognize that this is related to obsessive-compulsive disorder is excellent. It also sounds like you have insight about your OCD symptoms and the OCD positive feedback loop. Many people with religious obsessions don’t realize...

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Exposure and Response Prevention: An Analogy

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Exposure and Response Prevention (ERP) Exposure and response prevention (ERP) is just like a fitness program for your brain. However, instead of shaking up your fitness level, it’s designed to shake up stubborn OCD symptoms. Let’s expand on this analogy. Reasons for Doing Exposure and Response Prevention (ERP) People don’t adopt fitness routines for no reason at all; physical exercise is not a random activity. We don’t accidentally buy gym memberships or wake up on treadmills. Exercise is always purpose-driven and typically is intended to improve one’s quality of life in some quantifiable way. Common goals for exercising are related to health, aesthetics, or the feelings it evokes. Treatments like exposure and response prevention (ERP) are also intended to enhance your life in a meaningful way. Just like with exercise, your ERP efforts will be driven by your own...

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