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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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Starting Exposure Therapy: What’s it Like?

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For anyone new to exposure-based therapy, such as exposure and response prevention (ERP), there is often much anticipatory anxiety about starting treatment. “What is it? What will it be like? How bad will it be? Can I handle it? Will I be forced to do things I’m unwilling to do?” These uncertainties are typical for most people beginning the process. They’re also understandable. When you begin treatment, it often feels like you’re putting your fate in someone else’s hands. Because that someone is typically a stranger (i.e., your therapist), it would be a bit odd if you didn’t feel that way. Moreover, if you know the basics of exposure therapy, you understand that eventually you’ll be confronting the very things you fear. Some people accept this prospect with dread but others feel a sort of nervous anticipation. Although they...

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Fear of Saliva Swallowing & Choking: Treatment & Symptoms (OCD)

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Question: I have sensorimotor OCD, and I’m suffering from conscious swallowing. My main fear is that I’ll choke or swallow my own saliva whenever I’m speaking or singing. Any tips for how to tackle this fear via exposure and response prevention (ERP)? Great question. Consistent with general exposure and response prevention (ERP) principles, your exposures need to address your specific feared outcomes. Feared outcomes can vary greatly for individuals with the same presenting problem. I discuss this idea in a different context here: feared outcomes in OCD. For people with a fear of swallowing or drinking saliva, there are several possibilities. Fear of Potential Embarrassment: Social Anxiety If you are afraid of potential embarrassment due to coughing or choking while speaking, your symptoms might actually reflect underlying social anxiety (rather than somatosensory OCD). However, it’s also possible for social...

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OCD: Screaming, Blurting Out Obscenities/Cursing/Profanity, & Other Unwanted Impulses

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Question: I’m a teenager and keep having OCD symptoms related to impulse control. I often worry that I’ll lose control and scream or blurt out obscenities. I am especially triggered in quiet public places like classrooms, churches, and movie theaters. I have never actually acted on my impulses and cursed in public, but I still feel very anxious whenever these thoughts occur. Do you have any tips for me? These types of symptoms are very similar to other OCD symptoms in which people worry about losing control and acting on unwanted impulses. Most typically, these types of thoughts attach to situations that are considered morally or socially taboo. Related OCD symptoms include fears about losing control and: Harming a loved one (most often fear of harming a child, spouse, or parent). Killing a loved one (i.e., stabbing, shooting, suffocating,...

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Does Non-Avoidance = Exposure? No! Anxiety Disorder Treatment Principles for OCD, Panic, Social Anxiety, & Phobias.

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Anxiety Principle of the Day: Non-Avoidance is not equivalent to exposure. Although exposure is predicated upon the purposeful non-avoidance of anxiety-related stimuli, non-avoidance of anxiety triggers is not equivalent to exposure. What is non-avoidance? I liken non-avoidance to being in a particular place at a particular time. Essentially, it involves being in a situation in which your anxiety is triggered by proximity to anxiety-related cues. Non-avoidance requires no action on your part aside from being physically present in the situation. As such, like a hole, it’s possible for a person to accidentally stumble into a non-avoidance exercise. Isn’t that the same thing as exposure? No. Exposure is not merely a situation, and as such, it can’t be entered into by accident. Although exposure therapy has situational elements, it is a dynamic experience that has best practices, as well as...

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OCD Triggers in Daily Life? Don’t Ritualize. Be Strategic! 3 Tips for Fighting OCD.

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Question: I know about ERP, and I understand that OCD symptoms can be reduced by resisting rituals and then habituating to the anxiety brought on by obsessive thoughts. However…what if an obsessional thought requires no ritual? Confused! Great question. I think that in all cases of obsessive-compulsive disorder (OCD), there is some type of ongoing ritual that maintains the obsessional thought. This is because OCD is caused by threat misappraisals that are perpetuated and negatively reinforced by compulsive behaviors. As long as your compulsive behaviors remain in place, you are prevented from having the type of corrective learning experiences that are necessary for you to recover from your OCD. The reason that ERP is so effective is because it allows you to build these types of corrective learning experiences into your daily life. Sometimes a person has very obvious...

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