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ERP therapy for OCD: Shifting from destructive to constructive to gestalt notions

ERP for OCD is a gestalt process

Is ERP for OCD fundamentally a destructive or constructive process? Neither. It's more gestalt than dichotomy.

Here’s a question for you:

Is exposure and response prevention (ERP) fundamentally a destructive or constructive process?

I think that many people naturally conceptualize it as more of the former than the latter. They conceive of ERP as being the process by which we can “unlearn” or “weaken” maladaptive associations. We learn, through repetition, to no longer be afraid of those things that previously incited fear. On the surface, this appears to be a notion predicated on destruction. In actuality, it is not. If you ever take the time to refer back to the basic animal literature on fear learning and fear “unlearning”, you’ll find that associations appear to be weakened largely as a consequence of new learning taking place. This new learning competes with (and weakens the expression of) previous learning. It is this process that accounts for spontaneous recovery, difficulties with generalization, and other such phenomena.

As anyone who has completed a successful course of ERP can attest, the fear doesn’t truly just disappear. Rather, it’s replaced by a growing sense of agency, purpose, and a confidence in one’s ability to cope. Sure, the fear is, in essence, weakened. However, more importantly, one has learned to better tolerate OCD doubt and uncertainty, to be better at living without knowing. This gestalt, which emerges from destruction conjoined with construction, is the true basis of change.

Questions? Comments? Sound off below.




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