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ERP Tip of the Day #1


Don’t mistake rituals for exposure and response prevention (ERP). Embrace your exposures with fear, and embrace opportunities for openness, defenselessness, and vulnerability.

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 their OCD in a normal, everyday situation. In the past, they might have avoided this trigger by closing their eyes or walking away. However, now that they’re trying to practice non-avoidance and deal effectively with their OCD, they may force themselves to look directly at their trigger. So far so good, right? No rituals in sight yet, but… BAM!

They find themselves staring intently at the trigger as a way to internally check their physical or emotional response to it.

I see this happen commonly with sexual obsessions (particularly people with pedophile OCD [POCD] and sexual orientation OCD [sometimes called HOCD]) and violent obsessions, but it can occur for virtually any type of OCD.

For example, someone with pedophile OCD may be looking at the trigger while intently monitoring their groinal response to the child they see. If they don’t notice arousal sensations, they pat themselves on the back. They think they’re doing exposure by looking, but they are actually performing a reassurance-based checking ritual. These rituals make you feel good in the moment, but they further link the perception of a trigger with the mental ritual of checking (and consequent reassurance), which ultimately perpetuates the OCD cycle.

The better alternative is to look at the trigger, feel whatever you feel, try to resist internal checks…but if you do check, SPOIL THE RITUAL!

Remind yourself purposefully that it’s possible you might still be attracted to children.

Why would I suggest such a thing? Because OCD is smart. The good feeling that comes from reassurance is transient. If you reassure yourself, your OCD will lead you to interpret your ERP as a fluke event. It will imply that somehow you managed to dodge the OCD bullet by some act of fortune. It will say, “For some reason, you weren’t attracted to that particular kid. But there IS a child out there who will arouse you.”

That’s why relying on reassurance is short-sighted. It never lasts.

In contrast, with good ERP that is devoid of rituals, there can and will be an unraveling of fear over time with practice and persistence. If you accept uncertainty, OCD’s stranglehold over you will begin to loosen. This good feeling can be long-lived.

Yes, good ERP is hard. It involves opening yourself up to anxiety and allowing yourself to feel vulnerable. It means letting down your defenses.

Don’t mistake rituals for exposure and response prevention (ERP). Embrace your exposures with fear, and embrace opportunities for openness, defenselessness, and vulnerability.

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  1. Very good article!

  2. Great article! It shows while the premise of ERP therapy is simple, its proper execution can be quite complicated. I look forward to reading more of your tips!

  3. The last part about purposefully remind yourself that there is still a chance, seems very contradictory. I understand what you mean by not letting yourself rely on reassurance, but I see no good about reminding yourself of something like this. Can you explain?

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