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Starting Exposure Therapy: What’s it Like?

Exposure Therapy - Florida

Unlike Choose Your Own Adventure books, therapy is a forgiving process that gives you many potential paths to pursue on your road to recovery.

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 expect that treatment will be challenging, they also realize that life without treatment is often more challenging.

Starting therapy is a calculated risk. Sure, it’s possible that treatment will be hard. However, it’s probable that life without therapy will be hard.

If you remember the old Choose Your Own Adventure books from the 80’s/90’s, you have a good idea about how therapy isn’t.

If you or your kids were a fan of the series, you probably recall just how easy it was to fall into a ravine or get eaten by a pterodactyl. Death abounded at nearly every turn.  There was usually only one way to get the “right” ending, and I for one could usually only discover it by reading the book backwards and cross-referencing the pages in order to see how the story “should” unfold. With these books, one mistake could totally derail the ending.

Therapy isn’t like that.

Sure, there are some potential “traps” that are better off avoided.  However, most of these traps involve rituals, and once you get better at spotting your rituals, the process gets easier.

Treatment doesn’t lock you into a predetermined linear path.  Instead, it helps you become better at recognizing when you’re at a decision point. It then supports you in making choices that reflect your values rather than your symptoms.  Because this is a skill-based process, you learn to make better decisions over time.

You transform from pterodactyl prey to pterodactyl hunter.

Unlike Choose Your Own Adventure books, therapy is a forgiving process; it doesn’t require perfection. Treatment gives you many potential paths to pursue, all roads leading to the same basic ending: you taking your life back.

Pterodactyls beware. We’re coming for you.

Questions? Comments? What adventure will you choose today?

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  1. Great post that really puts ERP Therapy in perspective. I know some people believe this therapy for OCD is equivalent to torture, and I think your description and explanation should not only put their minds at ease, but hopefully encourage more OCD sufferers to seek treatment.

    • I often think about ERP as an exercise program for your brain. Why do people exercise? Typically to improve their quality of life in some way — be it related to health, aesthetics, or the way it makes them feel. People don’t take up exercising for no reason at all–it’s always purpose-driven. This is just like ERP. Why would you do it? Because it’s going to enhance your life in some way.

      The analogy can be taken a bit further, though.

      Exercise is not a singular activity. It’s something that’s often based around targeting a particular muscle group or certain aspect of health. People who want big biceps do different exercises than people who want to lose weight. This is similar to ERP. People who want to be less bothered by unwanted thoughts (e.g., thoughts of hitting someone with your car) do different exposures than someone who is afraid of contracting a deadly disease. The form of the “exercise” reflects a specific therapeutic goal.

      Moreover, there are multiple ways to target the same muscle group. People who want to work on their abs might consider crunches, leg lifts, push-ups, etc. In ERP, there is no one exposure that will help you get better. Instead, there is an array of options that might work for you.

      There’s also the hierarchical nature of exercise. If you want to get stronger, it’s smart to start with light weights and build up to heavier weights. It would be downright dangerous to attempt a 500lb bench press without proper training. In ERP, going for that “10” on your hierarchy is ill-advised at the beginning of treatment. Before going there, you need to lay the proper groundwork first. A gradual approach might take more time, but it will get you to the destination without subjecting you to unnecessary injuries.

      Finally, the world is full of different types of trainers. Not everyone is a drill sergeant. The best trainers will listen to you, work with you, and try to understand where you’re coming from. They’ll then use their expertise to design an individualized plan for you that is based on your goals, preferences, and perspective. The best therapists I know follow this same approach to treatment.

      My position is that if you’re completing an exposure under duress, you’re unlikely to benefit from it. It’s the process of choosing to face your fear (and willingly embracing the uncertainty that comes with it) that really makes the difference.

  2. Wow….what a perfect analogy. Everyone who is considering ERP Therapy should read your reply. Actually, I’d love to post it on my blog, if you don’t mind!

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