ERP: A treatment that seems to go against our instinct, but breaks the vicious cycle of OCD
If you live with OCD, you know the feeling all too well: a thought or image gets ‘stuck’ in your mind and just won’t go away. To reduce the anxiety, you turn to compulsions that bring momentary relief but only for a short while. Soon enough, the doubt returns and the vicious cycle begins again.
When you first hear what the treatment involves, it may seem irrational or hard to understand. As if someone is asking you to go against your instincts. How could they suggest you do exactly what you’ve been avoiding all this time? To come into direct contact with your fears. Does it sound paradoxical? Yes. But does it help in treating OCD? Also yes.
The vicious cycle usually works like this: an unpleasant thought or image suddenly intrudes into your mind. For example, you might think, ‘What if I said something wrong and unintentionally offended someone?’ The doubt triggers anxiety. To relieve it, you mentally replay the scene over and over in your mind or seek reassurance from those around you. The compulsion brings temporary relief, but soon the same thought returns, often even more strongly: ‘What if I really didn’t say it right? What if I actually upset them?’ And so the next round begins. The more you try to find certainty, the more the vicious cycle is fueled.
The therapeutic approach and more specifically Exposure and Response Prevention (ERP) suggests something different: staying with uncertainty without resorting to compulsions, no matter how irrational that may feel at first. Change comes gradually, through small steps. Little by little, you expose yourself to the thoughts or situations that trigger your anxiety. For example, if you fear you might have offended someone, one step would be to resist replaying the conversation in your mind. At the same time, you practice resisting the urge to seek reassurance or repeatedly apologize in order to feel temporary relief.
At first, this feels very difficult. It’s normal to experience discomfort or to believe you won’t be able to handle it. Over time, however, as you grow more familiar with the idea that you can tolerate anxiety without doing something to avoid it, things gradually become easier—like puzzle pieces slowly falling into place. The truth is, some of our worries may indeed come true and others may not; that doesn’t change, because that’s simply life. So we learn to live with uncertainty and, paradoxically, the more we accept it, the stronger we become and the more secure we feel within ourselves.
Treatment for OCD comes with its challenges and requires courage, persistence, strength, patience and self-compassion for the times when we struggle and give in to fear. It is natural for such moments to arise along the journey. So even if you feel like you’re going against your instincts or you’re afraid, place your trust in the process and move forward with slow and steady steps.