Once you’ve identified your specific triggers, obsessive thoughts, and compulsive behaviors, an ERP therapist will guide you with several techniques. These may include:
This aspect of ERP therapy includes learning about OCD and its symptoms, traditional treatments, research, and other related information.
You’ll also hear more about how the cycle of OCD works, and how ERP can effectively interrupt it.
This technique involves purposely being exposed to triggers in a gradual way.
“For example, if a client has an obsessive fear of getting a severe mosquito-borne illness, we will look at pictures and videos of mosquitos, read about Dengue fever, and practice going outside in the summer with shorts on,” says Grace Dickman, a licensed clinical social worker in Chicago, Illinois.
An important aspect of the obsession-compulsion cycle is the low tolerance to uncertainty.
When you have a distressing thought, you believe this thought may become a reality. You engage in a compulsion to neutralize it and prevent it from becoming real.
You need to engage in the ritual almost immediately because you have a difficult time dealing with the possibility it may become true. This uncertainty is what leads you to act on the thought.
In ERP, you’ll face your fear and then wait, instead of acting on it. Eventually, you may develop the ability to tolerate the uncertainty around your fears or the “maybes” it brings up.
For example, you may have an obsessive thought about your sibling getting hurt. You then move your hands in a specific way as a ritual to decrease the distress.
In ERP, you’d face this same thought but you wouldn’t move your hands right away. With time, you can see that your sibling remains safe even though you don’t engage in the compulsion.
In the future, whenever you have the same thought, you might not have to interrupt what you’re doing to follow a ritual. You’ll be able to tolerate the thought knowing your sibling will be safe.
Tolerating uncertainty is about learning how to say, “Maybe this will happen, maybe it won’t.”
If you find it difficult to face a particular trigger, your therapist may instead use a recorded script. This script will guide you through an imaginary scenario where you’d be exposed to, and face, that fear.
This is the key intervention in ERP therapy.
This technique refers to the intentional practice of refraining from engaging in compulsions or avoidance behaviors when exposed to a trigger.
Delaying the ritual
You’ll start by delaying your responses to triggers. Your therapist will ask you to increase the time between your obsessive thought and the behavior you usually do.
“For example, if a client has to say a prayer after every time they have a thought about harming a child, I would ask the client to wait 30 minutes before saying the prayer,” says Dickman. “This can be a good way to build up to refraining from the compulsion altogether.”
Doing the ritual differently
Besides delaying your responses, a therapist may also ask you to tweak your rituals.
For example, if your compulsion is to disinfect your kitchen, they may have you move things around instead.
That way, you’re acting on a thought, but since it’s not quite the ritual you’re inclined to do, you may find out that your obsessions don’t become true when you don’t do that particular ritual.