Avoid Turning ERP Into a Compulsion
For this week’s blog post, I wanted to write about a good recovery lesson that I learned towards the tail-end of my recovery process. If you’ve been reading my blog regularly, you’ll know how much I harp on Exposure Response Prevention (ERP) as being absolutely necessary for facilitating your OCD recovery - it is often regarded as the Gold Standard for OCD treatment for a good reason! When implemented properly and executed consistently, ERP absolutely will work.
When you’re first starting out with practicing ERP, common exercises will include things such as exposing yourself to your triggers and purposefully preventing the response. So for example, if you have an obsessive fear of contamination and compulsively wash your hands to negate that fear, you might do something such as touching a contaminated surface and then steadfastly refusing to wash your hands. That’s a very common and simple example of an ERP exercise, and it works extremely well by breaking the OCD cycle which I explain here.
As you get farther along in recovery and get comfortable tackling bigger and more stressful exposures, it’s easy to get wrapped up in the desire to seek out new exposure opportunities in order to practice ERP and improve your mental health and fitness. And that’s great - but it can also be a double-edged sword. This was something in particular that I began to realize as I felt more and more confident in my recovery - I had such a burning desire to be free from OCD that I would purposefully seek out or create OCD exposures to practice response prevention. So as an example, I would purposefully think terrible thoughts in my mind as a way to “prove” that I wasn’t affected by them.
I want to make a caveat that, for those who are beginning ERP, it is good for you to purposefully create exposures to practice with. You absolutely need to practice those skills and learn how to refuse compulsions, especially when you are just starting out. However, once you are more advanced at ERP and further along in your recovery journey, you have to be wary about this habit becoming compulsive behavior in and of itself. OCD is a very sneaky disorder! When it realizes that you’re not falling for the old tricks and compulsions, it will find ways to worm itself into other facets of your life to try and trick you into performing those compulsions again. That is something that we, as OCD sufferers, have to be mindful of and ensure we are treading that fine line between ERP recovery and OCD compulsion.
It can definitely be frustrating at times, because you are left wondering: is this exposure opportunity actually helping me, or is it instead a compulsion that I am subconsciously doing? Generally, my advice would be to take a step back and ask yourself two things:
Does performing this action align with my values? Would I normally want to give my time and energy into doing this?
If I DIDN’T do this action, would it cause me anxiety? If so, that’s a pretty good indication that your ERP practice has actually become a compulsion!
As a personal example - I had an obsessive fear of thinking bad thoughts which would cause harm to those that I loved and cared about. So every day, for ten minutes, I would spend time purposefully thinking those bad thoughts and refusing to react or be bothered by them. This was a beneficial habit and practice when I first started out with ERP - but after awhile, I began to realize that this act in and of itself was becoming a compulsion. If I missed a session, it would cause me fear that I was “losing progress” or that I was “too afraid to think of those thoughts.” I also realized that after awhile of doing this (maybe 1-2 months) that it really wasn’t adding much value to my life. I already knew how to accept my thoughts and not be bothered by them - so doing this exercise wasn’t teaching me anything new, it was mainly just going through the motions and becoming a compulsive habit.
I want to re-iterate that this advice only applies to you if you are further along in your recovery process or are already quite familiar with ERP already. For those who are brand new to OCD recovery or just learning how to do ERP, I think there is great benefit in purposefully creating exposures for you to practice on. And I don’t want anyone to read this post and think it means it’s OK to NOT practice ERP - that is not my intent!
However, as my personal anecdote shows, once you really grasp ERP and are more confident in your ability to refuse compulsions, you have to be wary about turning ERP into a compulsion. It’s a gray area and difficult to understand when you may have crossed the line from ERP into compulsion, but generally I think you will be able to guide yourself in the right direction based on the two bullet points I mentioned above. When in doubt, focus your actions on your values (what do I want to spend my time and energy doing right now?) rather than chasing a certain feeling.
Again, I want to explain that for those of you who are nearing recovery, this post is something to be mindful of and think about. For those of you who are just starting out and learning about ERP, it’s not really applicable as you should be seeking out and creating exposures to practice ERP techniques with. Don’t take this post as a recommendation to avoid exposure opportunities because that is absolutely not my intention!
As always, if you are reading this, I hope you have a wonderful weekend and I’m always happy to answer any questions you might have.
Eric