ERP (Welcome to Hell)

You’ve probably heard people telling you to face your fears before, and it’s certainly what we think of as the traditional treatment of phobias – chucking an arachnophobic into a pit of spiders or winding a boa constrictor around the neck of someone whose worst nightmare is… well, exactly that.

However with OCD the fear is not just of an object – it is of the thoughts, images, doubts and impulses that accompany daily life. Therefore we must expose ourselves to the anxiety and allow for it to fall naturally without avoiding or abating it. Sounds easy, doesn’t it?

The particular flavour of CBT used for the treatment of OCD is something called Exposure Response Prevention or ERP. This treatment is not only the most effective way of getting over this horrible illness, it is also hellishly difficult. We must allow the thoughts to pass through our head without reacting; we must sit out the spike of anxiety without allowing ourselves to react by performing a mental or physical ritual, without neutralising the thoughts.

The exposure refers to facing our fears – labelling the thoughts as OCD and irrational, and the response prevention describes the act of stopping yourself from engaging with them. The aim of this treatment is habituation, a nice scientific word that basically means getting used to it.

Let’s look at an example that you’ll all have experienced at some time in your life – jumping in to a cold swimming pool. The water feels freezing and you want to stand and shiver, but by moving around and thinking about something else the water starts to feel normal.

Okay, so that was a pretty prosaic example. For someone with OCD this can be a little bit more difficult. If we take someone who has intrusive thoughts that mean that he believes himself to be a paedophile (a pretty common and yet never talked about obsession) has to allow himself to be around children despite them and without stopping them.

Just one last thing, and then I’ll shut up. There’s an experiment that psychiatrists often use to describe why you must not fight the thoughts...

Try to think of a pink elephant for a whole minute? Did you manage? If you did, well done, I’m sure that you’ve got better concentration than me.

Try not to think of this pink elephant for another minute. Didn’t manage it, did you? The more you fight these thoughts, the stronger they get.

Good job that I’m ready for a fight then.

Obsessively, compulsively yours,

Bellsie