Exposure and Response Prevention is tough. It involves facing your fear head on. In my case, I had to think the very thoughts I wanted to avoid. It may feel like it isn’t going through the pain, but it is one of the few ways to treat OCD.
Before I talk about my ERP experience, it is extremely important to find a therapist who is very experienced in OCD and its treatment options. ERP is effective when it is implemented properly. Your therapist should act like a coach and show you how to do it properly, even when they are not present. One thing your therapist should not do is reassure you during their sessions. This will only temporarily provide relief and will cause more harm than good.
My first session was mostly about me explaining my symptoms, when they started, and what my compulsions were in relation to the thoughts. During my initial visit, I did not understand what my compulsions were. I even had some doubts about it being OCD because of the lack of compulsions I thought I had. At the end of the first visit, my therapist explained that my compulsion was rumination or analyzing the thoughts. I did no ERP, as this was more of an information gathering session so that my therapist could make a plan.
The rest of the sessions involved brief bouts of ERP, where I focused on practicing the prevention of my compulsions. Thinking these thoughts and triggering myself on purpose almost had me quit multiple times. I knew this was the gold standard in OCD treatment, but I felt like it wasn’t worth it.
My ERP involved me holding knives around loved ones while thinking triggering Harm OCD thoughts. This was terrifying because of how my thoughts made me feel. Another trigger I had to expose myself to was watching movies with actors that had their shirts off or in their underwear. This was all by the direction of my therapist. What I was missing with my first therapist, however, was the Response Prevention aspect of ERP. My first therapist was pretty old school and focused on habituation of the thoughts instead of focusing on not performing compulsions.
Treatment ended with me being better, but not quite 100%. There was still more work to do, and I knew I was going to have to find someone else to help me. Fortunately, I got a phone call from a therapist that had a 6 month wait I signed up for and totally forgot about.
This new therapist was a giant improvement. She told me that no one can habituate Harm OCD, and she was going to focus on me preventing the negative response that keeps OCD alive. I began practicing shutting off rumination. This was hard because the rumination cycle was so automatic. Every time an intrusive thought popped in, I would analyze it and tell myself I would never do that or, no, you’re not gay, you have a beautiful wife and child. The analogy that made the most sense that my therapist told me was to think of a rumination cycle as a text message on your phone, but you don’t read. You know it is there, but you don’t engage with it.
Eventually, my practice paid off. As the cycles began, I could shut them down. As time went on, I got better and better at it. I would literally smile and pat myself on my back when I successfully cut off a session of over thinking. I can now say I am almost completely symptom free! If I can do it, you can do it too! Don’t be afraid to put in the work, it is beyond worth it.