Smash the OCD Cycle with ERP
Have you ever wondered how that OCD cycle begins and what you can do to stop it or break the cycle? I am going to show you how.
Hi, I’m Paige Pradko, a psychotherapist that specializes in treating people with OCD, health anxiety and OCD. Welcome to Therapy for a better life. Before I continue, if you are wondering if you have OCD, I left you a free OCD self assessment at paigepradko.com along with a PDF called, "The Top 10 Things to Know to Practice ERP for OCD".
Although anyone can experience thoughts or images that pop into their head, but having OCD causes you to have what we call “sticky” thoughts, and you tend to give significance or meaning to your thoughts in a way that makes them become obsessive. And because these thoughts make you uncomfortable, fearful, anxious and even disgusted, you begin to do certain behaviors to try to calm yourself. These behaviors can then become compulsions and reinforce your OCD cycle.
To really see what’s happening with OCD, let’s look at the OCD Cycle:
- First, at the top, there is stimuli, or a fear trigger. It can be internal, like a thought, an image, a sensation or feeling, or it can be external like objects or activities or environments. For example, touching a contaminated object, or leaving or entering buildings, or driving, or interacting with certain people. The stimuli or fear trigger can be anything.
- Then, at number 2, there is a mental misappraisal, an instantaneous, mental error that occurs. We call that a Threat Misappraisal. It is a misjudgment, and it happens almost automatically that something is bad, dangerous, harmful, or wrong. This is where that meaning, and significance is attached the trigger.
- Next, at number 3, Tension, anxiety and discomfort builds
- Next, there is an immediate desire to seek safety, to avoid this discomfort and do something to calm oneself.
- At number 5, this is where the Ritualized or Compulsive Behavior begins. The behaviors can be physical or mental. The physical behaviors like checking, handwashing and cleaning are easy to see. Some compulsions and rituals can be functional like washing your hands, but become exaggerated, while other rituals are not related to the obsession trigger at all, I will blink my eyes 5 times, and tap my foot 3 times when I have that thought.
But often, there are also mental compulsions, especially for those who identify themselves as having Pure O, obsessions only OCD. They may begin to analyze the thought, ruminate about it, question it, pray it away, count, neutralize it, mentally check to see if it is there, or wish it away. These can all be compulsions that feed the OCD cycle. Some also try avoidance behaviors, to avoid their fear triggers all together, while others may look to family members to help them feel safe by seeking reassurance and other forms of accommodations.
- And, in number 6, you can see that they get a short-term benefit from their compulsions by experiencing a little, short-lived reduction in their anxiety and distress. This is unfortunate, because the reduction in anxiety reinforces the need for the compulsion, and they do not give themselves the opportunity to learn that they could have calmed down without the compulsions, rituals, and avoidances.
- Next at number 7, if you have OCD, you may understand this experience, negative thoughts of guilt, shame, depression, anger or frustration often follow.
- And finally, in number 8, this distress leads to more anxiety, and this further reduces the tolerance to the original fearful thought or trigger. This reduced tolerance also reinforces the cycle.
The OCD Cycle has a lot going on. It involves mental activity, often physical activity and certainly emotional activity. And it is a self-perpetuating cycle,
unless the cycle is broken.
This is where ERP comes in. ERP, Exposure and Response Prevention is the gold standard, evidenced-based treatment for OCD. It can be used on its own or combined with other therapies like ACT or Mindfulness or Medication.
Let’s look again at the OCD Cycle when applying ERP:
- Number 1, You are exposed to your OCD trigger.
- Number 2, Threat Appraisal – this is where you used to attach meaning and judgment to your thought or trigger. Now, instead of thinking—that’s bad wrong, terrible, dangerous, or disgusting, Instead, you recognize the trigger, whether it be the thought or feeling or sensation and identify it as OCD. This identification of ocd, already begins to defuse you or separate you from ocd.
It is not helpful to give yourself reassurance here, because that can become compulsive. Try your best to identify it as OCD. During ERP, even if you were to do nothing here, your brain will still learn at a deeper experiential level that you are safe.
- At number 3, Tension and Anxiety builds. Even though you have identified it as ocd, your brain is still is trying to figure out if this trigger or thought was dangerous and you will still feel that tension and anxiety until your brain has learned. But we want this anxiety. It means that you are facing your fear and your brain is having this opportunity to learn that you are safe. We notice the anxiety but do nothing to calm it. Part of ERP is learning to tolerate different levels of anxiety and learning that you can. It does get easier over time. You can say out loud, “I am having an OCD thought that is making me feel anxious.” Or you, can say nothing at all.
- In number 4, that urge and Desire to seek Safety is still there when you begin YOU’RE Your brain will still be trying to convince you that you need to seek safety and avoid or compulse or anything to feel better. The RP of ERP, Response prevention means that you are prepared for this. You have decided that you are willing to tolerate this anxiety and discomfort. You are staying in the exposure and not seeking safety.
- In number 5, instead of performing your mental and physical compulsions or avoiding the situation, you are practicing Response Prevention. Here, you are tolerating the discomfort, the anxiety, or the disgust. You are voluntarily staying in it without any mental analyzing or figuring things out and resisting your urges to compulse. You will do your best to always practice response prevention because the learning stops if you go back to your rituals and compulsions. You eventually want to always practice Response Prevention, before, during and after exposures. But sometimes we do have to follow certain rules to get us there. That’s another lesson.
- Now, in number 6, after not performing your compulsions, your brain is making new safety neuropathways associated with your obsession or trigger. Your brain has just learned, hey, what you thought would happen, didn’t happen.
- In number 7, you now experience positive emotions. You did it. You feel tremendously proud.
- And finally in number 8, you have now Increased your tolerance to the obsessive thought or fear triggers and this weakens your OCD and weakens the cycle.
Eventually, after repeating the process of ERP, and doing a variety of exposures and extending the time and practice of Response Prevention, you will have created new neuropathways incorporating safety learning, increased your tolerance for discomfort and anxiety and broken your OCD Cycle.
If you are wondering if you have OCD, I left you a free self assessment at paigepradko.com along with The Top 10 Things to Know to Practice ERP for OCD.
Until next time, I will see you in session.
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