Should You White Knuckle Your Way Through ERP?

Do you “white knuckle” it when confronting OCD? How stressful should it be when you’re defying OCD?

Last winter coming home from Rochester, I hit some very scary weather. I was in a state of great fear and tension. I didn’t want to be in this risky situation. It was bumper to bumper traffic on the thruway with tractor trailer trucks barreling through on either side. My hands were clutched so tightly on the steering wheel my knuckles were white.IMG_1153

At the OCD Conference last week, I was hit with the 2nd worst migraine of my life.  It’d been so long since I had one, it didn’t 160_F_103214808_6fDrzTjfFWbLIVFFbOHCbCoZqTKcCrW9occur to me that it was a migraine. I thought it must be a brain aneurysm or a stroke. I was in the middle of a case presentation when my head started to pound.

I couldn’t hear what anyone was saying. I kept nodding my head as if I was part of the conversation. Surely they must see something’s wrong. How embarrassing. I kept willing the headache away. It got worse. The lights seemed so intense. I became nauseous. It was like trying to give birth through the top of my head. 

Finally, in the middle of my presentation I admitted I wasn’t feeling well and excused myself. I said some kind of joke and everybody laughed. I needed to get to my room. Maybe I had some medicine there. I had to take one elevator to get to the other elevator. I had quite a distance to go. I “white knuckled” it all the way to the 26th floor.

I was alone in Chicago and terrified thinking somebody was going to find me dead in the elevator. I worried it would be someone with OCD who, as an exposure exercise, had just told their therapist, “I hope with all my might you die.” I wanted to write a note: “This isn’t your fault. There’s no such thing as Thought Action Fusion. This is a coincidence.” 

I practically crawled into my room and called home. I was reminded what I had done that caused the migraine. I had walked from the hotel to the beach through Toxic Lane. I even wrote about it in my blog the day before. I was paying the price as I’m sensitive to certain odors. The last time this happened was when I lifted the hood of my car and was exposed to radiator fluid.

After an hour and a half, with my head still throbbing, I went back and finished my presentation. I said, “If this is just a migraine, I 160_F_13025714_W1xclkZQdL1neclkC3uj7vn0ZRMtCvxYcan do this.” Again, I “white knuckled” through it. It went well and nobody seemed to see the 12# baby coming out of my head.

I’m sure all of you have experienced a time when you “white knuckled” it.  Hopefully, you’ll share your example in the comment section.

But whether or not you should white knuckle your way through ERP was the conundrum at the OCD Conference this year. I’ve attended this conference many times and there’s always been two or three different philosophies floating around from one workshop to the next. 

This year seemed different. At the end of each workshop there’s usually enough time left for speakers to take questions.  As I listened to their questions I could hear more than confusion in the audience. I could hear panic. 

I heard one father say, “I just want to do the right thing for my kid. I’m confused. In one workshop I hear it’s never good to white knuckle your way through exposure work. If you’re anxiety is higher than a 5 you’re doing the exposure wrong. In another workshop I hear it’s all about peaking anxiety and pushing through, no matter how hard. Please, I just want to do the right thing for my son.” 

Therapists who gathered for lunch were talking about it. “Well, I don’t follow a hierarchy. I just let them face what they are comfortable with at the time.” “Yeah, I don’t push anybody past 10 minutes if the exposure is really hard.” “I don’t do any ERP, it’s too much like torture.” “Oh, I fire my patient if after the 8th session they’re not climbing their hierarchy of fears.”

In one session, a young man with OCD was asked by a speaker to explain “white knuckling.” He explained: “It’s like being pressured by friends to go on a terrifying rollercoaster ride. I buckle in against my will. I tell myself soon it will be over. Just do it. In one minute this hell will end. I grab the hand rail as tight as I can and wait for it all to be over. When the ride ends I don’t feel any braver. I’m just glad it’s over. I hope they don’t make me do it again.”

Then he was asked to explain what the rollercoaster ride would be like if he wasn’t “white knuckling” it.  The young man answered, “I would not accept the rollercoaster challenge from my friends until I was ready. I’d do it for the experience of it. I’d be curious about my response and everybody else’s. If I was nervous I’d notice it and find where I felt it in my body…feeling the edges of my anxiety. Noticing where it starts. Where it ends. I’d ask what else I was feeling besides anxiety.”

So now I ask which approach is the correct approach to ERP? Don’t do it until you’re ready? Do an exposure exercise only if your anxiety is 5 or below? Experience the anxiety with curiosity, not judgment? Do it just to get the exposure over with? Do you sit with it until the anxiety recedes or do you go about life and desired activities even though your anxiety is still high?

Before I give my two cents, I’d love to hear your ideas. Please leave an anonymous comment!

2 thoughts on “Should You White Knuckle Your Way Through ERP?”

  1. I’ve done it both ways and found more lasting acceptance by pacing it. Meaning when I do a little and let it sink in, it “unlocks” even more OCD trap doors. Kind of like an investment which continues to pay dividends. I need to reflect on it and reaffirm it before going back for more exposures. But I’m an introvert by nature who is an observer to begin with so that may play into what works for me.

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