Let’s talk about ERP. The initials of ERP stand for Exposure & Response Prevention (preventing the response anxiety is telling you to take) or otherwise known as Exposure and Ritual Prevention.
ERP is the most highly recommended type of therapy used to treat OCD. It’s what’s called an evidenced-based intervention. Evidence from studies has proven ERP is very effective. Basically, you expose yourself to something that makes you uncomfortable and you do nothing to alleviate the discomfort.
First, you build a hierarchy of people, places, things or situations that trigger your anxiety or discomfort. You place them on the hierarchy (ladder) in terms of easiest to hardest to face. “If you were going to face this fear would this be easier to face than this?” Then you make a plan to gradually climb the hierarchy from easiest to hardest. You’ll know it’s time to move to another step when you’ve become bored or desensitized with the step you’re on.
I once knew a boy who was afraid of crickets. He couldn’t go outside because he was terrified that a cricket would land on him and bite him. He designed a hierarchy of gradually exposing himself to being near crickets. It started with being in a room with crickets living in a secure container. He ran into the room counted to 10 and ran out of the room as fast as he could. Gradually he increased the amount of time to 2 minutes. Eventually, he was quite comfortable being in a room with crickets in a secure container. He could even hold the closed container in his lap. The next phase was to open the lid of the container, and through similar incremental steps, he worked his way up to place his hand in the container.
The response he had to prevent during these exercises was to not reassure himself that crickets were harmless or couldn’t get out of the container. He had to accept the possibility of escape and being bitten. He talked like this to prevent himself from neutralizing his anxiety. This is Response Prevention. He tolerated the discomfort and in fact, I encouraged him to say he wanted the anxiety. He said, “I hope I’m anxious. I don’t care anymore. I want to be able to go outside and play with my friends. So go ahead. Make me anxious.”
At the top of his hierarchy was a plan to go outside where there were crickets freely living in a garden. But before he did that, he said he would need to take his shirt off and allow crickets to climb all over his body. Yikes! First, he did this with his shirt on and then eventually he took his shirt off. Crickets were crawling and hopping all over him. He was pretty tense at first, but suddenly he started to giggle, “It tickles.”
Every now and then I think I hear one of his crickets chirping in my office. I’m reminded of his courage and determination. He makes me smile. I know the bravest people in the world.