ERP With a Different Twist

Compulsions Are Nothing More Than a Coping Skill Gone Rogue

If you use avoidance behaviors or mental neutralizing rituals to manage anxiety and obsessional thoughts, then you’ve selected compulsions as a coping mechanism. You believe compulsions have value. Naturally, if a coping skill seems useful, you’ll use it often. The more you use a coping skill, the more mindless or automatic the use of it becomes.

Bossy-Pants OCD
A Compulsion Is a Coping Skill in Excess

Your brain perceives a threat or senses something unpleasant, your body reacts, and your brain selects a coping mechanism—and in your case, it’s often a compulsion. You employ a repetitive and well-oiled skill that has helped you cope in the past. You can employ this skill mindlessly—with no concern for consequences.

Ta-Da…You’ve mastered a coping skill!

Just because you’ve mastered a coping skill doesn’t mean it’s right for you.

Even when you think it’s a healthy coping skill because an authority or role model told you to do it—it can be a compulsion.

Have you ever been taught this coping skill: “A thought is just a thought.”

If you’ve read Brain Lock or talked with a therapist who doesn’t use ERP, then no doubt you’ve been reassured, “Just because you think it doesn’t mean you want it.” Many people have become proficient at repeating, “It’s just OCD, it’s not me. I am not my thoughts.” 

Yeesh! It’s a coping skill gone compulsive!

Compulsions aren’t spontaneous. They’re learned. Through trial and error, and reinforcement a compulsion is born.

It’s true; you are not your thoughts. You are your compulsions.

Compulsions form your loss of identity—and your lack of sense of self. I wish I had a nickel every time a client said to me, “I don’t know who I am without my compulsions.”

You and your compulsions are joined at the hip. Two peas in a pod. But, let’s get this straight…if you are engaging in compulsions you CAN’T know who you are. Drop the compulsions, and you WILL find yourself again!

Coping skills are employed for a reason—to achieve a goal. When you employ a compulsion, what is your goal?

Maybe you’re saying, “Tammy, I use compulsions to stop something bad from happening.” ~or~ “I use compulsions to try and figure out something important. I’m trying to answer a question that is gnawing at me.”

Ummmm, nope. That’s nothing but a hoax. Compulsions have no effect on anything but the quality of your life. Trick. deception. Fraud. Scam. I know you won’t argue that compulsions are all of that and more. Nevertheless, it’s how you cope.

Peel off the many layers of why you profess to engage in compulsions. You will discover you perform compulsions as a way to cope. You use compulsions to fire up or extinguish a feeling.

If you were willing to experience any feeling—all feelings—what would life be like for you? You’d be compulsion-free!

If you agreed to coexist with your feelings and obsessional thoughts, there would be no need to neutralize an intrusive thought. No more mental acts. No more trying to get to the bottom of who you are. No more rewinding, replaying, or forecasting. No more fixing. No more controlling what you can’t. No more hypervigilance. 

If you were willing to experience uneasiness the quality of your life would significantly improve. I’m not saying you have to enjoy anxiety or fear. I’m just saying you’d be compulsion-free if you agreed to coexist with your thoughts and feelings.

Tired of compulsions? Then apply the principles of Exposure & Response Prevention (ERP).

But hold on!!! If you decide to engage in ERP, the reason you’re doing it is critical. What is your goal? What do you hope to achieve through confronting OCD and resisting compulsions?

Are you engaging in ERP to stop thoughts? Bzzzzz. Wrong. Are you participating in ERP to avoid feeling unsettled or anxious? Bzzzzz. Wrong. Are you employing ERP to get rid of OCD? Wrong! Are you engaging in ERP to fire up anxiety or an uneasy uncertain feeling? Ding ding ding. RIGHT!

How else can you learn to tolerate an unpleasant emotion unless you hunt down ways to feel it?

You can’t heal what you won’t feel!

Now I want to give you, the reader, a peek at a therapy session:

Let’s say that for an exposure exercise you put a big piece of spinach in your teeth and talk to people all day.

ERP With a Different Twist

Predicting what will happen if you do this exposure is not new to the practice of ERP. The different twist is to make sure you lay it on thick. Don’t make little of what could happen. Be vivid. Go beyond saying you’ll “be laughed at” or people “will stare.” 

What do you predict will happen? Think about your worst fears. Go for it! Don’t just predict someone will think “less” of you. Use your words! Use foul distasteful adjectives! Amplify, magnify, go into detail and elaborate what you fear could happen.

Okay, I predict this will happen: People will be disgusted with my poor hygiene. They’ll accuse me of not bathing too. They’ll think I’m of low intelligence. I’ll be accused of never brushing my teeth. Someone will hand me floss and say, “Here, floss. Your teeth are disgusting.” Because of that spinach in my teeth, people will call me, a big fat pig! Oink Oink.

Now that we have gone hog wild and been thoroughly descriptive with your predictions, it’s time to put the spinach in your teeth.

ERP With a Different Twist

Make sure it’s noticeable. You might think, “Maybe we should start with a small piece.” Not really. You can if you want. That’s traditional ERP; slowly working your way up to a higher level of anxiety. But then you’re not fairly testing out your hypothesis. We need to see if your predictions come true!

We need to make sure the spinach is in plain sight! We need to find out what happens! Uh-oh…you’re losing your nerve, aren’t you? What are you having a hard time believing? Are you worried you can’t handle this experiment?

I’m worried I will be looked down upon. I’m going to fret all day long if that spinach is in my teeth. I’ll be demoralized and just want to die.

Do you feel like the anxiety is too much to tolerate?

YES!!! A thousand times yes! This is a horrible idea!

Okay, so that’s another prediction you’re making…”I can’t handle the anxiety if I do this.”

Let’s regroup for a minute. Do you want to live well with OCD?

Yes.

Well, then we need to test out your hypothesis! 

Be willing to find out what happens, and you can live well with OCD.

Before you put the spinach in your teeth, I just want to point out that it’s important to engage in ERP for the experience, not the outcome.

Be willing to find out what happens when you put your hypothesis to the test. In summary, what is your hypothesis?

I predict

People will think I’m a disgusting pig. I’ll be cast aside. I’ll be alone for the rest of my life.

I predict 

I can’t handle all of this anxiety. I’ll have a panic attack and never recover.

It’s been two weeks since our appointment. How’d you do?

Surprisingly, great!

Awesome! Despite your predictions, you feel great about your efforts! 

So, did your prediction turn out to be factual?

No one even seemed to care about the spinach in my teeth. There’s no way they missed it, but nobody seemed grossed out. Eventually, somebody pointed out I had spinach in my teeth, but it was no big deal. We laughed.

Your predictions were false. There was no catastrophe. Nothing bad happened. Nobody called you a pig or accused you of not bathing. And, you’re happy about your discovery!

The purpose of the exercise was to poke holes in your prediction. Did it work?

Yes.

But, if someone had called you a pig, would that be factual or an opinion?

An opinion. I can’t be a pig. I’m a human.

And by the way, only a person who is in pain would call you a name for having spinach in your teeth. A happy or caring person would have no need to bring you down. If someone calls you a name, we must have compassion for that person who must be hurting.

Alright, but there’s more to ERP than trying to disprove a hypothesis.

What if your fear cannot be readily disproven? Maybe you fear something that could happen months or even years from now. Or, what if you fear something where the outcome can never be known? Lesson #1 will be of little help to you.

ERP With a Different Twist

When does the exposure end? Hint: It doesn’t end when your anxiety comes down.

It’s not so bad to look foolish, be stared at, ignored, or called names. It’s unpleasant but not dangerous. The purpose of exposure exercises is to discover you’re more capable of tolerating anxiety and unpleasant events than you thought.

I didn’t think I could walk around with spinach in my teeth, but I did it! I didn’t panic! 

Did you keep the spinach in your teeth until your anxiety came down, or did you stay in the situation until your brain got an update about your ability to cope with the discomfort?

I ended the exposure when my anxiety came down. It came down when I realized my predictions were false.

How will this help you for obsessions that can’t be disproven? 

The lessening of anxiety because you recognized a discrepancy between what is predicted and what occurs is nice and all…but it’s not enough. There are many obsessional thoughts you can’t disprove. And many obsessions consist of questions that simply can’t be answered.

But, I could probably do that spinach experiment again now that I know my anxiety will lessen.

Yes, but will that be true at a later time or in a different context? Let’s not care so much about your anxiety lessening. If we place emphasis on reducing the anxiety, what kind of mixed message is that? That’s teaching you that you should be able to control your anxiety. And isn’t that what compulsions do?

Anxiety is inevitable, a part of life and it can be tolerable. Accepting this as the truth is how you can live well with OCD.

It’s important to stay with an exposure until you discover it’s okay to be anxious and have weird thoughts. Instead of trying to fix your anxiety through exposures, learn to be with or experience your anxiety.

If I ask you, “what surprised you about this experiment” and you answer, “I was surprised by how well I tolerated the fear” then hurray mission accomplished! But, if you answered, “I was surprised nothing bad happened,” that’s probably not going to translate into long-term benefits. Nor will it be applicable for every obsessional thought.

It’s about the lesson, not the lessening.

It doesn’t matter if your anxiety comes down. It’s all about the experience, tolerating it and discovering it’s okay to step out of your comfort zone. 

ERP With a Different Twist

The exposure ends not when your anxiety comes down, but when these objectives are met:

  • You realize anxiety is unpleasant, not dangerous.
  • You’re surprised by how well you handled the anxiety without a compulsion.
  • You accept it’s important to coexist with unpleasant feelings and obsessional thoughts.
  • You exceed your expectations about being able to continue an exposure even while feeling anxious and having obsessions.

If you’ve achieved those objectives even though your anxiety is still high, the exposure is considered completed.

Focus on the anxiety being tolerable; not the anxiety being fixed or controlled.

ERP With a Different Twist

You don’t even have to rate your anxiety. Instead, pay attention to your ability to withstand and tolerate anxiety and obsessional thoughts.

I end the exposure when I learn that I can stand uncertainty and anxiety. I tolerate experiencing these feelings and admit the feelings are unpleasant, not dangerous. And third, I must reinforce my strength and courage by admitting how surprised I am. Only then do I stop the exposure?

Exactly. 

Wait, that last objective . . . How do I exceed my expectations about being able to continue an exposure?

Step outside your comfort zone even more. Demand the anxiety become worse.

Not only put spinach in your teeth but also part your hair differently. Talk to someone really important with spinach in your teeth. Adding a bit more discomfort to the situation, and the fact that you survived it, would have even surprised you more! You would have exceeded your expectations.

One more time, what do you mean by “coexist” with my anxiety and obsessional thinking?

Be a person not willing to be overcome by anxiety or obsessions. Accept that anxiety and weird thoughts will be a part of your life and that you must live with this fact and tolerate it. Do not try to eradicate or influence thoughts or anxiety. Despite your anxiety and obsessions, agree to live together.

Remember, the practice of ERP is about the lessons, not the lessening!

ERP is more effective than any other intervention. AND, research continues to find ways to improve the short and long-term benefits of stepping outside of the comfort zone. Incorporate all three lessons into your daily life and you can live well with OCD.

6 thoughts on “ERP With a Different Twist”

  1. Thanks again for the posts! Another one that was right on the nose for me. Looking forward to using your OCD Coloring book when it arrives from Amazon! Just in time for the old Holiday stress train. More activity, less compulsory repetition is my goal for 2019. Learning to become comfortable with my own emotions was a big transition in 2018, something I learned right here at the Blog.

    1. Glad you liked the post and that you’re willing to coexist with anxiety! You focus well on goals so you’ll do great at your new goal for 2019.

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