What is ERP?

*Just in case I explain the following badly (I’m very tired as I’ve had two days of food poisoning in Kathmandu and might not be phrasing things too well) I am in no danger whatsoever of acting on any of these thoughts. This is not a weird internet cry for help. I ain’t going anywhere*

ERP stands for ‘exposure and response prevention’ and is the absolute gold standard evidence-based treatment for this dickhead of an anxiety disorder that is OCD. OCD is basically a fear of one’s own thoughts (the obsessions) and anything we do to try and get rid of them (the compulsions).

Unfortunately, the only way to undermine the disorder is to expose yourself to your obsession and refrain from performing compulsions. Because, particularly in ‘pure-O’, a subtype of OCD where compulsions are mostly internal (ruminating, distracting, avoiding, arguing, reasoning, etc) and sneak in without us noticing, we sometimes have to deliberately induce our core fear so that we are not unconsciously running away from it by distracting ourselves or trying to out-think the anxiety.

ERP has been called one of the cruellest and most aggressive forms of CBT possible. Who the hell wants to dwell more on their awful thoughts? But it works, eventually.

Let’s try a little exercise. I’m sure you’ve come across it before, but bear with me. Okay.

Try not thinking of a pink elephant. Try really, really hard.

That pink elephant isn’t budging, is it?

Now, try and think of a pink elephant as much as you possibly can.

It doesn’t take long for you to get distracted and start thinking about something else. Thus it is with OCD, except on a larger and somewhat more stressful scale.

My current primary obsession is that I want to commit suicide. Hurrah, happy days. So this is a little ERP exercise I have done over the last two days. I listed all the reasons my mind is throwing at me to want to kill myself, and here they are…

5 comments

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