Understanding Exposure Therapy: A Deeper Look Into Healing From Anxiety and OCD
The gold-standard therapy approach for people struggling with anxiety or OCD is exposure therapy (i.e., ERP). ERP can sometimes be misunderstood as just focusing on, “If you are afraid to do it, then you just need to do it.” However, ERP is a highly compassionate and empowering process that includes nuanced elements.
To understand ERP, let’s first delve into the anxiety/OCD cycle. Anxiety and OCD center on difficulty being with uncertainty/doubt. When people have intrusive thoughts (e.g., worries, obsessions) that cause distress, it is understandable they respond by doing their rituals (e.g., compulsions, safety behaviors) in an attempt to immediately feel better. However, the relief felt by rituals is only temporary and rituals are what actually reinforce anxiety/OCD cycle. The more people give into the anxiety/OCD by doing rituals the stronger the anxiety/OCD becomes over time.
This is where ERP comes into play. Exposure therapy helps people learn how to relate to their intrusive thoughts differently. People often think the intrusive thoughts are the “problem” and do whatever they can to stop the thoughts or convince themselves that everything is okay. However, the more people try to control the intrusive thoughts the more they occur. ERP helps people learn how to lean into their worries, instead of trying to rationalize with or avoid them. In addition to working on building one’s ability to be with doubt and discomfort, an equally important part of the exposure process is to work on actively reducing and resisting rituals. Just facing your fears without working on ritual reduction isn’t exposure therapy. As rituals are what reinforce the anxiety/OCD pattern, ritual prevention is an essential part of the process.
Moreover, the mindset that people embrace while doing exposures is another important aspect. For example, an exposure goal for someone struggling with rereading-related OCD, may be to send a text without rereading it. Instead of rereading, this person focuses on, “I have never sent an inappropriate text before, this is just my anxiety, I don’t need to reread the text, I know what I wrote is okay.” At a surface level, this may sound like a helpful mindset to embrace, but it actually is just reinforcing the OCD and is making the exposure practice ineffective. This is because the person has ritual swapped – went from checking to engaging in self-reassurance – and rituals are what reinforce the anxiety. When working on resisting the urge to check the text, the goal is to also embrace an exposure or acceptance-based mindset, such as, “I am not rereading the text, I can’t be sure if I didn’t write something inappropriate.” Doing the uncomfortable thing, while embracing the uncomfortable mindset, and working on ritual prevention are the three key components of exposure therapy.
Furthermore, at its core, exposure therapy is about helping to empower people. As people transition from being controlled and confined by their anxiety/OCD to feeling empowered and confident that they can handle whatever intrusive thoughts may come their way, this process creates a motivating and confidence building experience.
