Why ERP?

Why is ERP so important for OCD? Kristina Orlova explains what exposure and response prevention is, clears up common myths about treatment, and shows how the work helps you tell the difference between OCD threats and real-life threats. She describes how ERP is done step by step and at your own pace, which makes this a reassuring listen if you feel nervous about starting.
This video is for educational purposes and is not a substitute for one to one professional medical or psychological care.

Transcript

Today I want to talk to you about ERP, Exposure and response prevention. So one of the reasons that I wanted to focus on this today is because There are a lot of misnomers about treatment for OCD. Recently, There have been posts about the medium who, I forgot his name, But he was suggesting celery juice. And then there were conversations about doing heavy metal detoxes. In order to help cure your OCD. I've heard people talk about, You know, If I just meditate, Then that will cure my OCD. So here's the thing on OCD. There's a spectrum in terms of the level of intensity of how OCD manifests meaning. The statistics say that there's about 12% of people who have OCD in the population, But 10% of those are really not clinically relevant, Meaning it's not intense enough where it interferes with your day-to-day functioning, Like going to work or school or family life or things like that. And then about two to two and a half percent of folks is where it's clinically relevant, Meaning OCD is more severe and it is impacting their functioning. So what that means is there's a lot of people out there who are really high functioning and they have intrusive thoughts, But they're able to move on with their day and their compulsions don't quite take up as much time or they're able to perhaps even not do compulsions. So for folks who are on that light spectrum of substance severity, They oftentimes can in fact see results with things like meditation or mindfulness or even exercising. When I'm talking about OCD and the folks that I work with, Whether it's in the membership or in my private practice, I'm talking about when OCD is manifesting in such a way where the level of severity is higher, Where a person can still be very high functioning, But they're really having a difficult time getting through their day, Or getting out of the house, Or attending to family needs, Or attending to their own needs. So when we're talking about folks who are in that place of intensity. Just doing things like meditation alone or exercising is not going to be enough. And here's the thing. You know, The goal. With exposure and response prevention work is to really teach the person with OCD to one, Recognize that you can handle intrusive content, Whatever that content is. An intrusive content can be, It can be a thought, It can be an image, It can be an intrusive feeling state. It can feel like this impulse. So all of those can be intrusive, Meaning you suddenly get hit with something, Something pops into your body or your brain that you have no control over. It's something typically you don't like. It immediately triggers your flight and fight response. So you have instant anxiety that goes through the roof. And you know that something's off because physiologically you're feeling changes in your body, So you can have really, Like your heart could be racing really fast, You could get lightheaded, You can feel nausea, And so when those two things come together, They usually scare a person and they make you feel like something is terribly off or there's some sort of a threat and therefore you need to neutralize that threat, And that's where compulsive repetitive behaviors come in. Those are attempts a person is engaging in to essentially neutralize that anxiety to try to prevent that potential fear from coming true. Now, What do we know about humans? We tend to do things that we typically think will work. Now in everyday life, What do most of us do? If there's something that is threatening, We typically do what? We either think about it, We analyze it, We try to figure out and get to the root of the problem, Right? So that we can come up with a solution and then go ahead and execute that solution. Or we might try to avoid things, Or we might try to and go and get some sort of a reassurance that, Hey, This is not that bad or that I'll be okay, I'll make it. And so the typical things that we do do in everyday life. That typically work don't work in OCD episodes. Because all those behaviors I just mentioned, And those are just some, All those behaviors do is just reinforce that there is in fact a potential threat, So the brain starts to produce more of that message. So, People will say things like. . . You know, ERP is really scary or I hear it's really just like it's intense and I don't know if I'm ready for this. Well, Again, Here's the thing. With ERP, When you're working with a trained professional, Or at least in a group setting, Setting like a group coaching setting. You get to one, Learn the strategies. Then you get to build out your hierarchy and you get to take some control of the process. You get to go at your pace. Knowing that sometimes you might need to push yourself, Right, Because sometimes, As all of us, We can tend to kind of stay in this quote unquote safe zone for a little bit too long because we're uncomfortable and we're nervous. But like any muscle that you're training, You have to keep doing it, Right? You have to do the exercises and then it helps that muscle grow and get stronger and stronger. So ERP is essentially brain exercise so it helps your brain get stronger and stronger. It helps you with OCD learn to tell the difference between when you're having OCD threats and actual real-life threats. It helps you discern when you have a feeling like something is off or isn't right. And know when to actually trust that feeling and when to not trust that feeling because that feeling is connected to OCD. And that is the most important element of doing this work. With ERP single-handedly, You really get to learn that difference now. When you do this work. Does that mean that you can't do other holistic things? No, You can absolutely engage in other holistic practices. I'm a really big fan of holistic things. I myself, For example, I exercise, I'll meditate, I'll go on walks, I love to dance. I'll do sometimes baths with Epsom salt, But I do all those things for the purpose of that activity. I'm not doing those things because I'm trying to secretly find ways to get rid of my anxiety. And that's the thing that a person with OCD has to learn that when you're engaging in behaviors that people typically engage in like let's say aromatherapy or meditation, That you're doing it for the purpose of that activity. Not now using that activity in order to try to neutralize and get rid of your anxiety, Because anything can become a compulsion. So any holistic practice can become a compulsion. Okay, So when we're talking about ERP, You know, And we talk about. . . You know, Imagine some of the hardest worst thoughts that you could think of or fears that pop in someone's head, You know, At the moment when they really when it really hits. It feels very real. So it's really difficult because everything feels so intense and it's hard to tell the difference. But the thing with ERP is that when you are on purpose, Deliberately, Now seeking to trigger yourself. You now get to study your own anxiety cycle. You get to study your own physiological responses. You get to observe what is happening in your mind. You get to see, Is what I'm thinking, Is it clear? Is it balanced? Is it objective? Or are there distortions going on? And if there are cognitive distortions going on, Then you start to look at patterns. Which kind of distortions do I typically tend to have? Am I doing a lot of personalization, Where I take everything like it's somehow all my fault? Do I have a lot of catastrophic thinking? Do I jump to conclusions really fast? Or am I doing something called emotional reasoning, Which is really common for OCD folks, Which is where because I have this feeling like something is off, I start to generalize that out, Like that must be the truth. That must mean that everything is terrible, Everything will be terrible, And it will last forever. So you want to learn these patterns about yourself so that you can finally learn how to tell the difference and separate yourself from your OCD, Because you are not your OCD. You have OCD, Right? A person can have, I don't know, Examples I hear out there, Like I can have cancer, Which, You know, Not nobody wants that, But you can say I have cancer, Not I am cancer, Right? You can say I have an anxiety disorder, Not I am an anxiety disorder. Right, Who you are is a whole being, A whole person. And so with ERP, You get to learn how to really take control of your life. And learn how to recognize that you can in fact handle and have uncomfortable content and that you do not need to assign meaning to it. For example, There was a class I was in, We had to write down or excuse me, We had to think of a person that really meant a lot to us. So I thought of my mom. And then we were instructed to write down, I want, And then put the name of that person, Dead. You can imagine how that felt, Right? It felt a bit anxiety producing, Going, Oh my gosh, But I don't want that. I wouldn't want that. Why would I write that? And then I thought, Wow, Right, This is what happens. So I wrote it, Okay? I want my mom dead. Now after writing that I was able to also engage in this observational mode where I could see this recognize that yeah of course I know I don't want that, But me writing it also doesn't have any additional meaning. Doesn't mean it's gonna be more likely to come true. It's just words on paper and that's it. That's all it is. So being able to get to a place where you become stronger in that manner, Where you're able to have any and all thoughts, Especially your uncomfortable ones, Any and all images, Especially your uncomfortable ones, When you can face that topic that causes you distress and be able to see it for what it is, The more you train, The stronger you get, Which is, Again, This is true for every muscle. So please, I want you to know, If you are nervous about doing ERP, Part of the process is learning how to do it step by step. It is not something you just launch into. It is something that you learn about. It's very deliberate. It's very thought out. It's methodical. And we go at your pace. And usually, If you're working with a provider, With a specialist, They will also know when and how to challenge you a little bit more or when to kind of pull back and help problem solve and break things down into smaller steps so that you can, Again, Feel like you have some sense of control and actually learn from your anxiety disorder. The whole point of this behavioral work, It's a learning therapy. So it's for you to not just get caught up in the meaning of everything and your interpretation of everything, But it's learning how to separate from it in a healthy manner where you can observe it mindfully, Where you can notice what's happening and recognize it for what it actually is. Thanks for joining today and I'll see you in the next one.