ERP Help

[disneyandme]

Hi! Does anyone have any suggestions of different kinds of ERP to do? So far my therapist has shown me word associations (where you write down any feared word, rate your suds level, and keep writing the word for about a minute and then reassess your suds level), and also a similar thing but in sentence form (writing sentences like "Maybe nothing is real" a bunch of times and assessing suds level). She's also shown me scripts, but I'm not the best at script writing- it also confuses me because in order for me to write a script, it almost kind of requires me to start compulsing (analyzing/questioning).

The writing down sentences/words multiple times worked in the beginning, but now I seem to be desensitized to them (which I know is the goal), but this past week my OCD has flared up a bit (I went on a trip and I'm also pmsing- two triggers of mine), so it's frustrating and scary to me that ERP isn't helping with that anymore.

I should add- my OCD fears tend to center around getting into thought loops about not knowing the answers to philosophical questions; fearing going crazy/developing mental illnesses such as psychosis and schizophrenia; and the fear of self harm and becoming suicidal. My compulsions are almost always mental- analyzing/rumination. But also reassurance and research.

I don't understand why writing down my feared thoughts in a "maybe" statement isn't helping anymore. It almost calms me down rather than triggers me- another thing I'm confused about as my therapist has me do this as a coping tool as well as an exposure, how could it be both?

I hope this post makes sense... Does anyone have any suggestions? Has anyone else had this happen?? Thank you

[Selesnya]

Hi disneyandme,

I'm not sure exactly how to advise you. I feel like I still need help in coming up with exposures, but I can let you know some of what I have done so far.

I've done some exposures related to harm OCD and relationship OCD where I have recorded some worst case scenarios using the voice memo feature on my phone, and then I listen to the clip over and over. I've recorded one where my wife dies in surgery and then I kill my son. I've recorded one where I destroy the relationship with my wife and then she and my son move across the country and I'm left all alone and live a long time alone without making any friends or connecting with other people. I've recorded one exposure where I snap and kill my son and I am shut in prison.

When I am making the recording, my therapist has advised me to imagine what it would be like as the events are happening. What would I be feeling emotionally? What sensations are there in my body? What am I thinking? How do other people react? I haven't tried writing these exposures out -- I just sit in a room alone, close my eyes, and walk myself through these terrible situations as I record it. I make sure to leave pauses as I record so that I will have time to assess my thoughts and feelings as I'm listening to the recording later. There is no reason to rush through the process. Recording the exposure is usually the absolute worst part of the exposure and it is hard to keep from losing composure while doing so.

When I am listening to my recordings I think to myself that this may or may not happen. I try to accept that I could do these things. I make sure that when I am listening to these recordings that I'm not doing anything else so that I can focus on the situation and imagine it fully.

I've also done some ERP where I have held some scissors up to my therapists neck as if I might attack her. We have talked about moving up to using a big knife instead, but we haven't actually done that yet. Again, let yourself feel the uncertainty and anxiety and watch it subside over time.

I would guess that there is a lot that you can play with as far as situations that cause you anxiety and uncertainty related to your OCD themes.

[disneyandme in reply to Selesnya]

Hi Selesnya, you don't know how appreciative I am that you took the time to write this.. Thank you so much. This is so helpful. This does help me see how I can make my exposures harder. I need to be honest with myself and add more detail.

My question is- when you listen to these recordings, do you visualize the scenario in your head and try to get yourself to connect with the emotion? I feel like it's the only way I can get myself to experience the same emotions I do when I have intrusive thoughts, but my therapist seemed to think that doing that would be a compulsion which I didn't really understand.

[Selesnya in reply to disneyandme]

Yes, I picture the situation as I'm describing it and I try to feel the situation as completely as I did when I made the recording.

I don't understand how that could be a compulsion. A compulsion is supposed to ease your anxiety and uncertainty, and fully committing yourself to the situation is the exact opposite of that. Fully committing would increase your anxiety and make you sit with the situation that causes that anxiety.

For myself and my harm OCD, my main compulsions to decrease my anxiety are to think about killing myself or to picture leaving my family, my job and everything and wandering off homeless into the world. Either of these would offer some sort of escape for situations that seem completely overwhelming. Alternatively I might try to reassure myself that there's no way that I would ever do something like is in my exposures. I try to stay mindful of the recording and pay attention to my body and my reactions. I try hard not to let myself slip into my compulsions or reassurance by simply staying in the present moment with the exposure.

One other thing to pass on that my therapist has told me is that you eventually want to be able to take your exposures all the way to their extreme. Think of the situations that would cause you the most anxiety possible, and move toward that experience as much as is safely/practically possible. You may well have to work through various steps along the way and step up your exposures, but you want to show your OCD that you can handle whatever anxiety and uncertainty that it might throw at you. I say this easily, but you would laugh at how horribly I have failed with facing some of my exposures and how it has taken weeks of repeated effort to do what seems a simple thing. This is all aspirational in nature -- you eventually want to show your OCD that you are in control, but be OK with the process and know that the effort, not the results, is the important measure.

This is always helpful for me to read if I'm struggling with my ERP or OCD in general:

iocdf.org/expert-opinions/2...

Additionally, I would recommend looking at the end of this thread for my recommendation regarding Everyday Mindfulness for OCD:

healthunlocked.com/my-ocd/p...

I think that this would help you with some of your questions about ERP. It also lets you know to be kind to yourself. Your OCD is relentless. Do not be surprised that sometimes you handle things worse than at other times. Your recovery is not a linear process, but will change as your OCD tries to reassert control in different areas of your life. You will have times that you do great, and times that you aren't doing as well. It's all part of the process, so forgive yourself and know that it is normal.

[disneyandme in reply to Selesnya]

Selesnya, thank you so much for all of this. I appreciate it from the bottom of my heart. I'm sure you know how helpful this is. Thank you for the resources you've provided as well. I actually have Everyday Mindfulness and have already skimmed through it a bit, and you're so right about it. Being kind to ourselves is so important. I hope you're doing well, keep pushing through.

[Aleese]

Hi Disney-

It sounds like you are struggling some, that is to be expected at times. When you feel overwhelmed and full of anxieties it’s hard to see where you are going. For me I try to watch it as if it’s ‘over there’ not a part of me and observe it and let go. OCD is not you or me. I went thru a threat of OCD recently and talking it out, I realized that yes, it is OCD and now I’m going to do what I’m set out to do no matter what feelings or OCD threats try to push me down. This is my ERP. I’m not giving in. Keep up the great work. I don’t know if this has helped you at all. Hope you have a great evening😊

Aleese-

[disneyandme in reply to Aleese]

Hi Aleese!

I'm hoping that it's common to have ups and downs in recovery. As time goes on I get more nervous that I'm supposed to be fully recovered, so I'm hard on myself when I slip back into the cycle. You are so right about looking at it as if it's 'over there', thanks for reminding me of that- easier said than done sometimes 😉. Thank you for your message. I hope you have a great rest of your evening as well!

[Aleese in reply to disneyandme]

Good Morning Disney girl.

Yes, please don’t be hard on yourself. It’s normal to have ups and downs. In time, there will be more ups. From what I’ve observed, you have made so much progress in such a short time! You have a lot to be proud of😊

Hope you have a peaceful and fun day in this blasting hot furnace! A HOT one🔥

Aleese-

[Deeganmich in reply to Aleese]

Already I love your strategy of looking at it over there. Do you get erp therapy and if so, whose is your provider? I’m having a hard time finding one who accepts insurance.

[Hidden]

Do you find yourself in a catastrophic downward spiral sometimes. Sometimes like in a hamster wheel doing over to release the pent up anxiety and pain. Sometimes when I feel anxious about something I have to be aware that I am living in the moment and careful not to live in the future !

[Deeganmich]

It sounds as though it is working. I would keep doing it. Who is your therapist for erp? I haven’t been able to find one.