Is There an Undeniable Truth that Would Make ERP More Bearable?

[deValentin]

I think that everybody would agree that ERP (the gold standard treatment of OCD) is not easy to practice. It’s asking us to face triggering stimuli and prevent inadequate compulsive responses, but a mind on permanent alert is always coming up with doubts: what if I don’t have OCD and my doubts are justified? What if I don’t overreact to my awful thoughts and I start to consent to them? What if I stop trying to remember past events and I miss a critical clue? etc. Those doubts drive us to prematurely bail out of ERP.

Is there a truth that OCD couldn’t contest and could help us better tolerate ERP? I think there is one. It’s the possibility that the opposite of what OCD claims may be true. Yes, it’s possible that the worse-case scenario has happened or might happen, but it’s also possible that it hasn’t happened or might not happen. Yes, it’s possible I get sick if I touch this doorknob, but it’s also possible I won’t. Yes, it’s possible that OCD will deliver the peace of mind it promises, but it’s also possible it never will. If we are intellectually honest, we can’t deny those opposite possibilities. Emotionally it’s a different story because it's difficult to tolerate some uncertainties in a domain we value, and if we feel a strong desire to ruminate, search, check or ritualize in order to eliminate those uncertainties, it’s equally difficult not to believe our desire will be satisfied.

If we want to reduce the discordance between what we think and what we feel (psychologists call it the dissonance between intellect and affect), ERP is the tool of choice. Facing our worst fears or discomfort and not compulsing makes our urge to ruminate, search, check or ritualize abate and enables us to accept a cognitively undeniable truth: it’s possible that giving in to OCD urges makes matters worse and that there are healthier ways to achieve sustainable peace of mind.