Rumination-focused ERP?

[Dadof2kids3cats]

Has anyone heard of/know anything about "rumination focused ERP"? I came across references to it while digging through a listing of teletherapists with OCD training with BTTI certification who are available in Maryland that I extracted from the IOCDF find-help directory. Apparently associated with someone named Michael Greenberg and an outfit called "OCD Associates." They claim it is gentler than traditional ERP, so could be of interest to us....if it isn't "snake oil."

[Natureloverpeace]

Rumination is a mental compulsion that sometimes gets overlooked. Michael Greenberg adds in a psychoanalytic approach to standard OCD treatment. I personally don’t care for that but that’s my opinion. On the plus side, he does address the core fear of a person’s OCD which is essential for long-term recovery. Many OCD specialists only address the superficial fears such as fear of contamination from touching a doorknob or the fear of getting an illness. The person may not have an issue with touching doorknobs or fear getting an illness after treatment but if the core fear underlying the person’s OCD isn’t addressed, the person will likely end up playing whack-a-mole with their OCD. It may show up again as a new theme or an additional theme.

[Scouns]

I just want to let you know that I think you must be an awesome dad! You do so much for support and find help for your daughter and I just want you to know how special that is. My dad passed a few years ago but his way of “helping “ me was to tell me to take a chill pill or suck it up. And my mom thinks I can “rebuke it in the name of Jesus” or pray it away. I just wanted to tell you what a good dad you are. Lynn is very blessed.

[Dadof2kids3cats in reply to Scouns]

Thank you so much. I’ve had the benefit (?) of being very aware of mental health issues from an early age—my parents both had mental health challenges and I spent many many years in therapy for my own problems. It also helped that my mother (who mostly raised me and my sister) modeled giving a high priority to parenting and was always very supportive of us. Additionally, I am retired, so I have a lot of time for this, and I’ve always found it satisfying to be able to do research as a way of being helpful. (I am not always as good at saying the right thing at points of high emotion and tension.)

[Prometheus5719]

Yes, RF-ERP has helped me more than other therapy method when I'm stuck in a serious OCD spiral, specifically the concepts around "not figuring out the issue" and "delaying rumination for another time" have been helpful. I've only read the articles on Michael Greenbergs website though, I haven't actually done any ERP therapy with OCD Associates. The therapy with OCD Associates is very expensive, so you could first try reading the articles and see if they are helpful for you.

[Scouns in reply to Prometheus5719]

Hello - what is RF-ERP? I have never heard of that. I have heard of ERP but not the RF part. My main hurdle is wanting to "figure out the issue" or "solve it" so I can move on with my day. Also delaying rumination or compulsions is like asking me to cut off my own arm. It seems impossible.

[Prometheus5719 in reply to Scouns]

RF-ERP is "rumination focused ERP". Yeah delaying rumination is hard, it has to be a conscious choice. drmichaeljgreenberg.com/rum...

[Scouns in reply to Prometheus5719]

Ok sorry for the probably stupid question since I should know this but by rumination you mean obsessively thinking/worrying, correct?

[Prometheus5719 in reply to Scouns]

Yeah, correct. drmichaeljgreenberg.com/def...

[Natureloverpeace in reply to Scouns]

It’s not a stupid question. Greenberg puts more focus on the C in CBT. In other words, the cognitive part. OCD by its nature involves ruminating on intrusive thoughts and attaching meaning to them.

[Natureloverpeace in reply to Scouns]

It is too overwhelming for most people to suddenly stop doing a compulsion, including rumination. It usually needs to be done gradually by slowly decreasing the amount of time spent doing it, gradually delaying the time before doing the compulsion, and mixing up the steps in doing the compulsion. It’s understandable to want to solve things but not everything has an answer and certainty doesn’t exist. “Nothing is certain except death and taxes.” Even that’s not certain because of tax loopholes and people may argue that death of the body isn’t death of the soul. The more time we spend chasing certainty, the more uncertain we become. There will always be another “what if”. No amount of logic or chasing certainty will get rid of it. OCD is appropriately nicknamed the doubting disorder. Accepting uncertainty is necessary for long-term recovery from OCD as well as learning to trust ourselves and believe that we are capable of whatever curveballs life throws at us. Also, addressing the core fear, not just the superficial fears, are necessary otherwise OCD will probably show up again as a different theme. Another superficial fear but the same core fear. I can’t be absolutely certain that I wouldn’t intentionally harm someone, etc. but I trust myself and don’t believe that I would intentionally do something that goes so strongly against my values. That’s good enough. That’s accepting uncertainty and moving forward.

[lml885 in reply to Natureloverpeace]

I’ve been trying for years to get ERP to little luck and my OCD is mainly rumination right now. Yet every time I try to stop it whether by “not trying to figure it out” or trying to be in the moment or other techniques, they all just end up becoming a compulsion. It’s maddening. I literally can’t stop the ruminations. It’s like an emotional addiction to certain thoughts and how they make me feel. If anyone has tips like the above or more that can help that is ERP focused I REALLY need it. I’ve been tortured by OCD for decades now no joke and nothing is working!!

[lml885 in reply to Prometheus5719]

Do you have any more tips? No matter what I do I can’t seem to stop the repetitive ruminations. I’m losing my sense of self

[Natureloverpeace in reply to lml885]

Accepting the thought instead of trying to get rid of it is important. Thoughts by themselves don’t have power. Accepting a thought doesn’t mean you approve of it. Accepting uncertainty helps with distress tolerance in a healthy way. Jon Grayson, one of the top OCD experts, may still have a short video out on YouTube about accepting uncertainty. His book, Freedom from OCD, also goes into detail about accepting uncertainty.

[lml885 in reply to Natureloverpeace]

Im trying that but it also becomes a compulsion, i hope you understand, as the same thoughts repeat in my head and whether i try to or not or try not to attaché meaning they still persist and bother me. My brain is a hamster wheel and i want it to stop.

[lml885 in reply to Natureloverpeace]

i try to accept uncertainty and it becomes repetitive and a compulsion as nothing I do seems to accept the thoughts or clear my mind. Please understand that im doing ever te3chnique possible and still having issues. Meditation, medication, even looking into brain surgery. I’ll keep trying to accept uncertainty though.

[Natureloverpeace in reply to lml885]

You’re obviously trying very hard to deal with this and that’s commendable. What is the function of your behavior is a question that can help to understand what is going on. So I would ask what is the function of your behavior in trying to accept uncertainty? What are you hoping to achieve in accepting uncertainty? The answer may provide some helpful clues. Accepting uncertainty involves trust and a willingness to lean into the unknown despite feelings of fear, shame, guilt or disgust. Please check out Jon Grayson’s video on uncertainty or better yet, read his book Freedom from OCD. The path to recovery is challenging but doable. Don’t forget to give yourself some self-compassion along the way, you deserve it.

[lml885 in reply to Natureloverpeace]

It’s Moore like I’m not sure what is an OCD thought or what is a normal one. So I don’t know when or how to try ERP on what or what to address. Like for example I was thinking about what you said yesterday about accepting thoughts and not giving them meaning, but they are coming so fast like every other second so then every other second I am trying to remind myself not to give the thoughts meaning, but some thoughts I have to because they help me decide and function. So then it becomes compulsive. So should I meditate with this? Then when I realize the thoughts are still coming and giving them no meaning isn’t working I have to try something else. And all of this just repeats. I am also having ongoing dissociation which makes me stuck in my head all the time. I guess accepting uncertainty means I am no longer in “freeze” mode and will have to face reality and not be in edge. I’ve had this obsessive dissociation problem since Covid when my nervous system went on overdrive due to trauma. (I know I’m writing a lot it’s just to elucidate more and also helps me get some of this out).

So accepting uncertainty and being back in reality, (which I’m not even sure I can do as my nervous system has taken over) means me going back to severe anxiety mode and not dissociating anymore which I guess is super scary as when my body was in that mode during Covid I couldn’t handle it hence my nervous system putting me into constant dissociation or what is called (DPDR/ derealization, dépersonnalisation) where you feel like things aren’t real. It’s a way of your nervous system protecting you. So you’re in your head all the time and if you have OCD it means obsessing all the time. Getting out of it means going back into that panic mode and processing hard emotions and the uncertainty of another trauma happening. So it’s all complex and difficult.

[Natureloverpeace in reply to lml885]

Chances are if you’re questioning whether it’s OCD or not, it probably is. You probably wouldn’t question it otherwise. ERP is something that should be done with an OCD specialist. Some therapists claim to be one but haven’t received the the appropriate and specific training for it. It’s not taught in graduate school. They wouldn’t start the ERP until teaching you about OCD, specifically how it operates, what maintains it and what is necessary for long-term recovery. They would also assess what level of care is needed as well as identify any co-occurring disorders and how to address those. iocdf.org has a resource directory that you can use to find an OCD specialist. I encourage you to check out the website, not just for the Resource Directory but all of the other helpful information on there as well

[Natureloverpeace in reply to lml885]

Old school ERP was focused on habituation only but it has evolved to more than that. Unfortunately, there are some therapists that still practice old school ERP but it isn’t as effective as ERP with the adjuncts of ACT, Mindfulness and addressing the Core Fear. Besides addressing the underlying core fear, not just the superficial fears, ERP can be supplemented with ACT (Acceptance Commitment Therapy) and Mindfulness. Inhibitory learning can be part of the treatment too. Moving toward your values instead of doing what OCD tells you, can be a huge motivator in taking on OCD. That would be the ACT part. Mindfulness can help keep us grounded so we’re less likely to spiral with run away thinking. Inhibitory learning is literally a way of learning to inhibit the fear.

[lml885 in reply to Natureloverpeace]

and thanks for responding and reading. I’m reminding myself to be compassionate

[Scouns in reply to lml885]

I am so right there with you! It is maddening! I spent 2 days this week researching neurologists about the possiblity of having a brain tumor since medicine and therapy don't help me at all. I am doing i-cbt now and logically it makes total sense. I could literally teach i-cbt to anyone and explain it perfectly and geez I bet you anything I could write a manual on it, but actually utilizing it to not engage in my OWN compulsions and not ask for reassurance, well you might as well be asking me to cut off my own arm. My brother in law talked to my therapist on what they as a family could do to help. Before that my familys way of support was to tell me to pray more, trust God more, believe more, think positive thoughts, smile in the mirror, stand on a Bible verse, "Just stop", and so on. I was shocked when my brother in law asked to understand. My therapist told him that my family and pastor and friends need to stop giving me reassurance and feeding the monster. Makes sense. I get it. But now when I text or call my mom, adult daughter, sister, nieces, brother, friends, pastor, and brother in law, they just ignore it. Like I don't exist. Like I am a toddler throwing a tantrum in Walmart becuase I want a toy. I feel dehumanized. I feel alienated from my entire support system. They go on and have lunch together and shop and I stay home because when I am around them all I want to do is get reassurance that everything is ok and they hate it adn they don't mind telling me about it. I am not crazy but they really think I am. Pscyho, weirdo. I am a professional school counselor and a good one! I help hundreds of kiddos. But I cannot help myself. And I have lost my entire support system. And Im mad. I'm so mad! I want to know how and why this happened to me. And I am exhausted trying to find an answer/fix/solution. It is definitley like an addiction.

[lml885 in reply to Scouns]

Yeah I’d say ERP and really working to know that everyday you actually do deal with uncertainty in ways you may not know can help maybe. ERP as in your family not giving you reassurance is supposed to help. Sometimes addressing underlying trauma can help with that? Right now I’m obsessing over what is OCD or what isn’t so I’m questioning literally everything I do like the smallest thing. Also sometimes we have to not just face the uncertainty but the uncomfortable feelings we get from being uncertain. They say OCD is not just the thoughts but the feelings and emotions you have in your body that cause us to try to get reassurance. But I’m still struggling too. Just everyday is day try to see how it makes you feel to not get reassured about one thing.

[Natureloverpeace in reply to lml885]

Yes, it’s not just the thoughts but the feelings too and feelings can be intense. ERP also helps us to learn some distress tolerance skills.

[Prometheus5719 in reply to lml885]

I'm not sure, I struggle with it every day and am still trying to figure out how to deal with the disorder. I also struggle with doing ERP as well. I've had like 6 different ERP providers and also attended Rogers residential treatment program, but my OCD sometimes attacks the ERP process itself, making it very difficult to make progress. Do you take medication?

[Joseph46]

has anyone tried Sertraline (Zoloft)?

[Scouns in reply to Joseph46]

I have. I was at 300mg, but unfortunately it did nothing for my ocd. Although my therapist, who has recovered from ocd takes it and loves it for hers. And I have heard a lot of others like it. But for ocd it really needs to be a very high dose like 300mg according to my psych