What if I’ve started using ERP as a compulsion?

It’s quite common that somebody struggling with OCD can easily become very compulsive about trying to expose themselves to thoughts and feelings they don’t like or start to worry that they’re not doing therapy “right” so they’re constantly searching online for reassurance or repeating therapy exercises or any number of ways this might manifest itself.

This is all very normal if we look at OCD as being all about trying to avoid things we don’t want. It’s natural that somebody struggling with OCD will also try to avoid OCD. It’s a thing they don’t want, just like any other illness, crime, accident, disaster, nasty thought or whatever.

In this, you¬†can see the same behavioural pattern that underlies any compulsion: If I do this thing, then I’ll avoid/control that thing I don’t want. Like: If I do this ritual to prove the thought wrong, then I’m not a bad person. And that just gets extended to therapy: If I do this therapy exercise (ritual), then I can avoid/control the illness/anxiety. And like any ritual, then the brain tries to be certain about whether you did it “right”, whether you believed it fully, whether you missed anything, etc. And, of course, because OCD loves irony, trying to get over OCD just becomes a way to practice making it worse.

There are a couple of things to consider here. If you’re doing this, it might be helpful not to look at what you’re currently doing as “ERP” or as therapy. You’re just doing compulsions. There’s nothing therapeutic about this. If somebody feels they must consistently expose themselves to thoughts or situations that cause them anxiety, it’s a very¬†similar to the types of reassurance compulsions a person might engage in to test their arousal to images they don’t like. If just exposing ourselves to thoughts and feelings we don’t like could somehow cure OCD, nobody would have OCD because they already spend all day experiencing thoughts and feelings they don’t like.

If you’re not working with a therapist that has a track-record of helping people recover, also consider that your idea of ERP/therapy is actually not at all how one does it effectively. If you’re working on your own and trying to succeed via self-help, definitely get some help from a knowledgeable source.

And then one thing I found really helpful with therapy was orienting it around where I want to go in life and how I want to spend my time and energy. Compulsions are about trying to avoid and control uncertainty and other feelings I don’t like. OCD is all about trying to get rid of things like anxiety. So that can’t be the goal of therapy. It helped me to focus on doing the things I care about while learning how to experience thoughts and feelings. That creates a framework for effective ERP because your brain will try to get you to stop doing the things you care about so you can spend time trying to solve thoughts and feelings (that’s the Exposure) and then you can choose not to react to that by continuing to do things you care about (that’s the Response Prevention).

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4 comments On What if I’ve started using ERP as a compulsion?

  • A wonderful article and one that is very timely for me. I have struggled for the past 8 months or so with this issue and it has really had me quite stumped as the OCD was masquerading as therapy. I was obsessing about obsessing and the ‘correct therapeutic approach’ and although deep down I knew it was the OCD, the more I tried to ‘figure it out’ or research it and reassure myself, the further down the rabbit hole I fell. You are a great support Mark in all that you do, I am also slowly working through your new book. Great stuff. Thanks again for all you do.

    • Thanks, Gavin. Enjoy the book. If you have any questions as you’re working through it, feel free to post them. Have fun taking steps forward without needing to get things “right”!

  • So here’s a question. Let’s say a person has obsessions about stabbing people. I’ve read where maybe his exposure will be to carry a knife around and have it around people he cares about all the time in order to habituate himself and to desensitize his fear of stabbing people. But, like you said what if that turns into an addiction to where he carries the knife around to prove to himself over and over that he won’t stab somebody, which sounds like reassurance and checking. Then what? Should he only use a knife in normal life situations like cooking or whatever around those family memebers and endure that anxiety in a normal context and let that be the exposure situations and the one he uses to fight the avoidance instead of constantly carrying the knife around at all time? I hope that makes sense.

    • I don’t encourage people to chase “desensitizing” and “habituating”. That’s what leads into turning these things into compulsions. And then the brain will just give you more things you can try to “habituate” yourself to. I find it’s useful to build skills around stuff we want in our lives. For instance, one of the things I found most useful for my fears around knives and stabbing people was to take cooking lessons. So I had to buy large knives and use them around people and carry them around stations in the crowded kitchen and I also then cooked meals for friends and prepared them with them. I’m showing my brain that I can handle the fears it throws up while I build things I care about.

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