ERP Therapy for Intrusive Thoughts: Gold Standard Treatment
Intrusive thoughts that are unwanted, disturbing, frightful, and overbearing. They are persistent, involuntary and conjure painful feelings of anxiety and uncertainty.
People with intrusive thoughts can feel as though they are ‘going crazy’ and many live with the heavy weight of shame and guilt because of them.
Intrusive thoughts, however, are not solely experienced by those with OCD.
They are far more common than you think and often flow in and out of our minds within moments. Every human could experience a disturbing thought about jumping in front of a bus, dropping their newborn baby, or punching a friend in the face without thinking too much about it.
The thought is fleeting and easy to forget, for many.
But for those with OCD, these thoughts become sticky. An overwhelming feeling of doubt and uncertainty allows them to take root, and thrive. They become stuck in a rumination loop of doubt and questioning – What if I really wanted to do that? What if I can’t control myself? What if I’m just a bad person?
OCD cannot help but try to solve these thoughts and find a satisfying answer.
Yet there is no answer that is ever satisfying enough for OCD.
If you resonate with this and feel as though these intrusive thoughts are terrorizing every waking moment of your day, there is hope.
ERP therapy for OCD remains the gold-standard treatment for OCD recovery. This article will explore why this modality works so well and how it helps you manage those intrusive thoughts.
Content
OCD – An Overview
Obsessive-compulsive disorder is an incredibly debilitating psychiatric condition that is characterized by two key components, obsessions, and compulsions.
Intrusive thoughts are a type of obsession along with intrusive images, feelings, urges, and sensations.
The content of these intrusive thoughts can take many forms depending on the OCD subtype. What we do not understand is that OCD loves to jump between themes. It is important to note that it is not the subject of the thought that matters, it’s the fixation on these thoughts that we need to focus on.
These thoughts trigger immense anxiety and uncertainty.
When we experience this anxious response, we feel as though we must act immediately. The perceived threat (the intrusive thought) feels very real, very urgent, and very important.
In a bid to alleviate the distress created by these thoughts, we engage in physical and mental compulsions to seek temporary relief. Compulsions are ritualistic behaviors that offer a fleeting sense of comfort and reassurance.
It makes sense that someone with OCD performs these behaviors, as they induce such terror and can make you question everything.
Even though these compulsive behaviors do provide short-term relief, they are what keep the OCD cycle in motion.
Examples of intrusive thoughts and accompanying compulsions
While the specific manifestations of OCD can vary widely from person to person, here are some examples of common intrusive thoughts and accompanying compulsions within a handful of different OCD subtypes:
1. Contamination OCD:
– Intrusive thought: What if I touch a dirty surface and become sick?”
– Compulsions: Excessive handwashing, avoidance of “contaminated” objects, repetitive cleaning rituals, mental rumination of what has been touched, asking others to avoid places and objects etc.
– Intrusive thought: “What if I don’t lock the door properly and someone breaks in?”
– Compulsions: Repeatedly checking locks and frequently seeking reassurance from others, mentally reviewing if door was locked properly, taking photos to prove door is locked etc.
3. Harm OCD:
– Intrusive thought: “What if I lose control and stab my partner?”
– Compulsions: Hiding all knives or putting them somewhere out of reach, checking that your partner is alright, avoidance of partner, mental review to determine if one’s thoughts are wanted or not etc.
5. Religious OCD:
– Intrusive thought: “What if I’m a sinner who should go to hell?”
– Compulsions: Engaging in repetitive prayers, seeking constant reassurance from religious figures, avoiding situations that may be considered sinful, self-punishment for unwanted thoughts etc.
6. Hoarding OCD:
– Intrusive thought: “What if I throw away this item and something bad happens because of it?”
– Compulsions: Excessive saving and organizing of possessions, feeling extreme distress when attempting to discard items etc.
It’s important to note that these are just some examples within a few common subtypes, and individuals with OCD may experience a combination of different obsessions and compulsions.
OCD can be a highly personalized disorder, and the specific content of obsessions and compulsions can vary greatly among individuals.
What is ERP?
ERP is a type of Cognitive Behavioral Therapy and stands for Exposure and Response Prevention.
We can break this down into two components:
Exposure: The OCD sufferer is gently encouraged to purposefully expose themselves to the feared stimuli that stimulate those intrusive thoughts. This may sound scary and counterintuitive. However, the goal here is to teach our brain that we can manage anxiety without the help of compulsions. The only way we can do this is if we intentionally trigger those feelings of anxiety and uncertainty, so we can practice the second component of ERP…
Response prevention: Once the OCD sufferer exposes themselves to the trigger and feels their anxiety levels rise, the next step is to try not to engage in compulsive behaviors. This stage is incredibly important in OCD recovery. Each time we perform a compulsion, we strengthen OCD’s grip, and the cycle continues. To break the cycle, we must demonstrate to ourselves that we can manage the anxiety without the use of those safety behaviors and, over time, teach our brains that those intrusive thoughts cannot harm us.
The goal of ERP is to change how you respond to your intrusive thoughts and learn that the feared stimuli are not as important as our brain portrays them to be.
ERP: The most effective treatment for intrusive thoughts
The true goal of ERP therapy is to get you back to living the life you would choose to live if OCD did not exist. To do that, we must break the cycle of symptoms by eliminating compulsive behaviors, and teaching you how to tolerate distress without engaging in counterproductive behaviors.
The goal of ERP treatment is not to stop intrusive thoughts.
We cannot control our thoughts, we can only control how we respond to them.
Those with OCD often feel like their lives are shrinking as OCD robs them of experiences, joy, and the ability to make choices driven by their values rather than their fears.
So it is understandable that we naturally seek to escape from those feelings of terror as quickly as possible.
When we try to neutralize those thoughts, we reinforce the belief that these thoughts are important and dangerous. And the more attention we give them, the more they thrive.
Through ERP treatment, with each exposure, you teach your brain that these thoughts do not have significance and do not require your time and attention. Though we cannot stop these thoughts, we can experience them without allowing them to dictate how we behave and experience life.
| NOTE: It is important to work with an OCD specialist in your OCD recovery, if possible. They will be able to administer a thorough diagnosis so you can prepare the best possible treatment plan. ERP is commonly used in conjunction with other therapies such as ACT, as well as prescribed medication. Please speak to a qualified medical professional who can offer a tailored treatment plan designed around your needs. |
Practicing ERP therapy for intrusive thoughts at home
While we recommend working together with an OCD clinician to guide you through the recovery process, studies have found that both therapist-guided and self-administered exposure (exposure done outside of therapy) can better improve OCD symptoms.
If you’d like to get started at home, here are some guidelines to help support you:
- Select a trigger, an obsession-compulsion combination for elimination
The most successful strategy is to begin with the least distressful trigger. It can be tempting to go head first into the most distressing so that you can finally eliminate those terrible feelings. But for sustainable and successful recovery, we recommend taking it one step at a time, starting with what feels most achievable.
- Practice exposure by intentionally bringing on the obsession in reality or imagination.
In this step, your goal is to lean into the triggers that evoke those obsessions. We can do this by making contact in our physical world (such as meeting people we usually avoid, or going to places we usually avoid, or even looking at or touching objects we usually avoid). We can also create imaginary situations within our minds and confront those fears in an imaginal setting.
- Practice response prevention by resisting the urge to engage in compulsive behaviors.
For those trapped in the OCD cycle, there will be an initial urge to eradicate the fears brought on by those exposures as soon as possible. This is when we would ordinarily engage in compulsive behaviors. The goal here is to resist the urge to engage in those compulsive rituals. This may not be possible to do straight away. So you may begin by trying not to perform those rituals for as long as possible first, and increase the time in between the obsession and compulsion.
- Practice allowing and accepting the emotional and physical sensations experienced during these events.
What we want to achieve here is the ability to identify those thoughts, accept and allow the fear and uncertainty that arises, and carry on with our day as normal without the use of compulsions. This is the ultimate goal of OCD recovery.
Support with ERP therapy for intrusive thoughts
There are many modalities that complement ERP therapy for intrusive thoughts such as Acceptance and Commitment Therapy and Mindfulness.
Studies have shown that multiple modalities used alongside medication offer the best result in OCD recovery, but if you were to only choose one, ERP is the way to go!
We often have clients asking if OCD recovery is possible without medication, the answer is yes.
However, it is important that you work together with a qualified mental health professional to receive a tailored treatment plan. Medication has a lot of stigma attached to it, but for some OCD sufferers, it can feel like a lifeline and enables them to engage in therapy effectively.
Private 1:1 Therapy
We understand how nerve-wracking it can feel to take that first step toward recovery and reach out to a qualified professional.
After all, if you’ve read anything about OCD recovery, you likely understand that it isn’t a walk in the park.
It takes commitment, dedication, and a willingness to do the hard work.
Yet, there’s something our team proudly shares over and over again… Our clients may come to us with fear and reservations, but they never regret starting.
Our team is a group of highly qualified OCD specialists. We offer warm and compassionate support as you begin your recovery journey.
Together, we can help you stop letting those intrusive thoughts limit your experiences of life.
If you’re based in California, and you suspect you may be struggling with OCD, please submit an initial intake form here.
It would be our honor to support you with a tailored treatment plan and a specialist who truly understands the pain of your current reality.
You will be welcomed without judgment, only sheer determination to help you increase your quality of life.
Alternative options for therapy
Self-study online program
If you are unable to access private therapy right now, we have an affordable and accessible alternative.
ERP SCHOOL was created by top OCD specialist Kimberley Quinlan to show you exactly how to manage those intrusive thoughts so they no longer ruin your life, and resist the urge to do compulsions.
You will be given the exact tools and techniques used to support private clients.
And you will understand how to apply them to your specific OCD themes.
You no longer have to feel trapped inside your mind and a slave to your intrusive thoughts. You can regain your freedom, and live life how YOU choose.
Support groups
A journey like this is better done with people who understand.
Those who are ahead in their journey, those at the same point, and those who have just begun. There’s nothing more motivational than having the support of someone who truly get’s it.
There are many support groups available.
Please do not struggle alone, there are so many out there who can relate to your experiences and can offer the type of understanding you may not find from those who love you, but have not been through what you’re going through right now.
