If you are interested in stopping compulsions using attention control, this is the episode for you. I am really excited for this episode. This was a deep dive into really how to fine-tune your mindfulness practice for anxiety and OCD. Today we have the amazing Max Maisel, who is an OCD and anxiety specialist here in California. He came on to talk about these really nuanced differences of mindfulness, where we might go wrong with mindfulness, how we can get a deeper understanding of mindfulness, and this idea of attentional control. The real thing that I took away from this is how beneficial it can be at reducing mental compulsions, putting our attention on the things that we value, putting our attention on what we want to put attention on, not in a compulsive way at all. In fact, we addressed that throughout the episode, and it’s just so, so good. I’m so grateful to you, Max, for coming on, and I just know you guys are going to love this episode.
Understandably, many OCD sufferers who are plagued with relentless intrusive thoughts day in and day out look for any possible treatment that may help alleviate symptoms.
Recently, those with OCD have turned their attention toward ‘alternative treatments’ such as CBD (Cannabidiol).
In the last few years, CBD has gained global praise from users for its ability to help with anxiety and stress relief.
Welcome back, everybody. This is a last-minute episode. I usually am really on schedule with my plan for the podcast and what I want to do, but I have recently got back from vacation and I have been summoned to jury duty. For my own self-care, the idea of going to this master plan that I created for all of the other episodes that I do a lot of planning and a lot of prep and really think it through today, I was like, “I deeply need this episode to land on my own heart.” This is as much for me as it is for you, and it is a community effort, which also was very helpful for me.
The simple answer to what happens when OCD is left untreated is that OCD symptoms often get worse.
Often when people experience the onset of OCD it interferes with a small area of their life, but when left untreated, OCD tends to spread across other areas of life. Taking away time from their hobbies, family, friends, and pleasurable moments.
Leaving OCD untreated can cause devastation and tremendous pain in one’s life with obsessions and compulsions stealing every moment of our attention and limiting our experiences.
Today, we’re talking about when anxiety causes depression and vice versa. This is a topic that I get asked about all the time. It can be really confusing and a lot of time, it’s one of those things that we talk about in terms of like, is it the chicken or the egg? I want to get to the bottom of that today.
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.
Welcome back, everybody. It is so good to have you here talking about hyper-responsibility & hyperresponsibility OCD. A lot of you may not even know what that means and maybe have never heard it, or maybe you’ve heard the term but aren’t quite sure what it entails. And some of you are very well acquainted with the term hyper-responsibility. I thought, given that it’s a theme that’s laced through so many anxiety disorders through depression that we should address it. I think that’s a really great starting point.
If you’ve been doing research into OCD, you’ve likely come across ERP therapy (Exposure and Response Prevention).
ERP is the gold standard treatment for OCD and has been proven to change the game for those struggling with this common condition.
The goal of this therapy is to purposefully (and compassionately) expose yourself to the very things that trigger those distressing feelings of distress and anxiety. By doing this willingly, and resisting the urge to engage in compulsive behaviors that would ordinarily offer temporary relief…
…you begin to teach your brain that you can manage your response to those obsessions without the use of these safety behaviors and rituals.
I’m sure this sounds scary and challenging!
But, when you’re able to do this effectively, here’s what happens:
Initially, your anxiety and uncertainty levels increase.
Over time, you will find these thoughts and feelings uncomfortable, but you will also come to learn that they cannot hurt you and, in turn, feel much more manageable.
You will notice that when you stop fighting and wrestling with obsessions and uncertainty, the feelings of anxiety will eventually dissipate.
In many cases, you will habituate to a specific exposure, helping you to see that anxiety (and other forms of discomfort) is temporary.
You will notice that you are capable of managing everyday risk and uncertainty without obsessions and compulsions invading every moment of your waking day.
Indeed, ERP therapy isn’t necessarily easy.
But, as our clients like to say, you won’t regret starting.
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What is ERP?
ERP stands for Exposure and Response Prevention.
It is a type of CBT (Cognitive Behavioral Therapy) proven to create incredible results for those in OCD recovery.
The exposure element of ERP is the practice of facing the thoughts, images, objects, or situations that trigger your fears; the very stimuli that provoke your obsessions and cause an intense wave of uncertainty and anxiety.
The response prevention component of ERP is where we resist the urge to engage in compulsive behaviors in response to those obsessions.
In therapy, you work alongside your therapist to create a hierarchy of exposures that feel manageable, and you are never asked to do anything that you don’t feel capable of doing.
It can seem scary and counterintuitive to confront those obsessions.
Many sufferers hesitate to begin ERP therapy because it doesn’t feel quite right to purposefully place themselves in scenarios that make them anxious and conjure those fears.
But OCD is very similar to a faulty home alarm system, as mentioned by the IOCDF.
This faulty home alarm is overly sensitive to trigger warnings of danger and so, every time something even lightly touches the house… the alarm sounds.
It may be a raindrop, a fallen leaf, or even a sharp breeze.
The occupants would never truly know when it was firing off in a case of real danger, because it keeps firing off at false alarms. They never get a moment’s peace!
This is the same for OCD. The sufferer is hyperaware and highly sensitive to threats, no matter how small. ERP is an effective therapy for decreasing sensitivity and effectively rewiring the alarm system.
How is ERP different from CBT?
Cognitive Behavioral Therapy has two core components, cognitive therapy and behavioral therapy.
CBT is a broad umbrella term that encapsulates several cognitive and behavioral therapies, one of those being ERP.
ERP falls into the behavioral therapy camp that was specifically designed to help those with OCD and phobias.
While we must utilize the cognitive component of therapy to identify those intrusive thoughts and change our relationship with them (giving them less validity and therefore less control over our emotional state), it is the behavioral change that comes from ERP practices that ultimately breaks the OCD cycle.
How is ERP different from talking therapy?
Talk therapy (also known as psychotherapy) can be an incredibly valuable treatment for certain disorders.
It is based on the premise of improving a person’s psychological condition by helping them gain insight into their problems. Oftentimes, it takes a deep dive into a person’s past in a search for relevant moments in time that may contribute to who they are today, and why they behave and feel the way they do.
If you have OCD and a co-existing condition, talk therapy may be useful for the co-existing condition, but there is no research or evidence to suggest that it is effective in treating obsessive-compulsive disorder.
The process of talk therapy can very much become a compulsion in and of itself if used in isolation. The conversion and topic that is being processed can mimic reassurance-seeking and rumination compulsions as sufferers try to figure out ‘why they are this way’ or to solve the uncertainty they feel.
ERP therapy is the first port of call (alongside medication if recommended by a medical professional).
How does ERP work for OCD?
ERP can feel daunting for those about to embark on this new treatment in the hope of finally taking their life back from OCD.
The truth is, the ERP journey can be hard work. After all, you’re intentionally placing yourself in situations that scare you and trying to avoid responding in a way that helps you quickly escape and find relief from that intense discomfort.
The truth is, you do not have to do this alone. By working with a qualified OCD specialist, you will have the support and guidance of someone who understands your experiences and can offer a wealth of knowledge.
You and your therapist will work together to create a tailored treatment plan so can gradually move through a tiered set of exposures, from the least distressing to the most distressing.
You pick the exposures and you set the pace!
What does a typical ERP treatment look like?
ERP treatment for OCD usually follows this process:
Understanding and Education
We begin by setting the groundwork for your success!
This means giving you the understanding and insight to understand exactly how OCD works and why it thrives.
Equipped with this newfound psychoeducation allows you to be perfectly prepped for the treatment ahead. It will mean that you know why you’re doing what you’re doing, and how it’s going to make a difference to your life and contribute to your recovery.
You’ll have the practical tools to support you and make the most of this recovery journey.
Preparation is key.
Understanding your fears and compulsive behaviors
Next, you and your therapist will work to identify those fears and compulsive behaviors.
You’ll identify your specific obsessions, your mental and physical rituals, what you fear will happen if you don’t complete those rituals, and what you avoid so that you don’t trigger those intrusive thoughts or compulsions.
Create an exposure hierarchy.
Just before you take action, you and your therapist will work together to form an OCD hierarchy, or what some therapists call, an ‘anxiety ladder’ or ‘exposure hierarchy’.
This is a list of places, situations, and things you avoid in the hope to prevent triggering those fears. You will be asked to rank these in order of least distressing to most distressing on a scale of 0-100 (this scale is knowns as SUDS, or, Subjective Units of Distress Scale).
Treatment begins!
Once you and your therapist have created your anxiety ladder, it’s time to start practicing those exposures.
Your therapist will likely start with an exposure that falls somewhere in the middle of your SUDS scale. Often, you and the therapist will collaborate and find an exposure that feels suitable for you.
You will be led through your first exposure and response prevention session and practice skills and concepts (such as mindfulness, self-compassion, etc.) that help you practice not engaging in physical or mental compulsions.
In early therapy, you may find that you have to engage in certain exposures multiple times. This is very normal.
It may take time to work up to that next goal.
For example, you may be afraid to drive your car to work. First, you may just be asked to imagine driving your car to work. Then you may be asked to sit in your car and imagine driving to work. After this, you may try driving to the end of your driveway and then to the end of your road and back. You would build up this exposure until you feel capable of trying to drive to work.
The idea is to work through these exposures gradually. Although the difficulty of those exposures increases, as you work through your ladder, it becomes increasingly easier as your brain begins to learn that you are capable of managing the anxiety without compulsive behaviors and that you are safe from the perceived threat of those obsessions.
You may be asked to do an activity on your own and report back, or your therapist may witness you doing the activity.
How does ERP treatment feel?
When you first begin treatment, you’ll likely feel anxious and afraid.
You may also have reservations about whether or not you feel capable of facing those fears.
As OCD specialists, we understand that we’re asking you to do a hard thing.
But, once you begin treatment, you will learn that freedom from OCD is on the other side of doing the hard thing!
It is completely normal to want to avoid those anxiety-inducing triggers that have caused you such pain and torment.
But approaching them willingly and allowing those feelings of uncertainty and anxiety, is what therapy is all about.
When you can feel those extreme emotions and resist the urge to engage in those OCD rituals, you are one step closer to breaking the OCD cycle and loosening its hold on you.
OCD rituals exist because they transiently help you navigate the anxiety. You engage in those behaviors because they help you feel less afraid and offer temporary relief from the fear and discomfort.
If you can find the courage to sit in those feelings of fear and uncertainty without performing compulsive behaviors, your mind and body will learn that you can manage without them. This provides you the long-term relief of overcoming OCD and getting your life back!
Yes, at the beginning it may seem scary. But in the end, it’s empowering.
How long should you do ERP for OCD?
The length of ERP treatment is based on the individual and the severity of their OCD symptoms.
However, on average, clients can see clinically significant results within 2-3 months of treatment.
Those with more severe OCD symptoms can still achieve remarkable results, but it may require a longer timeframe.
The one thing to remember is that there is no “right” timeline for treatment. While the goal is to see improvements as soon as possible, we also do not want to put so much pressure on you that you now feel overwhelmed.
Our team of qualified mental health professionals and OCD specialists is committed to the successful recovery of our clients. We have found that those who see the best results commit to frequent and consistent sessions with their therapists, engage in the program, and communicate openly about their experiences.
We want to see you recover from this condition as quickly and effectively as possible, knowing that many clients come to us after suffering in silence for years before even receiving a diagnosis.
Can you do ERP therapy for OCD on your own?
While it is generally recommended to work with a trained therapist or mental health professional when undergoing ERP therapy, it is possible to practice certain aspects of ERP on your own.
However, it is important to note that self-directed therapy may have limitations and may not be as effective as working with a professional.
A therapist can provide guidance, support, and expertise to tailor the therapy to your specific needs, monitor progress, and address any challenges that may arise during treatment.
That being said, there are a few steps you can take on your own to implement ERP principles:
1. Identify your OCD triggers: Make a list of situations, thoughts, or objects that trigger your obsessive thoughts or compulsive behaviors.
2. Gradual exposure: Begin exposing yourself to these triggers in a gradual and controlled manner. Start with situations that provoke mild anxiety and gradually work your way up to more challenging triggers.
3. Resist engaging in compulsions: During exposure, make a conscious effort to resist performing compulsive behaviors or rituals. Instead, allow yourself to experience the anxiety without giving in to the urge to alleviate it.
4. Practice mindfulness: Learn and practice mindfulness techniques to help you observe your thoughts and emotions without judgment or resistance. Mindfulness can help you become more aware of your obsessive thoughts without becoming overly engaged with them.
5. Keep a record: Maintain a journal or log to record your progress, including the triggers you faced, the level of anxiety experienced, and any successes or challenges encountered during exposure.
While these steps can provide a starting point for self-directed ERP, it is crucial to consider consulting with a mental health professional who specializes in OCD and ERP therapy.
They can provide personalized guidance, monitor your progress, and ensure that the therapy is implemented effectively and safely.
ERP Therapy for OCD
Qualified 1:1 therapists
If you are based in California, our team of highly qualified mental health professionals and OCD specialists would love to guide you through your recovery. We welcome you with warmth and compassion, and without judgment.
While we understand that you may feel hesitant to reach out, we only want you to know that the best time to begin is today.
Nothing will be as hard as what you’ve already experienced, facing every day with this disorder. You’ve done the hard part!
Recovery is not easy, but it feels more achievable when you have a professional in your corner, and you begin to see and feel how life could be different.
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, LMFT 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.
Kimberley: Welcome. This conversation is actually so near and close to my heart. I am so honored to have Jessie Birnbaum and Sandy Robinson here talking about Managing the anxiety of chronic illness and disability. Welcome and thank you both for being here.
