Fear, Doubt, Uncertainty, ERP, & the Monster Under the Bed
Everyone I know has, at some point, had to deal with the monster under the bed. Some do it with grace. Others falter. I’ve always been clumsy. I can vividly recall many terrified nights from my childhood, when I would lie rigidly in my bed, utterly paralyzed by fear. Afraid to make the slightest movement, to breathe, to call out for my parents…lest I be detected by IT. The pounding of my heart would be so loud in my ears, and my breathing so ragged, that I could swear the entire house could hear me. And yet…no one came to help. The moment would stretch out like taffy. At some point, my raw fear would ever so subtly decline, freeing me up to end the stalemate in one of several ways. Some nights, I would call out for help....
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Pure-O OCD (Pure Obsessional OCD): Hidden Rituals
“Pure-O” OCD, or Pure Obsessional OCD, is a relatively less common form of OCD that seemingly differs from classic presentations of the illness. What distinguishes Pure Obsessional OCD from classic OCD is that in Pure-O OCD, symptoms are predominantly obsessive (rather than compulsive) in nature. Although individuals with Pure-O OCD frequently experience intense and distressing obsessions, they typically report few (if any) overt compulsive behaviors. However, in almost all cases, pure obsessionals do engage in a variety of rituals. These rituals just manifest as mental compulsions rather than behavioral compulsions. Unfortunately, most psychologists haven’t been trained in how to ask the types of questions that are necessary to identify these “hidden rituals.” As a consequence, these rituals often go undetected. Because effective treatment requires consistent response prevention, a failure to recognize and resist mental compulsions makes true exposure and response prevention (ERP) impossible. Treatment...
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Exposure & Response Prevention (ERP) for OCD: Treatment Mechanism
How does ERP work? What mechanism underlies it? Obsessive-compulsive disorder (OCD) is characterized by obsessions and compulsions. Obsessions are disturbing thoughts, images, or impulses that increase feelings of anxiety. Compulsions (also known as “rituals”) are the strategies that individuals with OCD use to reduce the anxiety associated with obsessions. Rituals are effective coping strategies in the short-term, in that they lead to fairly rapid decreases in anxiety. However, rituals are considered maladaptive, because the anxiety relief they bring is short-lived. Engaging in rituals ultimately increases the likelihood that obsessions will be re-experienced in the future. This can be thought of as a positive feedback loop, in which compulsive behavior indirectly reinforces obsessions. This is depicted in the bottom half of the included figure. The treatment of choice for OCD is exposure and response prevention (ERP), which not surprisingly, has...
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ERP therapy for OCD: Shifting from destructive to constructive to gestalt notions
Here’s a question for you: Is exposure and response prevention (ERP) fundamentally a destructive or constructive process? I think that many people naturally conceptualize it as more of the former than the latter. They conceive of ERP as being the process by which we can “unlearn” or “weaken” maladaptive associations. We learn, through repetition, to no longer be afraid of those things that previously incited fear. On the surface, this appears to be a notion predicated on destruction. In actuality, it is not. If you ever take the time to refer back to the basic animal literature on fear learning and fear “unlearning”, you’ll find that associations appear to be weakened largely as a consequence of new learning taking place. This new learning competes with (and weakens the expression of) previous learning. It is this process that accounts for...
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Advanced ERP for OCD: how subtle rituals can limit your progress
What is exposure and response prevention (ERP) for OCD? As any good psychologist experienced in treating OCD can tell you, the most effective treatment for OCD is exposure and ritual prevention (ERP). You may also see this type of therapy referred to as exposure and response prevention. In this case, the semantics are immaterial; the concepts are exactly the same. ERP is a type of cognitive behavioral therapy (CBT) that is based on the premise that the best way to reduce your symptoms is to practice activities designed to trigger your anxiety and then resist any urges to ritualize. ERP has two main components: exposure – purposely doing activities that are designed to elicit your anxiety response prevention – actively resisting the urge to complete a ritual For example, for someone who worries about germs, an exposure might involve...
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Dr. Steven Seay is a licensed psychologist in Florida & Missouri. He is the Director of the Center for Psychological & Behavioral Science and provides treatment & therapy throughout South Florida, including Palm Beach Gardens, Jupiter, West Palm Beach, Boca Raton, Boynton Beach, Fort Lauderdale, & Miami.
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