It’s not uncommon for those with obsessive-compulsive disorder to experience recovery avoidance. Fighting OCD is tough to say the least, and it takes a lot of strength and courage to embrace exposure and response prevention (ERP) therapy.
But what if the opposite happens? What if you have been plagued by OCD for years and have not only just received a proper diagnosis but have also been informed that this disorder you didn’t even know you had is treatable. You can get your life back! You hear about ERP therapy and are raring to go! The sooner you can get rid of OCD the better.
Maybe you decide not to waste any precious time finding a therapist who specializes in treating OCD, but rather just read up a bit about ERP and tackle it on your own. No need to create a hierarchy – you’ll just begin with one of your most anxiety-inducing situations.
There are many variations of the above scenario, where people either jump into ERP full force or are led into it. Perhaps you are working with a therapist who thinks starting at the top of your hierarchy makes sense. Maybe you’re in a treatment program that uses flooding. Or perhaps you’ve had success with ERP therapy in the past and have relapsed a bit. You feel there’s no reason to start “small” again and instead attempt some really difficult exposures.
No matter what the reasons are for this approach to ERP therapy, it is likely to backfire. It’s too much too soon and usually sets up the participant for failure. Those with OCD might become so discouraged by their lack of success that they might deem themselves “untreatable” and refuse to try ERP again. Others might be traumatized, and still others who deal with perfectionism might find this approach particularly taxing.
That being said, there are times when going right to the top of a person’s hierarchy might be appropriate. The trick here is to work with a competent therapist who truly understands OCD and how to treat it. Good therapists will never force any treatment on you. Rather they will discuss their plan and why they feel you should proceed in a certain way (for example, maybe the fear at the top of your hierarchy is preventing you from even functioning, so that needs to be tackled before more progress can be made). They will not forge ahead unless you are in agreement, as good ERP is client-driven.
In general, I think jumping into ERP full force is akin to starving yourself on a weight-loss diet. If you’ve ever approached dieting in this way, you know you are likely to gain back all the weight lost, and then some. In most cases slow and steady wins the race and gradual exposures in ERP therapy will produce the best results.. If you are willing to commit to ERP therapy, you’ve already won a major battle. Now take it one step at a time to win the whole war.