Exposure Therapy is Both the Best and Worst Thing I Can Do For My OCD

It’s terrifying, but it’s worth it.

Yesterday, I felt my OCD rearing up again and decided the best thing for me to do was my exposure therapy. I’ve been doing this therapy – Exposure Response Prevention Therapy – for the last four months, following a diagnosis of severe Obsessive Compulsive Disorder.

According to OCD UK, “Exposure Response Prevention, commonly referred to as ERP, is a therapy that encourages you to face your fears and let obsessive thoughts occur without ‘putting them right’ or ‘neutralising’ them with compulsions. Exposure therapy starts with confronting items and situations that cause anxiety, but anxiety that you feel able to tolerate. After the first few times, you will find your anxiety does not climb as high and does not last as long. You will then move on to more difficult exposure exercises.”

As I geared myself up to do the exposure therapy, I was terrified. I knew this was the best thing for me to do to improve my welfare in the long term, but, in the moment, I was terrified.

It felt like the worst thing ever.

Every time I do my exposure therapy, I record it in a notebook.

The location: my house

The obsession: my clothes are dirty

The compulsion: I need to shower now and change my clothes

The why?: because I can’t sit down anywhere without spreading the contamination

The exposure activity: no showering or changing clothes AND sit on the bed and chair, spreading the “contamination”

Anxiety level at start: 80%

Anxiety level at end: 30%

Time it took for anxiety level to drop: 1 hour

I’m pleased to report I successfully completed this exposure exercise.I ignored my compulsions and purposefully exposed myself to an activity that made my anxiety worse.

It’s important when doing exposure therapy that you don’t distract yourself from the feelings of anxiety but really focus on the anxiety itself. So when I sat on my sofa and bed, I didn’t do anything else but think about the unease I was feeling and the contamination I was sure I was spreading around my house.

I thought about the unease until it went away. It took an hour, but by the end of it felt better. And next time I have to do that same exercise, my starting level of anxiety should be lower.

But the beginning of that hour? Well, it felt like the worst thing ever. My heart was racing, my brain was over-active, telling me how what I was doing was wrong. I couldn’t stop thinking about the danger.

But “there is no way past OCD except through it.”

Recent studies show that those with OCD experience changes in their brain that mean they cannot understand when there is a real threat of danger. Their fight or flight response goes off at the slightest thing.

This is certainly what I experience with my OCD. For six months, I lived in a near constant state of fear due to my fight or flight response being constantly set off, multiple times an hour. Even when I was asleep, the changes in my brain meant I was still experiencing fight or flight — I’d wake up and be absolutely terrified. I wouldn’t know why I was terrified, but my OCD would try and explain it through my contamination fears: “You need to clean this” or “you went to bed without doing this properly.”

It was exhausting, and for those six months, I slept very poorly. I rarely entered REM sleep.

The Anxiety and Depression Association of America reports that “OCD is the fear network of the brain sending a signal that something is wrong and needs to be done about it IMMEDIATELY. OCD only reports on feared consequences that are important to a person.”

As “ERP involves exposure to the feared stimuli (the exposure part of treatment) and simultaneous prevention of a ritual, which is typically performed in the face of the anxiety-provoking stimuli or obsession (the response prevention part of treatment)” (Psychology Today), starting ERP is the hardest. Every time I’ve done an exposure exercise I’ve found this: the knowledge that it’s about to set off my fight or flight response is almost worse than the panic I will actually feel.

The anticipation of this horrible feeling then sets off my fight or flight response, so this response gets triggered not only by the actual exposure exercises, but at the thought of doing the ERP too.

But learning about the fight or flight mechanism in the brain — and how this is overactive in those with OCD — is vital to recovery.

Psychology Today goes on to say, “Emotion Processing Theory, part of a Cognitive Behavioral Therapy model, asserts that patients learn new implicit and powerful lessons when they engage in ERP treatment. One such lesson is the way in which the “fight or flight” system works. Patients learn during ERP that their sympathetic nervous system responsible for the physiological part of anxiety is unable to maintain a fight or flight response indefinitely.”

For me, learning that my fight or flight response couldn’t last forever when I was doing an exposure exercise was so reassuring — because at the time, it feels like that feeling will last forever and that I’ll never be free of it again.

Of course, my fight or flight response was constantly being triggered, but I did have moments in between these episodes — but I was terrified that those moments would get fewer and fewer, until I was in a constant state of adrenaline and OCD.

So, for me, ERP does two important things for my fight of flight response: it retrains my brain so that my fight or flight response isn’t constantly going off at the slightest thing through teaching me the perceived danger isn’t real, but it also helps me manage my fear when it does go off. I now know that the feeling will pass. I just have to get through it.

But every time I go to start an exposure exercise, it still feels awful. The only thing that keeps me doing it is my fear of the OCD itself. I remember what it was like when the OCD completely controlled me. I lost months of my life. And I don’t want to be like that again.

Doing exposure therapy may feel awful at the time, but in the long run, I know it’s the best thing I can do to overcome my OCD.

But it takes work, dedication, determination, and patience.

Madeline Dyer is a young adult novelist. She also writes personal essays on topics such as mental health, disability, and neuropsychiatry. You can follow her on Twitter and Instagram @MadelineDyerUK and visit her website www.MadelineDyer.co.uk. If you’d like to keep up to date with her writing, you can follow her on Facebook for both her novels and her personal essays.