Exposure is Never a Replacement for Response Prevention

Perhaps the most common question I hear OCD therapists ask is what Exposure to do for a certain compulsion.   Unfortunately, such a question reflects a misunderstanding of how ERP works, because Exposure doesn’t eliminate compulsion.  The only thing that eliminates a compulsion is the decision to stop doing it.  This is the Response Prevention part […]

Exposure Is About Learning, Not Habituation

When I was first trained in exposure therapy, I was taught that exposure works because the patient habituates (gets used) to the stimulus that causes them anxiety, or habituates to the feeling of anxiety itself.  On paper, this makes a lot of sense. Here’s how I used to explain it to patients: “If a person […]

What If Exposure Shouldn’t Make You Anxious?

The following is a thought piece.  In contrast to my other articles, it’s not meant to educate as much as to start a conversation.  When I started on my journey away from the importance of desensitization, I initially just let go of the idea that feeling anxious during an exposure was an important mechanism in ERP.  […]

ERP Exercises for Compulsive Rumination

I use the series of exercises in this article to help patients practice eliminating compulsive rumination.   Since Exposure is About Learning, Not Habituation, the goal of these exercises is not to make patients anxious.  Rather, the goal is for them to learn that they can control rumination, even when they encounter a trigger. Some notes to […]

It Matters How We Talk About OCD: The Importance of Using Language of Agency

OCD isn’t random or illogical.  It is a comprehensible, logical strategy (avoidance and compulsion) aimed at preventing the Core Fear.  Recovering from OCD requires recognizing that you are employing a strategy that doesn’t work, and learning that you have the ability to make different choices that lead to feeling better. Put another way, recovering from OCD […]

Using Imaginal Exposure When Practicing ERP from the Perspective of Learning

I approach exposure from the perspective of learning as opposed to habituation (For further discussion, see Exposure Is About Learning, Not Habituation).  From this perspective, the point of exposure isn’t to habituate to a stimulus but rather to learn something. It’s easy to conceptualize how this might work for an ‘in vivo exposure,’ in which you […]

Rethinking the Process and Treatment of Compulsive Rumination

The below is a the first article I wrote on this topic a few years ago. Please note that these ideas have evolved significantly since that time. Please also note that the below is geared towards therapists and those very well acquainted with the theory and practice of ERP. I believe that the issue of […]