What You Should Know About Exposure and Response Prevention (ERP)

Did you know that there’s a treatment for Obsessive Compulsive Disorder (OCD) that’s been shown to be effective for up to 80% of people with OCD? It’s a type of Cognitive Behavioral Therapy (CBT) called Exposure and Response Prevention (ERP).

What is Exposure and Response Prevention (ERP)?

ERP was developed to treat OCD, and it can be an incredibly effective form of treatment for folks dealing with obsessive thoughts and compulsions. 

To understand ERP, it can help to understand more about how Obsessive Compulsive Disorder works. OCD involves intrusive thoughts that are disturbing and unwelcome. Often, these thoughts create a lot of distress for the person who is experiencing them. When these thoughts pop up and cause distress, people with OCD attempt to relieve the distress through compulsions, which may work briefly. 

After a while, though, the thoughts come back, and the cycle starts again. The compulsions that a person uses to relieve their discomfort eventually become part of their daily routine, which can get in the way of work, family, and other relationships. 

When we think of OCD, we often think of someone who is obsessed with cleaning, but that’s not actually how most people experience the disorder. People may have recurring, unwanted thoughts about harming people they care about, or that something bad will happen if they don’t follow through with their compulsions. Some people experience intrusive sexual thoughts, or thoughts of doing something violent or illegal. These thoughts are not in the control of the person experiencing them, and they can be extremely frightening. 

To try to lessen the fear they feel from these thoughts, people with OCD may develop compulsions or rituals like checking to make sure the smoke detectors work, making sure the baby is still breathing, making sure that the emergency brake is on, or checking that the security system is on. The overwhelming feeling is that if they don’t practice these compulsive rituals, something terrible will happen, and that can be an exhausting way to live. ERP was designed to interrupt this cycle and reduce the anxiety that feeds these intrusive thoughts. 

How does ERP work? 

There are two parts to ERP - the exposure and the response prevention. Within the safety of a therapist’s office, you’ll be exposed to the triggers and thoughts that cause you distress. Then, you’ll practice resisting the urge to perform the corresponding compulsions or rituals. 

First, you’ll work with your ERP therapist to determine what all of your triggers, intrusive thoughts, and compulsions are, so you can work through them in a safe place. This helps you and your therapist determine which triggers and obsessive thoughts cause you the most distress, so you can work your way up from lower levels of distress to higher levels over time. Exposure and Response Prevention works gradually. You aren’t going to be asked to confront your worst fears right away. As you move up the hierarchy of distress, you’ll gain confidence and experience, which help when it comes to the more distressing levels. 

As you’re exposed to your triggers or your intrusive thoughts in ERP therapy, you’ll learn skills from your therapist to help you learn how to sit with discomfort and resist your compulsions. Working with a therapist can help ensure you avoid replacing one compulsion with another, in addition to teaching you skills to help lower your distress level when the unwanted thoughts come up. 

Exposure and Response Prevention works for two reasons - habituation and inhibitory learning. Repeated exposure to your triggers will help you learn to tolerate your distress and discomfort more effectively, which reduces your overall distress level over time. This is known as habituation. Inhibitory learning happens when you learn that your intrusive thoughts don’t always come to pass when you’re exposed to your triggers. ERP helps to prove your obsessions wrong, which helps to lessen their impact. 

What are the benefits and drawbacks of ERP?

ERP is generally known as the gold-standard treatment for OCD, because research has shown that it can be extremely effective. However, it’s important to note that Exposure and Response Prevention takes work, and it’s not always easy. 

Confronting the things you’re afraid of can be terrifying. Effectively learning how to break the cycle of obsessions and compulsions requires work in between therapy sessions, which can be intimidating, especially at first. Folks with OCD are practiced at avoiding discomfort, so learning how to be okay with discomfort takes time and practice. 

Can ERP help with anything else?

Yes! ERP can help with disorders besides OCD, including: 

• Anxiety

• Eating disorders

• Phobias 

How to find an ERP therapist

If you or someone you know is struggling with intrusive thoughts, ERP might be a good fit. Our clinicians at Hope+Wellness have experience supporting clients who have Obsessive Compulsive Disorder. We serve the McLean, Great Falls, Falls Church, Arlington, Alexandria, and the greater Washington DC regions, as well as offering online services in DC, MD, VA, and all PSYPACT states. 

If you would like to talk to one of our therapists, please contact info@hope-wellness.com or get in touch with us here.

Managing Racing Thoughts That Keep You Awake

What are racing thoughts?

Have you ever been trying to fall asleep, but your thoughts just wouldn’t stop? One minute you were sleepily dragging yourself under the covers, and the next your heart was pounding and your thoughts were racing and your breaths were coming in short and quick?

Racing thoughts aren’t uncommon–we all deal with them from time to time. Some people experience them during the day, but often our daily routines and responsibilities and the general business of life keeps our minds occupied more naturally. 

At night however, suddenly your brain can’t shut off, you’re feeling all of that stress you didn’t have time to focus on during the day all over again without anything else to occupy your mind. Now, maybe even more so because now you have the added stress of not being able to fall asleep when you need to. This can also make your racing thoughts feel impossible to fight against–you want to sleep so you just lay there, but then just laying there gives more opportunity for your thoughts to race. 

What does it feel like to experience racing thoughts? 

When your thoughts are racing, it feels like an endless spiral you can’t get out of. Any attempt to end your thoughts just leads you down a new avenue for more spiraling thoughts, and on and on and on. 

There’s a physical response as well: pounding heart, increased sweating, and breaths coming in short, quick bursts. Your body is basically in a stress response, which puts it on high alert, making it physically harder to get back to that feeling of sleepiness. 

Why do racing thoughts happen?

Racing thoughts can be a symptom of a larger mental health concern such as: 

• Anxiety or Panic disorder

• Bipolar disorder

• Post traumatic stress disorder

• Obsessive compulsive disorder

• ADHD

If you’re experiencing racing thoughts chronically, take time to talk to your therapist and doctor, because there may be a larger issue to be addressed with medicine or therapeutic treatment, or both. 

But chronic conditions aren’t the only things that cause racing thoughts. Other things that can influence the frequency of racing thoughts at night can include: 

• Times of high stress: If you’re struggling in your relationship, navigating family, financial or professional stress, trying to juggle the stress that comes up around the holidays, spikes in your stress levels can precipitate an increase in racing thoughts as you’re trying to sleep. 

• Big transitions: A new job, moving, ending or beginning a relationship, beginning parenthood, etc. can all bring on major stress, which can in turn bring on the racing thoughts. 

• Some medications: If your racing thoughts began around the time you’ve started a new medication, it’s good to bring it up with your prescribing doctor. 

• Caffeine consumption: try to avoid caffeine after 6pm, drinking coffee or caffeinated soda/tea too close to when you go to bed can stimulate your brain and make it harder for you to fall asleep. 

What to do when your thoughts are racing: 

Mindful breathing practices:

Practicing mindful breathing helps both to calm your body as it slows and steadies with your breath, but it also helps you to reroute your thoughts away from the spiral and into the present moment. Some mindful breathing exercises you can try are: 

• 4-7-8 breathing: Inhale for 4 seconds, hold your breath for seven seconds, release for 8 seconds, and repeat. 

• Box breathing: breathe in, hold breath, breathe out, hold breath, repeat. 

• Diaphragmatic breathing: Breathing from your diaphragm, inhaling as fully and slowly as possible, exhaling and repeating. 

Get up and do something (then go back to bed): 

There is nothing else for your mind to latch onto when you’re trying to go to sleep, so it’s easy to get trapped in racing thoughts.If mindful breathing doesn’t help slow your body and mind down, pick something small to get out of bed and do. Get something to eat, a glass of water, read a chapter of a book, do a few stretches. Give your mind an opportunity to get tired, then get back in bed and go back to your breathing exercises to help sleep come faster. 

Establish better sleep hygiene:

Create a routine that helps you slow down your thoughts and relax your body before bed. Adding a few minutes of calming stretching can help slow and deepen your breathing and allow your body to relax and it can also help you practice mindfulness which will in turn help you manage racing thoughts in the future.

Explore the root cause and long term treatment options with your therapist:

Whether you’re going through a period of high stress or a big life transition, getting curious about what is prompting your racing thoughts in therapy can help you better learn how to manage them. Or, if a more chronic condition is at the root, they can help guide you through the next steps for treatment. 

If you need more support, contact us today! Our therapists can help you address and resolve your racing thoughts. 

Is Perfectionism Holding You Back?

What is perfectionism?

“Perfectionism is a trait that makes life an endless report card on accomplishments or looks.” That is how Psychology Today makes short work of defining perfectionism. While simple, this succinct definition of perfection hits the nail on the head. 

While achieving perfection sounds positive, the trait of perfectionism is actually more toxic than beneficial to our overall health and wellness–because, as most of us know, perfection isn’t actually possible to achieve. Instead, perfectionism is a trait that acts as a harsh, critical voice inside our heads, making us too afraid of failure or criticism to try new things, expand our world, or let ourselves be vulnerable in any way. 

In essence, if you are a perfectionist, the thought of doing something incorrectly can hinder you from trying it at all. There is a constant fear of judgement, criticism, or ridicule in the back of your mind. You also likely attribute your value, your worthiness, your purpose, etc. to things that you can achieve. Due to this, the idea that you might not be successful at something new isn’t just a learning experience for you; it’s an experience that makes you question your value entirely. 

Signs you might be a perfectionist: 

• You would rather not do something at all, than do it incorrectly

• You’re specific about your process: things have to be done in a certain way or else they are wrong

• You’re overly critical of yourself

• You pay more attention to criticism than praise

• Your standards (in work, regarding personal goals, etc.) are extremely high

• You’re prone to procrastination

• You invest too much time in something, often “correcting” mistakes that others don’t see

•  Success is never enough: no matter what you accomplish, you feel you can still achieve more.

Where does it come from?

As we touched on above, perfectionism is rooted in fear, which can essentially be boiled down to one general fear: that you won’t be enough. 

Whether that comes in the form of not being smart enough to do something well, or not being creative enough to tackle a new project, or not being skilled enough to be an expert at everything, there’s is an underlying fear at the root of all perfectionism. 

In the mind of a perfectionist, criticism isn’t just a tool that can be used to learn, grow, and get better. It’s a judgement on their worthiness, their quality, all of the core parts of their identity. 

How does it impact our lives?

Obviously, this trait can have a huge impact on our lives. 

Whether your perfectionism comes in the form of obsessively hiding your imperfections from others, or in trying to achieve perfection in all things, it can take a huge toll on the self. 

If you are constantly worrying about perceived imperfections, you will be more concerned with how you’re appearing to others than actually taking care of yourself. Rather than making decisions based on what it is you need and want, you’ll make decisions based on how those choices will appear to an outside observer. 

And if you are constantly trying to achieve (or at least project) perfection in all things, failure–or not being able to achieve absolute perfection–will feel devastating. In fact, it will feel so horrible that you likely will stop trying new things, stop allowing yourself to be vulnerable, and stick only with what you know you can do. 

In either of these cases, it’s clear that perfectionism is a one way track to stopping our growth and self betterment. 

How can we resist the pressure of perfectionism?

Learning to resist the compulsion for perfectionism is hard, and can feel very scary. But it is also an amazing step on your journey toward self care! While healing from perfectionism can be a long and arduous journey, there are a few things you can do for yourself to get you started:

1). Give yourself concrete reasons for change

This may seem silly at first, but make a pro + con list when you see your perfectionism rearing its head. How are you benefitting from the need for perfection? How is it holding you back? Maybe there’s a big project you need to be working on, but you know that you aren’t ready to do it perfectly, so you’re putting it off. The “pro” here is that you’re giving yourself a sense of reassurance that there will be a later time when you’re more prepared to handle this task, and you are saving yourself from immediate criticism. But how else is it impacting your life? In the “con” side you might out things like: putting this project off is making it harder to manage my time, I’m constantly stressed because I know I will have to deal with it later, I’m giving myself a shorter amount of time to produce something of quality, etc. 

Be kind to yourself when doing this exercise. Remind yourself that your perfectionism serves a purpose–it likely exists to offer you some sort of protection. However, at this point in your life, the protection it offers is outweighed by the burden it puts on you. Giving yourself a physical list to show this can be a powerful reminder & motivator when trying to overcome your perfectionism. 

2). Celebrate what you’ve done well

A big problem in perfectionism is that when a perfectionist is not 100% successful at something, they don’t just see it as an instance in which they failed. Rather, they see it as the turning point when they became a failure. Reminding yourself of things you have accomplished, jobs done well, even small victories, can help you to remember that even if you don’t succeed at one thing, you aren’t a failure. 

3). Only compare yourself to you 

If you’re trying something new, and you compare yourself to an expert, you’re obviously going to feel like you’re coming up short. Instead, use yourself as the yardstick to measure accomplishment. If you want to learn to play the piano, don’t compare your first day at a piano to Elton John now. Instead, think about how yesterday, you didn’t have the courage to even sit down at a piano, and now you’re actively learning! In a month, or a year, you’ll be able to look back and see what progress you’ve made. 

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therapist in falls church, mclean, tysons corner, merrifield, arlington and vienna, va

Hope+Wellness is a psychotherapy practice serving the Falls Church, McLean, Great Falls, Vienna, Arlington, Alexandria, and the greater Washington DC region. We provide individual therapy to children, teens, and adults with stress, anxiety, and depression. Our practice is in-network with BCBS and provides Cognitive Behavioral Therapy (CBT), mindfulness and acceptance based therapies, and other top, premier evidence-based treatments. Call, email, or schedule an appointment with us online today. We’re happy to help!