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Your Anxiety Toolkit - Practical Skills for Anxiety, Panic & Depression
482 Why My ERP Isn't Working: 5 Common Mistakes & What to Fix
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Welcome back to your Anxiety Toolkit podcast. I am so excited you're here. Now listen up. If you are listening to this on the day in which this is released, which is April 22nd, I want you to not walk, but run all the way to cbtschool.com I want you to click the link below this podcast because we are having a little bit of a launch party for one of the courses that we have, which is called your OCD toolkit for today only. If you register for your OCD Toolkit, you will also get a free live Q and A with me where I answer all your questions about the course, about the modules, about ocd, what's getting in the way. It is going to be so much fun. I have been doing this about once a month with different courses that I have. If you're someone who wants to be in the know of what's going on with this, do go over to cbtschool.com and sign up for our newsletter because I give a lot more. More noticed than I am today. But what we want to do here is I'm loving answering your questions. I'm loving you guys taking the courses as a cohort and then coming on and doing live Q&As with me where we really get to the nitty gritty. So again, click the link in the show notes. I cannot wait to meet with you and see your beautiful face and chat with you online. All right, let's get over to the episode. Now, you're doing all of the exposures, but why does it feel like you. Nothing is changing. Nothing is moving the needle. Now, ERP is one of the most powerful tools for OCD and anxiety, but there are specific tricks that make it work a little better. Now, by the end of this video, you will learn the five most common ERP mistakes, how to do exposure and response prevention in a way that actually works. And I'll also include what to do
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when you're beating yourself up because you're struggling.
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Welcome. My name is Kimberly. I'm an OCD specialist and I am on a mission to help 10 million of you suffer less with anxiety and OCD. Now, the good news is the New York Times also listed your Anxiety Toolkit podcast as one of the top six anxiety podcasts. So, wow. So excited about that. And so it's really put a fire under my heart to really help you as much as I can. Now, the thing to remember here is you are not broken. You might just be making a couple of these teeny tiny mistakes. And once we recognize that you're on your way. Now, the truth is, is that most people who struggle with erp, it's not because they're doing anything wrong or by lack of trying. They're just missing a few critical nuances. And today we're fixing that. So if you've ever thought I'm doing everything right, but it's just not working, this episode is for you. Now, as always, we're going to give you your anxiety toolkit, and I'm going to give you the five mistakes and how you can fix. So mistake number one is that there's no ritual prevention. Now, in your OCD toolkit, we have what we call the OC cycle. And this is really explaining specifically what's going on for you. If you have ocd, first there's an obsession, then you have discomfort, then you engage in a compulsion to make that go away, and then you get some relief. But the problem is that compulsion reinforces the anxiety, and so now you're stuck in a loop. Now, what happens with ERP is we practice exposing you to your fear, whether that be your intrusive thoughts, your feelings, your sensations, urges, or images. We practice having them on purpose. And often people are focusing a lot on these exposures, but they're not investing in the actual response prevention. Now, what's most important, and if there's one thing you take away from today, which it needs to be that erp, in my opinion, should really be response prevention and exposure, not exposure and response prevention. I have found that with my clients, when we focus on response prevention, that gives them more bang for their buck than doing exposures all day long. Often people will say to me, I'm facing my fears. I'm facing my fears. I'm facing my fears. I'm facing my fears. And I'll say to them, well, what are you doing after you face your fear? What are you doing with that fear? How are you responding to it? And they'll say, well, I'm ruminating, or I'm, you know, I'm freaking out, or I'm catastrophizing, or I'm going to ask for reassurance. And sometimes they'll say, I can't even help myself. And so what we want to do is really get good at understanding what specific compulsions you do. In your OCD toolkit, we actually have a whole worksheet for this. We want to know what compulsions you're doing, and we want to do response prevention to each and every one of those. So if you're doing Physical compulsions, we want to work at being able to reduce those. If you're doing avoidant behaviors, we want to reduce that. If you're doing a lot of mental rumination, we want to have skills to learn how to ruminate less. If you're doing reassurance seeking or self punishment or depressive compulsions, we want to make sure that we're doing response prevention to reduce these. Now, the thing to remember here is it's not a. You know, often I'll talk to my clients and I'll say, well, we need to do response prevention. And they'll say, well, that sounds easier said than done. And that's because that is true. Practicing response prevention takes time, it takes patience, it takes willingness to be uncomfortable and uncertain. It's such a huge part of the work we do. Exposure and response prevention isn't just running out and facing your fears. It must involve holding back from engaging in any of the behaviors we do to try and reduce or remove the discomfort or uncertainty that you're experiencing. Now, the second common mistake I see is we've already touched on this a little bit, which is sneaky mental compulsions. Often clients will say, no, I'm not checking. I'm not asking for reassurance. I'm not googling, I'm not, you know, I'm not doing any of those behaviors. And when we really do a thorough analysis, we do find that there are always these nuance sneaky mental compulsions happening. Now, I'm going to give you a little list here of some common mental compulsions. These are just a few of them, but these are things I want you to look out for if you're reviewing or replaying what's going on and what was happening and the thing that you're anxious about, if you're neutralizing it. So if you're replacing a scary thought with a positive or a happy thought, if you're ruminating, going around and around and around trying to solve something, mental checking is important to know about too. So, yeah, we might check the stove, we might check the door, but are you mentally checking the door? Are you walking and glancing at it? Are you walking past just to see whether the thing that you're afraid may or may not happen has happened? That is called mental checking. Are you seeking certainty? Are you looking for the answer to a question that doesn't actually have an answer? Often I'll say to clients, if you're ruminating, the chances are that the thing you're trying to solve is unsolvable, is very, very High. Another one is internal reassurance. So sometimes clients will do an internal check to make sure that they're not having an urge to harm someone or they're not having sexual arousal. If they're having more sexual obsession, they might check internally on whether they're having good thoughts, whether the thoughts they're having are pure and aligned with their values. That is another sneaky mental compulsion that people deal. Another one is thought suppression and distraction. Now, it's okay to move on and put your attention onto what matters. That is a huge part of managing mental compulsions. But if you're moving forward thinking, no, no, no, no, no, no, I don't want to think that. Don't think that. Don't think that you're pro more thoughts. Remember, what you resist persists. The act of trying not to have the thought is you having the actual thought. Again, it's counterintuitive, but thought suppression does not work. Another one is imagery compulsions. Often people will be practicing imagery of having a good thought, having a good image, trying to avoid those scary images that they're having intrusively. That is another sneaky mental compulsion. We also have mental confession and, and rehearsal. And another one is ritualized thinking. One that I didn't mention here is mental hoarding. This is where you're mentally taking Polaroids or mental images of things so that you can remember them so that you're not uncertain later. Again, these are all very sneaky forms of mental compulsions that can reinforce that OC cycle. So the third common ERP mistake that people make is really misunderstanding the importance of hierarchy levels. Now, when I'm working with a client, so let me give you an example. In your OCD toolkit, we actually have a worksheet called the Obsession and Compulsion worksheet. This is where you write down all of your obsessions on the left, and then on the right you write down all your compulsions. And then what we do is we assign a number value to those compulsions you're doing on how hard it would be for you to not to engage in that compulsion. Remember, that's the response prevention piece.
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Now, as you know, I have a private practice. I have six amazing therapists in Calabasas, California. However, we do not take insurance. Now, if you are looking for insurance covered OCD or BFRB treatment, I want
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to let you know about nocd.
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NOCD provides face to face live video sessions with specialized licensed OCD therapists. Now, their therapists use exposure and response prevention. We know this is the gold standard for OCD so you can be absolutely confirmed that you're in the right place there. And they have a clinically proven app
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that helps you stay connected to your
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therapist and others who have OCD between sessions. So you'll always feel supported. Now, the cool thing is NOCD is available in all 50 US states and even internationally, and they accept most insurance plans, making it affordable and accessible.
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We love that.
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Now, if you think you might have OCD or you're struggling to manage your symptoms, you can book a free call. Just click the link in the show notes@nocd.com I am on intended to partner with NOCD. I want to remind you that recovery is possible. Please do not forget that. Now, big hugs and let's get back to the show.
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And so a really common example might be someone who has, let's say, harm ocd. They might say that they commonly check their baby for harm. And I'll ask them, how much anxiety will it cause you to not engage in that behavior? Let's say they say, well, it'd be like a 7 out of 10 if 10 was the highest and one was completely, really barely any anxiety. So if let's say they said it's a 7 out of 10, let's say they have a list of 15 to 20. Sometimes it's 100 things or compulsions that they're doing and they've listed out of 10 how difficult that is. Now, when you go back to this main mistake we make is often people are either going in way too low, they're starting at twos and threes, and they're not getting any benefit of the exposure because it's not high enough for them to really get that learning. A lot of ERP is you learning that you can tolerate discomfort. And so they're staying really safe by doing the twos, threes and fours. Where we want you to be at is really at the sevens and eights. I love an exposure that's at 7, 8, maybe a 9. Now, 7 and 8 is the sweet spot I have found to where it's challenging enough. You get a ton of learning from it. You really learn that you can tolerate discomfort. You get more bang for your buck. Now, the other problem is, is that sometimes people go too high. They hit that 10 out of 10. Let's go back to that harm example is maybe avoiding diaper changes as was it. You know, if they were to practice doing that, that would be a 10 out of 10. So they just throw themselves into that 10 out of 10 thinking like, I'll skip all the hard stuff. I'll just go straight to the top again. I'm okay with this. Sometime will practice this. When I'm with clients, however, they throw themselves into a 10 out of 10 to where they have no skills to manage it and they have no choice but to go back and do some compulsions again. Now remember, exposure is only effective if you're also practicing response prevention. I would prefer response prevention over exposures. So if you need to do an exposure that's lower in your hierarchy, when you know you can practice response prevention, well, that's way better than hitting those nines and tens. But then after you do that exposure, you're completely unraveled and you've got no choice but to go and do a ton more compulsions. So just to recap, we want to really make sure that you're not chasing fear reduction in your exposures. This is only going to keep you locked in the cycle. So remember, as you're doing exposures, make sure that you're not doing exposures as a compulsion. What do I mean by that? You're thinking, oh, last time I did exposures, I totally got all this relief. Nothing bad happened. Oh, I'm so relieved. Yay. And so you start to do, so you start to do exposures as a way to give yourself reassurance that you're nothing bad will happen or that you're not a bad person or you won't lose control. Anxiety during ERP is not a failure. It's actually the point. The whole purpose of us doing this terribly difficult work is to practice and learn that we can tolerate anxiety. That is the point of this work that we're doing. And the last thing I want you to remember is I want you to redefine success. Instead of thinking, how can I just get through this as fast as I can, I want you to ask yourself, was I willing to be uncomfortable? How can I increase my willingness to next time I go to do this? And with each exposure, you're going to build evidence that, wow, I can really handle this. Let's move on to number four. Now this is very important because I've seen clients chug along in therapy. They're doing all their homework, they're like a straight A student. They're doing so well, but they beat themselves up the entire way. It is like a full on whipping event. They are just whipping themselves. So they're doing the exposure, they're doing the response prevention. But they're like, you shouldn't be doing this. You shouldn't have had to Go through this. Why is this happening? It's so painful. The harder you judge yourself for the thoughts that you're having and for the disorder that you have, the more threatening and more anxiety you have. We've talked about this so much on the podcast. The more you beat yourself up, the more anxiety you're going to have. You're actually feeding your body this feedback loop that you're in threat. The danger is here that you are bad. And again, you can probably hear it in my voice if I say to you, if you're listening here and I say to you, like, why are you this way? What's wrong with you? My guess is your anxiety is going to go up. You're going to feel this visceral, horrible feeling, and you're going to notice sensations of discomfort almost immediately. And that's what's happening when you beat yourself up. So we have to remember here that shame after intrusive thoughts keep the threat signal alive, and judging yourself actually makes the obsession stronger. Now, the solution here is always going to be self compassion. First, we're always saying during exposures, especially when I teach my clients and in your OCD toolkit, our online course for OCD is that exposures need to have compassion at the beginning, compassion during, and compassion afterwards, usually in the form of celebrating your wins. This is going to be so important. And the more you can wrap that ERP in a wrap of self compassion, the better. Let me give you an example. We just had Easter, and every Easter egg that I bought my children and every Easter egg that my children received were wrapped in this beautiful wrapping. It's got flowers and tulip bunnies. They're not just plain rappers with black and mean faces or anything. They're the whole beauty of Easter eggs is how they're wrapped up. And that is the truth of ERP as well. We want to wrap ERP in loving kindness, not avoidance, not beating yourself up, not criticizing, and definitely not reassuring ourselves. We want to do this kindly. So let's move on to goal number five, which is that you're setting the wrong goal. Goals. The goal is not the complete removal of anxiety if that is your goal. Yes, exposure and response prevention will become a compulsion, and you probably will not get better because the more you try not to have anxiety, the more you're training your brain to be afraid of fear itself. Now, the goal is also not the removal of intrusive thoughts. Again, what you resist persists, and there is nothing wrong with your intrusive thoughts. Let me say that again. There is Nothing wrong with your intrusive thoughts. I really want you to remember that everybody has them. The only problem is you're probably giving them way too much meaning and you're responding to them as if they are facts, not just thoughts. Now, the last thing is our major goal here is kindness, always number one, and the mastery of anxiety. So as you're going through erp, if your real measuring stick is did I have anxiety? And respond in a kind and effective way, then you're on the right track. If you're finding that you're slipping into like, how can I not have anxiety? You've fallen back into the trap. Now I get it. I don't want anxiety either. It sucks. I totally understand. It's a normal response to not want to have anxiety. But we have to do that paradoxical shift, which is to lean in and to practice having anxiety and teach our brain that it's safe to feel anxious, that we don't need to run. I always think of, like, when my son or my daughter is anxious, my job is to put my hand on their shoulder and say, I know you're anxious, but let's just stay here. Let's be in this experience. I don't want you to run away. I want us to stay here and train your brain to not need to run away the minute you feel uncomfortable. Now, if you want to learn more about how to do this again, I'm going to strongly encourage you to head over to CBT school. We have a complete step by step online course. It's specifically created for folks who don't have access to treatment. It's called your OCD toolkit and is me teaching you everything I teach my clients in a very step by step fashion. Head over to CBT School. I am in love with this course. I'm so proud of it. I find that it is just everything I know in one place. It's like I poured my brain into one place and I'm so happy that, that it's here for you to use. Now, as always, I'm going to leave you with a little bit of homework. I want you to pick one of these things to work on. Not all of them. 1. Pick one and really work at mastering it. Really work at doubling down on fixing that one thing. Of course. Please also remember that you're not broken. You're learning. And every imperfect exposure is still an exposure. Still know that you're doing the best you can with what you have and that is enough. Just make 1% improvements. That's all we're looking for here now. As always, thank you so much for being here. You know how much I value your time. Please remember it's a beautiful day to do hard things and I cannot wait to see you next time. Please note that this podcast or any other resources from CBTSchool.com should not replace professional mental health care. If you feel you would benefit, please reach out to a provider in your area. Have a wonderful day and thank you for supporting CBTSchool.com.