When ERP is the obsession ('Pure O')

[Pants]

My lovely brother's battled with OCD all his life, in recent years, essentially in the 'Pure O' sense.  He's sought therapy and tried Exposure & Response Prevention, but now that approach seems to have become part of the problem.  I so want to help him, but it has become a vicious circle.

He starts with a random thought - say he looks at a car driving past, and can't decide whether it was a Ford or a Fiat.  'Knowing' which it was/making a decision becomes an obsessive thought which he can't get out of his mind.  So he starts to try to employ ERP, but then the focus of the obsession moves to 'am I doing the exposure properly?'  'Am I minimising the original obsession?' 'If I'm not doing the ERP properly, am I making my OCD worse - if not now, then in weeks to come?' etc.

He's desperate to get some benefit from ERP as he's heard that it can really help with OCD management and he's suffered for a long time.  He tells me that if he manages to break out of the cycle of thinking/ruminating by minimising or ignoring the thoughts, he often feels really disconnected and numb for the rest of the day - a little like the day after a bad migraine headache.

I so want to help him, but I've no idea how.  I keep finding resources on the net about how ERP is a powerful tool, but not how to cope when ERP becomes the obsession!  Any suggestions very gratefully received.

 

[gingerbreadgirl]

Hi there  

I think a big thing that ocd sufferers need to expose themselves to is doubt, ambiguity and uncertainty. It sounds like your brother is trying to get erp "just right" and can't allow for any uncertainty in this. As you say this has become its own problem. 

I have been guilty of doing the same thing with erp and cbt in general. It can become almost compulsive. I think the key is for your brother to get used to feeling uncomfortable, for things to feel wrong or off or uncertain with both the original them and his approach to it. 

Has your brother done any cognitive work with a therapist? It sounds like he is focusing just on the behavioural aspect. The cognitive aspect is so important in getting a handle on it and I think it is often overlooked. 

 

Edited October 14, 2019 by gingerbreadgirl

[paradoxer]

On 14/10/2019 at 09:41, Pants said:

My lovely brother's battled with OCD all his life, in recent years, essentially in the 'Pure O' sense.  He's sought therapy and tried Exposure & Response Prevention, but now that approach seems to have become part of the problem.  I so want to help him, but it has become a vicious circle.

He starts with a random thought - say he looks at a car driving past, and can't decide whether it was a Ford or a Fiat.  'Knowing' which it was/making a decision becomes an obsessive thought which he can't get out of his mind.  So he starts to try to employ ERP, but then the focus of the obsession moves to 'am I doing the exposure properly?'  'Am I minimising the original obsession?' 'If I'm not doing the ERP properly, am I making my OCD worse - if not now, then in weeks to come?' etc.

He's desperate to get some benefit from ERP as he's heard that it can really help with OCD management and he's suffered for a long time.  He tells me that if he manages to break out of the cycle of thinking/ruminating by minimising or ignoring the thoughts, he often feels really disconnected and numb for the rest of the day - a little like the day after a bad migraine headache.

I so want to help him, but I've no idea how.  I keep finding resources on the net about how ERP is a powerful tool, but not how to cope when ERP becomes the obsession!  Any suggestions very gratefully received.

 

Pants, sorry your brother's going through it, and yes, the disorder can be terrible for loved ones too. The bad headache feeling you describe (or its aftermath), is unfortunately therapeutic. To beat the disorder, it's sometimes necessary to (be prepared to) feel mediocre and in pain. Short-term suffering, long-term improvement.  

[paradoxer]

On 14/10/2019 at 09:50, gingerbreadgirl said:

The cognitive aspect is so important in getting a handle on it and I think it is often overlooked. 

 

Seconded. ERP is nothing without it.