A client of mine had the greatest metaphor for her obsessive compulsive disorder. She said that when she came to see me, she had been singing “OCD’s song” for 50+ years. Through our weekly sessions and A LOT of work between sessions, she was able to learn “a new song which gave her freedom.” A freedom she felt she hadn’t had in decades.
When she came to see me, her desire to fight OCD was greater than her fear. Her life had become so small, and her rituals so time consuming and tortuous that she was willing to do whatever it took. She’d done a lot of work previously, but it wasn’t until she learned exposure and response prevention, or ERP, that she was able to change her tune.
ERP is a behavioral model which posits that change happens through new learning. The crux of the work, therefore, happens between sessions rather than in more traditional “talk therapies,” where the mode of change is through processing — change happens in the therapy session. Clients then need lots of opportunities for learning and practice, which happens between sessions.
I give my clients assignments to complete in-between our sessions. After all, we’re learning something new, and we need to practice. To extend the metaphor, if you want to sing a different song, learn new lyrics. To help, here are 10 examples of actions I encourage my clients to take.
- Educate yourself about what you have, be it OCD, generalized anxiety disorder, or social phobia. Ask your therapist for resources, so you can be informed. This is easily done by reading books (there are so many great ones), listening to podcasts, reading articles and blogs.
- Start a consistent mindfulness practice. As Jon Hershfield, LCSW says, “mindfulness is a great enhancer of ERP.” You can’t pull yourself out of an anxious spiral if you don’t know when you’re starting to spin (or already spinning). The key word here is consistency. It takes time to build this mental muscle.
- Practice, practice, practice being mindful (or notice when you’re reacting mindlessly). The important pieces are to notice and bring yourself back to the present. Over and over.
- Do your between session work, even if it makes you anxious! Many times there’s some aspect of the homework that can be an exposure too (e.g., logging information, fear of writing the “wrong thing,” urges to write and rewrite sentences). Every opportunity you’re anxious is an opportunity to get stronger.
- Look for opportunities to practice outside of planned times.
- View being anxious as an opportunity to practice singing your new song. Mindset matters!
- Be willing to take the risk that anything can happen—your OCD/anxiety will tell you it probably will happen (or definitely will). Your job is to be willing to accept the possibility, however small, that it could and go for it. Because that’s the reality: there are no guarantees of anything, except death and taxes.
- Keep track of what you’re learning, including how many times your anxiety or OCD prediction came true.
- Be willing to stop seeking reassurance! I have yet to meet anyone with OCD who doesn’t seek out reassurance. And if not from someone else, then from themselves. Lots of people with anxiety disorders seek reassurance, too. In order to gain freedom, you must be willing to tell that person not to give in. You can do it in a way in which you still feel supported, but it must be done.
- Anticipate your triggers and plan for them. This is hard initially, because everything may feel like a trigger for your anxiety, but it’s likely not all a 10/10 in anxiety intensity. Regardless, expect your anxiety to show up (remember your amygdala is only trying to protect you!), greet it with lovingkindness and try to behave in line with what’s important to YOU, not your anxiety/OCD/panic, etc.