S3C4. Deliberate ERP vs Accidental ERP vs Exposures Only

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Sometimes your OCD may impair most of the day, and you may begin to say, “I am always triggered.” But that is not entirely true. There are moments of clarity that help you understand the irrationality of your triggers. Those are the moments when you feel that you are not a bad person, regardless of what your OCD tells you. They may be few and far between, but they are there for sure. That is the reason why you are reading this course book.

I will take a moment to explain the difference between deliberate exposure with response prevention, accidental exposure with attempted response prevention, and exposures without response prevention. Getting exposed to a trigger with complete preparation is deliberate exposure. You can expect the anxiety and learn to lean into it to prevent the compulsive response. Getting exposed to a trigger without being prepared to face it is accidental exposure. The anxiety hits you all at once, and then you are left scrambling to find the right response. And being prepared to do the exposures but following it up with compulsions is just exposures and no response prevention. In these three scenarios, deliberate exposure with adequate response prevention is the healthiest option to manage your OCD.

Imagine that you are sitting on a beach with your back to the waves, and a wave slams into you from behind. You will probably be flustered if you are unprepared. That is accidental exposure with attempted response prevention. What you can only do as response prevention is move away, dry yourself, and try to “un-fluster” yourself. But if you sit facing the waves, you can see when the wave is about to hit you. That is preparing for the exposures. If you let the wave hit you, you can brace yourself for the impact. You can move away and dry yourself, feeling less flustered since you saw it coming. That is deliberate exposure with response prevention. The “un-flustering” will not take too long. But if you sit with your back to the waves and keep letting the waves hit you, without moving away and expecting the waves to stop hitting you and continuing to be flustered that the ocean is not stopping, that would be exposure without response prevention.

This is the essence of true ERP. Hence, deliberate exposures with adequate response prevention are a key requirement for managing recovery more effectively.

Exposure without response prevention is the unhealthiest option, obviously. Of the other two, deliberate ERP is better than accidental ERP because, one, you can decide the time when you would like to face your fears and hence be prepared for them. Two, you can decide the intensity of exposures and choose not to overwhelm yourself with anxiety. Three, because the decision to face the triggers is yours, you do not need to wait until you are triggered; you can practice exposures proactively and speed up recovery.

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