What we have discussed so far about ERP, about how it is done, is called in-vivo exposure. In ERP, the combination of in-vivo exposures and imaginal exposures yields the best results (Gillihan et al., 2012). In ERP, in-vivo exposure means doing the exposures by placing yourself in the same situation that causes the anxiety to begin with.

You may think that you may cause accidental harm to someone or you want to cause deliberate harm to someone. In such cases, being around people in social situations may cause anxiety. In-vivo exposure is choosing to be in such social situations with other people and triggering your anxiety on purpose. When you place yourself in a triggering situation, you get the associated obsessive thoughts and feel the urge to do the compulsions. The anxiety needs to be borne without ritualizing or doing the compulsions.

In-vivo exposures are more helpful if they are done in situations that cause fear and if there are chances of the fear coming true. So, if you are in a social situation with other people only virtually, the situation may cause fear but the fear of harming someone is not likely to come true and hence this would be less effective. Being in a real live social situation on the other hand may feel like the fear may come true too, and hence may be more effective.

If you are triggered by the presence of your girlfriend, be around her. If you feel you can harm a child while using a pair of scissors, use a pair of scissors around children. Do more stuff that will cause you the anxiety that you have been trying to stay away from. Observe yourself and your urge to do your compulsions. Identify your compulsions and follow the steps for response prevention.

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