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 your partner is not good enough for you or you may think your partner may be interested in someone else.
In such cases, being with your partner in social situations may cause anxiety. In-vivo exposure is choosing to be in such social situations with your partner 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 your partner where the members are only your partner’s family, the situation may cause fear but the fear of your partner getting interested in someone else is not likely to come true and hence this would be less effective. Being in a situation with your partner’s friends on the other hand may feel like the fear may come true too, and hence may be more effective.
So, placing yourself bang in the middle of situations that cause you the anxiety would be in-vivo exposures for you. If you are triggered by your partner’s imperfect nose, look at it. If you feel your partner will leave you for someone else, encourage her to go for parties without you. 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 five steps for response prevention.
In the next chapter, we shall explore another technique of exposures called imaginal exposures.