[Photo by Patrick Mueller on Unsplash]
The therapeutic experience is one that inherently involves a willingness to process and confront thoughts, feelings, and behaviors that you might consider problematic or unwanted. This exploratory lens in psychotherapy is crucial in increasing self-understanding and awareness. As a way to expand upon this increased knowledge of self, and to directly challenge undesirable experiences of anxiety, your therapist may also introduce you to Exposure and Response Prevention (ERP). This evidence-based practice is commonly used to treat a spectrum of anxiety disorders, including Obsessive Compulsive Disorder, Specific Phobias, Body Dysmorphic Disorder, and Eating Disorders.
To understand the purpose of ERP, we need to first illuminate the anxiety cycle. The cycle begins with a triggering event: a stimulus or reminder that elicits feelings of anxiety, worry, fear, trauma, etc. These triggering situations can take various forms, including specific anniversaries and dates, people, places, activities, memories, to name a few.
Based on what you know, or have come to believe about this triggering event (i.e. past unpleasant experiences), you start to interpret its outcome as “negative.” This interpretation signals an anxiety response that takes the form of uncomfortable cognitive/emotional symptoms such as worry, fear, and racing thoughts, and uncomfortable physical symptoms like a racing heart, tension, and sweating.
You have a few options at this point. Option A is to confront the trigger, including all of the real and/or perceived discomfort that accompanies it. Option B is to avoid it at all costs to reduce discomfort and anxiety. It’s not uncommon to want to avoid, to escape, to flee from discomfort, rather than confronting the anxiety head-on. In an attempt to keep anxiety at bay “safety behaviors” which are various avoidance strategies. Perhaps the avoidance looks like procrastinating on a challenging task, or avoiding an anxiety-inducing social gathering, or steering away from full body-length mirrors.
You are likely to experience a temporary feeling of immense relief following the use of avoidance strategies; however, doing so tends to have the opposite effect than what is desired or intended. When these avoidance behaviors are used consistently over time, anxiety actually increases, and may lead to disconnection from what you value. The associated fear is reinforced when you avoid the people, places, events, and/or things that elicit an anxiety response.
Tackling the triggering stimuli head-on is not necessarily “enjoyable” or “pleasurable.” However, it will help to decrease anxiety and fear and support you in building a more neutral and/or positive relationship with the feared stimuli itself. Collaboratively, you and your therapist utilize ERP to deliberately and gradually expose you to stimuli that trigger an anxiety response. Rather than using avoidance behaviors, you begin to learn new coping skills to accept and sit with the discomfort that the anxiety may have historically caused.
Similar to any form of psychotherapy you embark on, ERP requires a high level of willingness to experience distressing thoughts, feelings, and sensations that may accompany this practice. The initial (very valid) discomfort is intended to transform into more effective distress tolerance, greater engagement with the present moment, and ultimately, greater feelings of emotional and cognitive freedom.