Exposure and Response Prevention Motivators

Exposure and response prevention (ERP) is hard work and it can be terrifying.  We always say that both ritualizing and treatment are difficult and that the only difference is that treatment leads to an end of rituals and avoiding treatment leads to endless rituals.  Nevertheless, ERP is painful and what can you do when you feel your fear rising and the idea of a OCD free life doesn’t seem as important as your anxiety in the moment.  I think at these times it is useful to remember why you want to get away from OCD.  Below are two sets of questions with suggested sub-questions.  I would urge you to write about these in the most painful way you can remember, so that when OCD threatens to overwhelm your treatment, you will have more to fight back with.

The first set of questions concerns what have you lost to OCD?  Within this set think about 1) Because of OCD, I’ve Missed; 2) Humiliating Experiences; 3) Financial/Employment Losses; 4) Guilt; 5) Lost/Wasted Time; 6) Because of OCD, I’ve Been Late To; 7) Damaged or Lost Relationships; 8)Other OCD Losses:

The second set of questions concerns how have you hurt your loved ones with your OCD? 1) Forcing Them to Ritualize; 2) Making Them Late or Missing Events; 3) Hurt Them with My Other OCD Demands; 4) Hurt Them with My OCD Anger; 5) Hurt Them with My OCD Rigidity; 6) Ignoring Them Because of OCD Thoughts; 7) Ignoring Them by Withdrawing; 8) Other.

So rather than avoiding an exposure think about your reasons to fight OCD and remember that if you get better, not only will your life improve, so will the lives of your loved ones.


  • I saw the Oprah episode which featured you and your camping exposure therapy. I am very pleased to learn that you are now available on-line. Thank you for all that you do.

  • Dear Dr. Grayson,
    I just read your ERP reasons to to risk it. Your so right we do subject our family to our crazy thoughts and rituals. I am thinking about this all morning and hope your words of truth will inspire me to change.
    Thank you

  • After reading this book of Dr. Grayson’s I’ve given it a whole lot of thought. On one hand it appears to be a wondrous way to beat “OCD,” and on the other it frustrates the hell out of me; more and more it seems to be a plain, simple challenge to just “accept everything because there’s no other way out”.

    Regrettably, it’s not something most sufferers can do despite comprehending the idea fully. Maybe “obsessions” are not just a fear of whatever is occupying one’s mind, but a fear of fear itself. I can see myself in the middle of this “uncertainty” program, months from now, still in fear of losing control and, again, fear itself. It may only be my individual case of “OCD” — pure mental “obsessions” — and I may be of those for whom this concept will not work. And it may even perpetuate everything.

    I already *know* most of what caused my OCD symptoms, because the feared consequences of ending my “rituals” make it evident, so why can’t I just treat that? Why can’t I just treat the “worst that could happen” using an alternate psychotherapeutic approach? My 8 years of OCD have revolved around *one* thing, therefore I’m not worried about “OCD” continuing to evolve or change into something else as it normally does, at least nothing serious.

    This book — self-therapy for accepting uncertainty — gave me hope… and now a lack thereof. 🙁

    • I would love it, if the advice was simply ‘just accept it…” Although acceptance clearly plays a role, there is more to overcoming OCD than just doing one thing. The acceptance issue itself is huge, because acceptance is a process, not a simple decision. Just as overcoming and accepting the loss of a loved one doesn’t isn’t an overnight process, acceptance of what it means to live with uncertainty is also a process; however, thankfully, it isn’t years.
      On the other hand, the writer suggests I say there is no other choice. This is true to an extent. If I have lost a loved one, I don’t have to accept the loss, but if I don’t, then there is no way for me to continue on, since they aren’t coming back. Similarly, there is no way to truly have certainty, so if my plan is to never accept it, I will continue to have problems. I hate to refer to my book, but chapter 5 discusses this issue and the reasons acceptance is hard and most important, that it is something to work on, not a simple decision.

  • Have had same problem as Nina’s since ’81; right now it’s really effecting me, even young family members who it confuses and also in my teaching career. So frustrating. Nothing’s ever said but I know people talk about it. Guess that’s part of the humiliation of the illness. I’m at my wit’s end but terrified to make things worse with this erp therapy; is that something that happens? Is there a safer approach like distraction?

  • I have “Pure O” O.C.D. (The name itself may be a misnomer, because “Pure O” types are said to have “doing” and “undoing” rituals going on in their mind.)For whatever reason, there are days when all I hear in my head is shit, fuck, screw it all, to hell with it! I also imagine people urinating through their clothes, or passing gas. For the most part, the images occur when I go to services. In addition, I get very hyper around Rosh Ha Shana and Yom Kippur. (In Judaism, G-d is said to judge our acts and makes decrees about our destiny at that time of year.)During the remainder of the year, I hear my own voice telling me, “You are not pulling your weight in Heaven.” “You are capable of doing more good deeds.” “You haven’t even tried.” I exhibit a fear of reading scarry things in Jewish books, and people in my family keep me aways from them for fear that I’ll freak out. I worry that people whose beliefs and practices are more stringent than mine will perceive my level of religious practice to be inadequate. I fear that I will be picked on because of it. I also worry that since my clothing is different than the clothing of many of the people in my neighborhood, I will be singled out. Although I am moderate in my practice of Orthodox Judaism, and the people in my neighborhood are far more stringent, none of the things I’ve spoken about have ever become a day to day reality. How would someone do E.R.P. with me?

  • Dear Dr. Grayson,
    I have another concern. Of late, when people have spoken to me about religion and its practice, it has triggered irrational guilt and washing behavior. As you implied when you answered the woman with symptoms of scrupulosity, the Master of the Universe, as we of many different faiths and ethnic backgrounds understand him, does not want us to stand in a boiling hot shower for up to 1/2 hour scrubbing ourselves with an entire bar of safeguard soap so that we can relieve our anxiety re: not worshiping Him in the various ways that our faiths prescribe.
    The misconceptions about religion that send me to worship the “shower god” via the “safeguard ritual” are the same misconceptions that have caused me to fear the Jewish High Holidays. Thus, anything I’ve written about my faith should be taken with a big grain of salt! No matter who we are, all of our faiths should provide us with a sense of inner peace and joy, as well as an abiding sense of trust that all that goes wrong can be made well somehow.

  • Dear Dr. Grayson,
    On a cognitive level, I am aware of the fact that I am wasting too much time ruminating about people criticising me because I am not observant enough and the clothing styles I like (perfectly modest,just more colorful,which is ok, but not seen in Ultra Orthodox circles)are different from theirs.
    Religions of all types don’t stress external matters. They stress internal ones. If anyone dares to criticise the way other practice their faith, he/she is certainly not worthy of attention. If anything, he/she needs to consult his/her sacred writings and visit his/her institutions of worship.
    Like me, so many people with O.C.D. can write down their problems like I did, and figure out their issues immediately. The problem lies in diminishing?/extinguishing? the illogical thoughts and behaviors. I look forward to reading your answer re: the thoughts and behaviors.
    Thanks so much for providing me and others like me with the oportunity to blog here. It is helpful to see that we are not alone in our suffering.

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