Am I Doing My Exposure Homework Right?
As an OCD therapist, many of my sessions start with a check-in to see how the previous week, and the exposures assigned, went for my clients. The work done in therapy is important, but what clients do between sessions is arguably the biggest indicator of long term success in managing OCD and anxiety disorders.
To put it simply, the work you do outside of therapy matters. A lot.
When exposures are done correctly, they train our brain to view our fears more to scale and actively rewire our threat response. When done incorrectly, exposures can function as compulsions, keeping us stuck in the OCD cycle, even as we "do the work" and go to therapy each week.
Here's how to maximize your time outside therapy:
Schedule exposures
Having an unstructured deadline like, “do my ERP homework by next session" might not work for some clients, and can lead to the decision fatigue of wondering when the "right time" is to challenge fears.
Rather, schedule specific times to do exposures. Try choosing a time like "Friday morning after school drop off," or "Wednesday on my lunch break." Scheduling exposures can help reduce the stress of needing to practice your ERP at the exact perfect time, which is often an avoidance in and of itself.
After all, there is no such thing as the perfect time to face your greatest fears.
Ask clarifying questions in session
Work with your therapist to word exposure goals in a way that feels measurable and attainable. This can be done by setting specific time limits, or number of times to practice the exposure each week, realizing that It's OK if you take longer to complete your exposure goal, as long as you are willingly moving towards it week after week.
For example, if "driving to the supermarket alone" feels like too overwhelming of a task, try breaking it down into something like "driving around the block alone" or even, "driving to the supermarket with a family member". No matter how small the step, challenging your fear sends that all important message of irrelevance to your brain, the one that lessens anxiety over time.
Plan for response prevention
Many times we see our client's willingly engage in the E (exposure) of ERP, without the RP (response prevention) portion of the task. For example, they may willingly text their partner "I love you so much" throughout the week to work on their fear of vulnerability in relationships, but then ruminate on the text for hours after they sent it. On the surface it may seem like they are doing ERP, but they are actually not engaging in the critical task of response prevention- they are not tolerating the discomfort of sending the text without any action to calm their anxiety, whatsoever.
Avoiding compulsions is HARD, we're quite simply not wired to sit in pain without trying to escape, even if it's for our ultimate benefit. Make space for this inherent difficulty and stick to your plan to ensure that your homework is successful.
Recognize your "why"
It's normal in the beginning to feel that ERP is confusing, counterintuitive, and sometimes even cruel. It calls on us to defy every physical and emotional urge we have, and trust that we are going to come out alive and breathing on the other side. The hope is that over time, we can retrain our brain to no longer see these situations as life threatening, which in turn leads to resilience in facing day-to-day uncertainty and a lived experience that is more pleasurable and aligned with our values.
Remembering your "why" can keep you firm in the face of anxiety and help you step into the unknown, one transformational step after the other.
Ultimately, each time we make a conscious decision to do something difficult, the type of thing our brain tells us not do under any circumstances, we take power back from OCD. No matter how small, each brave ERP step we take builds a meaningful path towards healing.