The following three elements of inhibitory learning include surprise, combining fear cues and variety. Considering the third element, surprise, this works when the outcome of an exposure and feared belief are hugely mismatched. For example., if one has an obsessive fear that someone will break into their house if they do not repeatedly check the locks, performing an ERP by not performing the compulsive checking and staying with the distress of uncertainty if the door is, in fact, unlocked but on returning to find the home safe will provide a shocking surprise element. Similarly, people might be preoccupied with specific numbers. Having to check several times, say 7, will make them believe they are avoiding a feared outcome.
However, if the ERP is about exposing them NOT to count seven times but to another number, which may cause discomfort, then proving that the feared outcome did not happen will help them have a surprise about the lack of effect of the thoughts. The next element is to combine the exposure cues. The cues can be both in real life and imaginary. Using multiple cues for exposure reduces the symptoms more effectively. Next is exposing them to cues in various situations. When one fears contamination, revealing them in numerous places such as offices, homes, and malls will be more effective. Also, exposure to different emotional conditions will be more effective. The idea of the exposure is to trigger the obsessive thought. This can be done in vivo or imaginal. Next, REFRAIN from performing the compulsive behaviours usually engaged in. Also, refrain from avoiding and reassurance-seeking. Practice ACCEPTANCE and EXPERIENCING the thoughts, emotions and physical sensations.
Wait for long enough for it to subside. You will learn that this will lead to understanding that the outcome is safe and it is safe not only to experience the thought but also the emotional distress. There are two essential elements that we have to learn when doing ERP therapy. One is that exposure and response prevention must be carried out for as long as it takes to override old beliefs, and new beliefs that the thought is safe are learnt. The second learning is that it is safe to experience fear, distress and panic, and one can continue to function despite experiencing the distress. More and more recent evidence must show that relapses may occur unless new learning occurs (not just habituating to the stimulus).
Hence, ERP must be conducted till new inhibitory learning takes place to be effective. In the following blog, we will learn about imaginal exposure and how to write a script for imaginal exposure. These blogs will help you understand the nature of OCD and the various therapies used in OCD. Chennai Minds, the best Psychiatrist in Chennai, specialises in treating OCD.
