Many are not!
Around a quarter of those who agree to participate in ERP will drop out of treatment shortly after starting.
This is NOT for me!
Some other people will:
- Chronically cancel appointments
- Not follow-through with ERP “homework”
- Spend the therapy hour focusing on side-issues in order to “run out the clock”
Treatment really works…if you stick with it!
The majority of people with an anxiety disorders or OCD, however, will make significant progress IF they can persevere with the treatment as prescribed by a competent anxiety specialist or even an evidence-based self-help book or website—assuming they are free from other conditions that might interfere with anxiety treatment such as interfering mental health or addiction issues or unrelated life crises (which are probably best addressed first).
Bolstering Your Motivation
What remains as the primary factor in determining whether someone seeks out and follows-through with treatment is MOTIVATION.
No one wants to do ERP—It’s a time consuming and often unpleasant activity, requiring one to do things that are very uncomfortable and that might even feel dangerous (flying the turbulent skies, for example). Clearly it takes a significant amount of motivation to get oneself to follow-through with this very effective treatment.
To bolster your motivation, try the following activity:
Step 1: Take out a piece of paper and draw a line down the middle forming two columns.
Step 2: Title the first column “Benefits.” Here you will list those things you stand to gain if anxiety is no longer calling the shots. How, specifically, will your life be better (now and in the future) if you successfully face your fears. For example:
- I’ll feel less tortured
- I’ll have more friends
- My relationship with my wife and family will improve
- I’ll be able to go back to college
- I’ll be able to start surfing again
- I’ll be able to start enjoying my life again!
Step 3: Title the second column, “Cost.” Here you will list the costs of facing your fears using ERP. For example:
- Time consuming
- I will experience more anxiety when facing my fear initially
- I don’t know what my life will be like if not defined by OCD
Step 4: Write down an adaptive response to each “Cost.” For example:
- Treatment will be time consuming.
- It is worth investing time now so that I can get unstuck.
- I will experience more anxiety when facing my fear initially.
- Avoiding facing my fears is short-term gain for long-term pain. If I face my fear it will be short-term pain for long-term gain.
- I don’t know what my life will be like if not defined by OCD.
- I’d rather define my own life!
Step 5: Ask yourself:
- Is it worth it to me to face my fears through ERP? Remember, you can choose your pace, as long as you stay consistent.
- Am I willing to make treatment a priority?
- Am I willing to take risks that most people would say are reasonable (For example, touching a toilet flusher with your hand or fly in an airplane)?
- Am I willing to wean off of my compulsions or safety behaviors?
- Is this the right time?
If you answered “No” to any of the questions above then write down, specifically, what would need to happen for you to feel ready to proceed with ERP.
To help with this, you can:
- Learn more about your anxiety disorder.
- Talk with friends and family.
- See a therapist to help you explore the role your anxiety disorders have played in your life, and then re-evaluate at a later time.
- Determine when time or life constraints will ease up so you can focus on your treatment (Can you do something to ease time or other life-constraints?).
Sometimes people, especially children and young adolescents, have a hard time understanding that doing something uncomfortable in the short term can lead to a more comfortable future. They might not understand that you need to go towards a fear in order to fear it less. In these cases setting up an incentive program can be a powerful motivator.
For example, every time they follow through with their ERP exercises they get to earn a token that at a later time can be exchanged for something they find reinforcing. This can be a powerful way to bolster motivation in the unmotivated. Motivation can also be bolstered by not accommodating a loved one’s anxiety. For example, if you have a spouse with OCD and a germ phobia, his or her motivation is not enhanced by helping them compulsively clean the house.