Ep. 212 How much ERP should I do daily?

SUMMARY:

In today’s podcast, we take a deep dive into a common question I get from followers and CBTschool.com members. HOW MUCH ERP SHOULD I BE DOING DAILY?  Because ERP is such an important part of OCD treatment and OCD therapy, I wanted to outline how you might set up an ERP plan for yourself and how that can help you with your OCD treatment.

In This Episode:

• What is ERP (exposure and response prevention)?
• What an Exposure and Response Prevention plan looks like.
• How to determine how much ERP you should do each day
• Why it is important to practice ERP for OCD, health anxiety, and other anxiety disorders.
• How to taper off doing ERP once your obsessions and compulsions have reduced.
• How to practice self-compassion during ERP

Links To Things I Talk About:

• ERP School: https://www.cbtschool.com/erp-school-lp
• Kimberley’s ERP Book: The Self-Compassion Workbook for OCD
• CBTschool.com

Episode Sponsor

This episode of Your Anxiety Toolkit is brought to you by CBTschool.com.  CBTschool.com is a psychoeducation platform that provides courses and other online resources for people with anxiety, OCD, and Body-Focused Repetitive Behaviors.  Go to cbtschool.com to learn more.

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EPISODE TRANSCRIPTION

This is Your Anxiety Toolkit – Episode 212.

Welcome. I am so thrilled today to talk to you about a question I get asked all the time, which is, how long should I be doing exposure and response prevention per day? So we are going to go all the way through that here in just a sec. But before we do that, we always start the show with our “I did a hard thing.” Now, each week people submit their “I did a hard thing” and we share it because we want to spread the word on all of the hard things that people are doing to inspire you, to help you realize you’re not alone and to help give you that little bit of motivation to face your fears as well.

Now, what we usually do after that is we do the review of the week as well, which is where people leave a review on iTunes for this podcast, Your Anxiety Toolkit. But today, somebody left a review that was also the “I did a hard thing.” So I thought, no better opportunity than to do both at once. This is from Jayjenpeezy, and they said:

“Right on time! I cannot even begin to say how helpful this podcast is and I have incorporated into parts of my daily meditations and/or listen to it on my walks. A few weeks ago I was admitted to the ER and kept overnight for an observation and what the doctors originally thought was tachycardia turned out to be a panic attack which I had never experienced to that degree before. I spent the next few weeks even more anxious at the thought that it would happen again and thought I’d lost my mind and began taking antidepressants as a quick solve which now I know is not the solution I truly needed. (Mind you, I am speaking only for myself and understand that not everyone is able to be off their prescription meds.)” I love that you included that.

“After doing some research I learned about this podcast and ERP and am starting to feel much better about a lot of things. I’ve also changed my diet to be more alkaline, incorporated daily meditation, gratitude journaling and have been able to finally leave my house to take daily walks. The journey is different for everyone but as she continuously reminds me that “it’s a beautiful day to do hard things” and that panic attacks are not actually attacking you it’s your adrenaline rushing through you and in time comes to pass when you are able to meet it eye to eye. I also learned to look at it as willful tolerance,” we have a whole episode on that “and it is not so scary anymore. I am taking it one day at a time and am mindful of being present as possible. Ending up in the emergency room while my children were left at home at night was enough for me to take any and all necessary steps to not allow my anxiety control me. Sending love to all and may the force be with you.”

I love that. Let’s just say that is the perfect marry between “I did a hard thing” and a review. So thank you so much to our reviewer, Jayjenpeezy. I am in such admiration of you.

So let’s get over to the show. Today, we are talking specifically about how long or how frequent your ERP should be. Now, when I say “should,” I’m going to disclose here, it’s different for everybody, but I’m going to tell you just briefly what I would tell any of my clients. And then from there, you get to go and decide what is right for you. Okay? So, let’s go over to that topic.

When someone asks me how long or how frequent and what duration I should do for an exposure, I almost always tell them the same thing. In ERP School, the online course for OCD, and in my new book, The Self-Compassion Workbook For OCD, I say exactly the same thing in both, which is ideally, you should practice exposures for around 45 to 90 minutes per day. Now, I know that doesn’t work for everybody. So you have to go and do and find a balance of what’s right for you. But let me show you how you might incorporate that 45 minutes to 90 minutes per day.

While it’s totally fine if you do this, in fact, I applaud you if you do this, but I don’t suggest that you do it just in one lump sum time. It’s hard to schedule 45 to 90 minutes if you have a job, a family, or you go to school or you have another mental illness that you’re working through. What I encourage people to do is to displace that time throughout the day. Again, you can follow my rule. I did a whole episode about scheduling and how it’s important for your recovery. You can schedule it into your day in blocks, like for 15 minutes after breakfast, you do an imaginal, or for 15 minutes before lunch, you’d go and face something that you’re afraid of. For 10 minutes before you go and make coffee, you may do some of your homework. You can schedule it in blocks. I like that. That’s my preference if it were me.

But a lot of people, what I encourage them to do is pair it with activities you’re already doing, or you would already be doing had you not had OCD or this fear. So an example might be, as you’re driving to work, you could be listening to your scripting in ERP School, our online for OCD, and in The Self-Compassion Workbook For OCD. We explain extensively how to do scripting and imaginals. You can do that while you drive to work. You can do that while you make your breakfast. You can do that while you wash the dishes. You can do that while you walk around the block. You can do it while you stretch. You can do it while you’re in the shower. These are activities where you don’t actually have to stop what you’re doing to do exposures. You can do many exposures in your normal daily life.

In addition, let’s say you have the fear of contamination or doing some activity and fear of what thoughts you may have. I would encourage you to try to go about your day, having the thought on purpose. So you don’t have to, again, stop your day and stop your schedule and your normal functioning. You could start to implement these things that you’re afraid of throughout the day. Or if again, something you’re avoiding, you may then want to practice implementing that back into your day, particularly if it brings you fulfillment and wellness and more functionality into your day. Instead of, let’s say, you have a compulsion where you ask somebody to accommodate you, you might actually choose to do it yourself. You get points for that. That is an exposure. That should go towards your 45 to 90 minutes per day.

Now that being said, that’s just exposures. The response prevention is something that you do throughout the entire day. For those of you who don’t really understand the difference, an exposure is where you face yourself to your fear or your obsession. You face that fear of obsession. Response prevention is then not engaging in a compulsive behavior to reduce, remove, or eliminate the discomfort, uncertainty, or feeling that you’re experiencing. Some form of discomfort it usually is.

The response prevention is something you will practice for the whole 24 hours as best as you can. Now, does that mean you need to do your exposure? Let’s say your exposure is to touch a certain object or face a certain object or have a thought. Does that mean you need to go completely cold turkey from your compulsion? No. In a perfect world, yes, that would be the case, but we don’t live in a perfect world. You don’t have super powers. I wouldn’t expect my clients, myself, or you to go from 0 to 100.

What we can do there is we can practice it in small baby steps. You face your fear and you say, “Okay, I’m going to try and do response prevention for the next five minutes.” Then you move it up to 10 minutes. Then you move it up to 15 minutes. Then you might move it up to an hour or whatever feels right to you.

What we’re talking about here is, do as much response prevention as you can, work your way up. As we say in ERP School, ERP is really like a ladder building hierarchy. You start small and you work your way up slowly. Preferably you have a plan. You know what the plan is, you know what the first step is, you know what the second step is. Life isn’t perfect, like I said, so I don’t expect it to be perfect. But I think with that model, where you first practice accumulating 40 to 90 minutes of exposures, and then you practice response prevention as much as you can, as you build up and build up and build up steps, you have a great ERP plan right there, an amazing ERP plan.

One thing to consider. When my husband came on the podcast, it’s episode 99. He talked about his panic attacks that he had an agoraphobia he had on airplanes. He brought up the concern of, it’s not like he could get on a plane for 10 minutes and then get on a plane for 15 minutes and then get off. There are certain situations where you have to go from 0 to 100. So you have to get on the plane and stay on the plane. In his case, it was 17 hours to Australia.

So there will be situations where you have to take that huge leap. That is okay. You can still tolerate that. I still want to reinforce and empower you to believe you can still tolerate those big, big exposure jumps from 0 to 100 or from maybe four or five to 100. You can still tolerate those. I don’t want you to feel like it’s not possible. Anyone can face their fear. It just depends on how willing they are to be uncomfortable.

But what he did as he led up to that is find creative ways to practice the scenario and simulate the scenario as best as he could. He took the train. He took little buses. He took the trolley. There’s a small trolley back and forth from the mall, so he practiced on that and practiced tolerating his panic. So you can find ways. Even if it’s not the specific fear, you can find other ways to simulate that fear or that thought or that sensation so that you can practice building up to those bigger, longer exposures where you don’t get to choose how long you do the exposure for.

So there are some ideas on how you can practice ERP, what frequency, what duration. Now the other question I commonly get is, do I have to do it every day? No, you don’t have to do it every day, but I always encourage my patients to do it as much as you can. This is like building a muscle. So the more mental push-ups you do, the better and stronger you get.

Now we also know that you can do too many pushups and burn out. And so it’s important to keep an eye on that. I always try to talk about balance. So try to find a plan or a system or a routine in your calendar that is sustainable, that you can continue to do over time. Some people have written in and said, “I went full gung-ho, went hard, burnt out. The idea of ERP was so overwhelming after that. So I stopped.” So I really discourage you from going that kind of way.

You don’t have to be perfect. Please don’t do this perfectionistically. Find little baby ways to implement it throughout your day so you don’t burn out. That is how you do this work for a long period of time. That is how you get better. That’s how you do it in a healthy, compassionate way.

So that is how we do it. You don’t have to do it every day. In fact, some of my patients schedule different obsessions on different days. Other patients take a six-day exposure and take Sunday off or one day off a week. You could do whatever feels right to you. Just be really honest with yourself. When you schedule your ERP, are you scheduling it because of your values and your self-compassion or are you scheduling it because you’re secretly afraid? Even if it’s that, even if it’s the letter and your scheduling because you’re secretly afraid, no problem. We are doing the best we can with what we have. Just be really honest with yourself, and look and work on that if that’s the main issue.

Thank you so much for being here today. I am honored to spend this time chatting with you. Hopefully, you got a ton from this episode. I love when I get questions from you guys. If you are, go over to Instagram and you can chat with me there. I’ll leave the link in the show notes. You can always ask me questions there. I often do Q and A’s and I’d be more than happy to answer your questions.

All right, you guys know what I’m going to say. It’s a beautiful day to do hard things. Go and do the hard thing. You will not be sorry. You will be so empowered. You will feel so much better. It is hard work, so be gentle with yourself. But I believe in you. Have a good day.