erp therapy

Exposure And Response Prevention: Break The Avoidance-Cycle

Where’s Your Humility!

Are you white-knuckling your way through sobriety? Do you want to get drunk but feel too embarrassed to share it? Do you think you know it all and think the advice of your peers is moronic and unhelpful?

Well, my friend, you need a dose of humility and if experience has taught us anything it’s that either you take a slice of humble pie or it’s a force-feeding.

I wish there was an easier softer way but there is not. The only way to break the avoidance-cycle is confrontation and rarely are confrontations fun. 

Avoidance-Cycle

Here is the skinny: if you’ve spent your life running from pain and darting to pleasure you’ve calibrated your brain and body in such a way that it will revolt at actions that run contrary to its programming. 

So, when you want to get high simply discussing it in an open forum of sorts won’t get loads of support from your body and brain. 

Instead, your body will likely shoot you up with adrenaline, cortisol, and whatever chemicals it needs to get you stressed and moving (more like running). 

Your brain on the other hand will provide the neurotransmitters necessary to produce cravings, obsessive thinking, and a game plan to escape the discomfort. 

You’re up against yourself – no doubt about it. 

It does this because it’s been programmed to do so. Therefore, you need to deprogram it.

So, what can we do about it?

Exposure and Response Prevention (ERP)

Let’s break this down into its three constituent parts. 

Exposure: exposing yourself to thoughts, images, objects, and situations (it’s best to think of these in terms of triggers) that make you anxious, start obsessive thinking, or otherwise cause immense emotional discomfort. 

Examples: 

  • Someone talking about getting high when you’re trying to get sober. 
  • Fear of socializing and being at a social gathering.
  • Any number of stressors that produce cravings and urges to do something unhealthy and destructive.

Response Prevention: this component refers to the fact that you have a choice not to follow through with the routine (see mechanisms of a habit), or compulsive behavior once you’ve been triggered. 

Yes, this means you “mindfully” sit and observe the chaos coursing through your entire nervous system. It sounds awful and I assure you that at first, it is (sorry, there are no short cuts for anything worth it).

I’ve heard one gentleman refer to it as the mindfully do nothing technique. It’s like running a marathon and never leaving your chair! 

Hopefully, I’m not pushing you away, but if you felt the cravings, the obsessive thinking, and radical emotional and physical discomfort, then you know what I’m talking about. 

What’s the mission statement that our internal con-man sells us daily?

“I need to be somewhere, just not here. The answer is someplace else, I just need to go find it.”
-Internal Con-Man

That is perhaps the evilest belief to ever infiltrate the mind, that the solution is just beyond your reach. 

I’ve heard one individual call this state of mind “the fear of emptiness,” and another termed it “chronic malcontent and dis-ease,” but I refer to it as “persistent gut-wrenching impending doomism.” 

But whatever, regardless of its name like all darkness it dies in the light of exposure. Additionally, this isn’t some mystical hocus pocus – it’s science baby!

It’s highly suggested you do this under the guidance of a professional, however, in due time you’ll be able to do this on your own. Nevertheless, don’t underestimate the value of a support group or fellowship – if you’re ignoring that aspect of your recovery life change will be unlikely (see my three requirements for a solid program of action).

It might sound awkward, exposing yourself to the things that make you uncomfortable and anxious. 

It may feel counterintuitive, but once you understand how your neurological programming works you’ll see it’s merely common sense. 

A crucial part of ERP is what I refer to as Total Commitment

You must sign a contract on your heart to not give in and to see it through. This isn’t like Rational Recovery’s “Big Plan” where you wag your finger in the face of adversity and just say no!

Rather, mindfulness is paramount to surf this surge.

Surfing The S(urge). 

“Urge Surfing” is a concept developed by proponents of Acceptance and Commitment Therapy (ACT). In my opinion, without this strategy, ERP is futile, that is unless the urges are incredibly weak. 

Nonetheless, ACT and ERP both fall under the Cognitive Behavioral Therapy (CBT) umbrella so they complement each other wonderfully. Like cheese to a cracker! 

In any event, what’s urge surfing?

“Urges can feel like waves,” particularly acute is the emotional riptide, you cannot fight this or it will drag too far from the shore (seemingly beyond aid, on autopilot and heading towards destruction). 

These waves “rise in intensity and tug and pull us towards using old behaviors that may provide us a temporary relief, but often lead to negative consequences in the long run. Rather than struggling and fighting an urge we can ride it by staying present and mindful, noticing the moment it peaks and the moment it crashes.”

A simple 5-Step Method to “surviving the surf” that you can employ today is:

  1. Identify the Physical Sensation in the body
  2. Focus on the Sensations
  3. Notice Breathing
  4. Refocus on Your Body
  5. Stay Curious and Present

For more information on Urge Surfing click here and here.

The more you expose yourself to the triggers and surf out the urges the easier it gets over time. The physiological process called “Habitation” enables you to move from response prevention to response intention.

You are responsible for your choices. Yes, urges can influence the difficulty level, but you can do something about it. And we know it, because it’s how we are designed. 

Habitation is basically the reality that nervous system arousal decreases on repeated exposure to the same stimulus.

This is why sex therapists routinely tell their clients to “spice things up,” a clever euphemism for doing something different!

“This mechanism is hard-wired into the human genetic program. It has clear adaptive value because habituation to familiar stimuli allows more energy to be directed to novel stimuli, hence improving the odds of survival…”

Therefore, this is how we are by design. I know we love to think we are all terminally unique but we are more like unique apps on one specific operating system.

The experience of anxiety involves nervous system arousal. If your nervous system is not aroused, you cannot experience anxiety. Understandably, but unfortunately, most people attempt to cope with feelings of anxiety by avoiding situations or objects that elicit the feelings. Avoidance, however, prevents your nervous system from habituating. Therefore, avoidance guarantees that the feared object or situation will remain novel, and hence arousing, and hence anxiety-provoking. Moreover, avoidance tends to generalize over time. If you avoid the elevator at work, you will soon begin to avoid all elevators, and then all buildings that house elevators, etcetera. Soon enough, you’ll be living in a prison of avoidance.”

Right? If it’s adaptive then your body and brain by design will see the threat as genuine and will fortify all defenses to ensure that threat is henceforth avoided at all costs. That’s why if you are terrified of socializing and you avoid it that it goes from uncomfortable to paralyzing. You’ve calibrated your design this way. Yet, this is good news! Why? Because if you hold the wrench, then the ball is in your court to change it! 

Time To Tweak The Design. 

As we being the confrontation process, understand that habitation targets every facet of being human.

Think of each individual represented by a baseball diamond. First base is the physical. Second base is the psychological. Third base is the behavioral. Lastly, home plate is the emotional aspect. What about spirituality? Well, that of course is the player running the bases!

Anyway, let’s take a gander at what occurs when passing through each base.

Tweaking The Psychological

Every time you confront your fear rather than avoid it you have radical feelings of empowerment and accomplishment. Truthfully, each time you turn that wrench you realize the power and strength you embody i.e. your anxiety threshold increases. 

Just like the process of drug tolerance – when you use a certain drug, over time you need more and more of it to produce the same effect, in like manner you grow a tolerance to anxiety. You need a heck of a lot of it to trigger you after you habituate your system. 

Once you understand this reality on an experiential plane, namely once you have evidence that it works, the motivation and enthusiasm you have for it will be practically unceasing. 

Tweaking The Behavioral

The difference between the novice and the master is the master’s willingness to fail gloriously. The more one fails, the more one progresses. In time mastery actually reduces the chance of failure and decimates the need to constantly worry (because habitation has adjusted your system in such a manner that it no longer responds to unnecessary stressors).

Tweaking The Emotional

What’s odd, is that whatever was the initial fear or trigger becomes so amplified that by the time this base is reached it’s no longer the object, person, or place that is feared. Rather, it’s the feeling of fear that is feared.

This is the worst of all, the fear of fear. This is the fundamental issue in conceivable every anxiety issue.

We fear the sensations of fear itself. 

Exposure to the sensations of fear allows us to habituate to the sensations, which in turn increases our emotional intelligence because we learn how to regulate the sensations.

Some of us don’t even think this is possible but recall this is how we are by design – you hold the wrench!

The Internal Alarm System

The following analogy demonstrates in an unbelievably relatable and understandable way, I pray it connects with you ⇒ the following is taken from The International OCD Foundation.

Think of your anxiety as an alarm system. If an alarm goes off, what does it mean? The alarm is there to get your attention. If an intruder is trying to break into your house, the alarm goes off, wakes you up, gets you to act. To do something. To protect yourself and your family. But, what if the alarm system went off when a bird landed on the roof instead? Your body would respond to that alarm the same way it would if there were an actual threat such as an intruder.

Compulsive urges take over your body’s alarm system, a system that should be there to protect you. But instead of only warning you of real danger, that alarm system begins to respond to any trigger (no matter how small) as an absolute, terrifying, catastrophic threat.

When your anxiety “goes off” like an alarm system, it communicates information that you are in danger, rather than “pay attention, you might be in danger.”

Unfortunately, your brain tells you that you are in danger a lot, even in situations where you “know” that there is a very small likelihood that something bad might happen. This is one of the cruelest part.

Now consider that your compulsive behaviors are your attempts to keep yourself safe when that alarm goes off. But, what does that mean you are telling your brain when you engage in these behaviors? You are reinforcing the brain’s idea that you must be in danger. A bird on the roof is the same as a real intruder breaking into your home.

In other words, your compulsive behavior fuels that part of your brain that gives out these many unwarranted alarm signals. The bottom line is that in order to reduce your anxiety and your obsessions, you have to make a decision to stop the compulsive behaviors.

It is important to know that Exposure and Response Prevention changes your body and changes your brain. You begin to challenge and bring your alarm system (your anxiety) more in line with what is actually happening to you.

In Sum

So, here’s the bottom line:

  • Confront the trigger (wave)
  • Surf out the urge (mindfulness)
  • You eventually master the surge (the trigger becomes desensitized and the accompanying urges decrease in intensity).

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