Exposure and Response Prevention

Exposure and Response Prevention

On Wednesdays, I go to an outpatient group program focused on Cognitive Behavioural Therapy for Obsessive Thoughts. It’s an extension of support offered by the Psychiatric Hospital I spent 10 weeks in last year. It’s a relatively small group of about 7 individuals, a mix of genders and ages. We spend the first half of the session every week each sharing how we’ve been, what challenges we’ve faced and obstacles we might have overcome. I was kind of dreading my turn today. I wasn’t sure of the reaction I’d receive when I told them the reason I hadn’t been at group for the previous two weeks because I was overwhelmed by my Psychosis diagnosis, and still coming to terms with it. To be honest, I wasn’t even sure if I’d still be allowed to remain and participate in the group anymore because of the nature of my diagnosis. But when I shared all this with them, everyone was incredibly supportive. I talked about the fears I had relating to the stigma of the illness, and the symptoms of the sickness itself that frighten me. I got a bit teary while talking about it. I don’t know if that was relief or fear, but I did feel better after I’d told them and received understanding feedback. Then I mentioned that I’d started blogging about my mental health journey, no holds barred and my facilitator helped put it in context as an Exposure and Response Prevention (EX/RP) exercise. EX/RP is about exposing yourself to a person, place or object that triggers your obsessions, and then deliberately resisting the urge to carry out the compulsion that would normally relieve the anxiety the circumstance provoked. In this instance, that was living more transparently through my writing. Normally any time I’ve thought to share anything about my mental illness on social media, I’ve deleted it before I’ve ever hit send. Or I post it, freak out that someone will judge me and hastily delete it. Every time I don’t delete a post here, I’m seeing it as an exercise in exposure, literally and figuratively. The desired outcome is habituation, which is basically provoking a decrease in response to a stimulus after being repeatedly exposed to it.

I actually practiced another EX/RP today. This time, a woman I know at the Day Program was raving on about her lipstick. She kept telling me how amazing it was, and how it never comes off (mostly because she’d noticed I’d eaten most of mine off my lips). Before I could stop her, she’d grabbed my hand and rubbed a swatch of her lipstick on the back of my hand to demonstrate it’s extraterrestrial staying powers. I was instantly filled with fear, disgust and embarrassment that she might see the reaction on my face. I commented on how pretty it was, and told her I had to run to the bathroom, where I desperately wanted to wash it off with soap and water, removing any contamination from my hand. Instead, I stood in the bathroom and took a few big breaths and sat with the discomfort and fear it had provoked in me. I sat with the anxiety a full five minutes before I scrubbed my hands. That’s five minutes longer than I would have normally. If something like that had happened in the past, I probably would have had to go home straight away and wash my hands with Methylated Spirits and copious amounts of antibacterial soap. Small victory, but I’ll take it. By the way, she was right. That lipstick really does stick like shit to a blanket.


EX/PR The distress should diminish over time, and with repeated exposure to the situation that provokes it.

I ducked out of group 15 minutes early to make it to an appointment I had scheduled with the new Psychiatrist on the floor above the day program. He was as kind and friendly as he had been last week, and we talked about the blood work I had done to check the levels of my antidepressant in my blood. He said it’s on the low side of normal, so that means we can afford to up the medication by another 50mg. I went up another 100mg on one of my antipsychotic medications as well. Both of these are to help the increased levels of anxiety I’ve been feeling the past few weeks. He’s also scheduled me an ECT because one of the medications I use can screw with your heart (fun!), so I’ve got that booked in too. He told me not to hesitate to call him if I needed anything before our next session and was kind enough to offer me a reduced rate for our sessions if I can’t get in on the days my Health Insurance pays for it. Goes to show you, good Psychiatrists are around, it’s just a matter of finding them.