”Nothing in life is to be feared, it is only to be understood. Now is the time to understand more, so that we may fear less.” – Marie Curie
Has a bad experience kept you from things you enjoy? Do you avoid certain situations so that you can escape the anxiety that surrounds them? When you begin to refrain from situations, this avoidance solidifies the event as ‘scary’ and when we encounter similar circumstances, we get anxious. Prolonged Exposure Therapy (PET) is about approaching those situations thoughtfully, in order to reduce the overall power of the situation.
Exposure and Response Prevention Therapy (ERP) is a different approach designed to assist individuals with OCD overcome cycles of obsession. While we may not always recognize our fear or triggers in the moment, this can be learned and there are tools you can use to break the cycle. Let’s go over the strategies now.
Prolonged Exposure Therapy (PET)
Prolonged Exposure Therapy is used to treat anxiety and PTSD. PET is based on Emotional Processing Theory where the following are demonstrated:
We all have cognitive fear structures. A compilation of thoughts, feelings, and senses associated with a trauma or fear.
We all have fear responses. Examples of this are withdrawal, react, evade.
Through careful instruction a person can learn to encounter the fear, recognize the fear structure activated, then examine and change the fear response. When we encounter events that are safe or low threat, but have a high or escalated fear response, it is important to examine the impact of this event. We can then recalibrate in order to reduce long-term distress. We can start with making a list.
In PET, triggers and fears are ranked in order of how distressing they are so we can establish a fear hierarchy. We order our fear from sort of uncomfortable to very scary, ranking distressors from 1-10.
After you make a systematic list, the process of establishing how to face these fears can begin. In PET an individual can face these fears imaginably, such as through memory recall, and visualization in the imagination. A person could also approach fears In Vivo (aka In Life), such as direct experience. This process is called systematic desensitization.
Systematic desensitization starts with exposure to the trauma or fear, followed by employment of relaxation techniques. An individual reviews their fear hierarchy list and incrementally faces obstacles preventing a thriving life. Exposure to a fear stimulus in a controlled setting allows for reduction in anxiety regarding the stimulus over time.
Since our minds connect elements of traumatic experiences with other experiences, we start to avoid what hurts us and embrace what eases our anxiousness. After falling off our bike our thoughts could be, “Last time I got on my bike I got hurt,” or “bikes are scary.” That is why as kids we are encouraged to get back on the bike. That childhood lesson is important. As we grow older, we may not even consciously recognize our fear avoidance as we say to ourselves, “I think I will walk today.”
Exposure and Response Prevention (ERP) Therapy
This approach was designed to counter a cycle of obsession. An individual with OCD may experience a cycle similar to encountering stimuli, experiencing obsessive thoughts, followed by compulsive behavior in order to dispel the invasive or obsessive thoughts. This cycle can cause overall distress due to the effort required and anxiety experienced by the person.
With mental health support, a person can be incrementally exposed to more and more distressing stimuli (similar to a fear hierarchies above) while applying relaxation techniques. Refraining from the compulsive counter behavior becomes easier for the person over time.
Preventing the behavior allows the person to begin to let go of the belief in its necessity. ERP disrupts the cycle before the person engages in the compulsive or ritualistic behavior. Over time, piece by piece, people discover that they are safe when exposed to stimuli.
What is similar, What is different
Although these two strategies are designed around exposure, they are quite different. PET is designed to help individuals with PTSD who have withdrawn, while ERP is designed to help those struggling with an obsession cycle.
Both strategies involve a goal to condition the individual to tolerate stimuli, and invasive or obsessive thoughts without compulsive behavior. Both processes involve the part of the brain responsible for stress responses, the amygdala. The amygdala is a part of the limbic system in the brain involved in judgment, memory, and emotional responses. Our amygdala determines what to be afraid of, or in other words what fear structures we have.
With both strategies, once the fear or trigger is identified, strategic exposure to the fear element allows you to incrementally address it. Both ERP and PET are tools that we can use to chip away at your fear, a little at a time until one day it’s not even on your list.