ERPin' and derpin'

And a few other recipes for success.

Oct 20, 2022

Gas prices might be going up—but a Psychology Onions subscription is still FREE FREE FREE!!

If you’ve been enjoying Psychology Onions and you’re feeling a bit saucy, it would mean the world to me if you’d share this newsletter with everyone you know—friends, colleagues, the current chair of the Board of Governors of the U.S. Federal Reserve System, Jerome Powell… literally anyone. Mr. Powell: there’s a painless way to fix inflation—stop raising interest rates and start reading Psychology Onions!

“An onion a day keeps the inflation away.” - Benjamin Franklin

By the by: I quickly spun up a template promoting Psychology Onions that you can fill in and email out to your friends, family, and colleagues. Don’t even think about it—just press send!!

Dear [insert person’s name],
I have kidnapped your [insert someone they care about]. I would also like to introduce you to Psychology Onions, a newsletter that sometimes talks about OCD and mental health but also sometimes doesn’t. I implore you to subscribe to Psychology Onions if you ever want to see [the person they care about] again.
Warm regards,
[insert your name]

I’ve written at length about shitting out your emotions, ketamine, and John Malkovich from the movie Being John Malkovich—but I haven’t really discussed ERP (exposure and response prevention) therapy. So let’s spend a bit of time exploring this OCD treatment—no frills, no fluff, no foolin’. Just facts.

Also—this should go without saying—but I’m not a medical professional. So if I get something wrong… plz don’t get mad at me. I’m just a weedy little guy who’s out here trying his best. And there’s already a ton of medical misinformation on the internet so just mindlessly share it on Twitter and move on.

But also let me know because I’d actually like this newsletter to be a helpful resource.

Now with all that legalese out of the way—exposure and response prevention can be separated into two components: EXPOSURE and RESPONSE PREVENTION.

The “exposure” part of ERP is about approaching and triggering your OCD. Those of us in the medical community like to call it arousing your OCD. 😉🤤

“Ahh baby I’m about to blow” 💦🍆 —your OCD

The “response prevention” part of ERP is about deliberately NOT performing the compulsive behavior, not obsessing, not ruminating—not seeking the temporary release that comes from giving into your compulsions.

ERP is like… huh. It’s kind of like psychological edging, I suppose. Wow. This metaphor really took shape. Nicely done, me!

Here’s a simple example: let’s say you have some sort of contamination OCD. To you, faucets or door handles are “dirty.” If you touch a faucet or a door handle, your hand becomes contaminated. If you then touch your face or your jeans or your shoes, those objects become contaminated. If you put your jeans on a chair, that chair becomes contaminated. If someone sits in that chair… you get the idea. Your OCD tells you that you need to wash your hands a specific way, take off your jeans, take a shower and wash yourself a certain way, scrub the chair with bleach and so on and so forth. But with ERP, your goal is to touch the faucet or the door handle anyway, and then sit with those feelings of discomfort. Lean into the nasty, anxious thoughts. This is a good moment of practice. Don’t just stop yourself from washing your hands. Don’t shy away from the discomfort. Touch your face and your jeans and everything around you and just… shrug. Your OCD will spike and you’ll feel like shit—but that’s part of the process.

ERP therapy is about changing the relationship between you and your intrusive thoughts. Some of the “content areas” that I’ve really struggled with revolve around crime—murder, violent assault, sexual crimes. For example, I have these obsessive thoughts that I’ve killed someone or I’m going to kill someone. ERP IS NOT about being like, “Eh, maybe I did kill someone,” SHRUG. 🤷‍♂️ It’s about allowing those thoughts to enter your brain, ping pong around up there, and acknowledge that your OCD is the issue at hand—not the criminality or legality of anything. That’s all just noise.

AND—this distinction is really important because it’s how ERP differs from traditional talk therapy. Talk therapy is all about diving into your problems and your worries—and gleaning insights about them with a mental health professional. Standard talk therapy is not considered an effective treatment for OCD

. In many ways, talk therapy can be detrimental and become its own sort of compulsive, obsessive, reassurance-seeking type of activity.

Lemme expand on this a bit—let’s say you and your wife are having a few marital issues and you decide to seek counseling.

Your wife: He’s not present with the kids.
You: “I’m not present, Meredith, because I’m working 14-hour days at the power plant to dig us out of the financial hole YOU put us in with that idiotic wholesale real estate investment scheme you sunk our 401(k)s into.”

There are things you can both can work on, remember what you love about each other, let’s linger on these hurt feelings for a bit longer, etc., etc.—traditional talk therapy or marriage counseling might sound a bit like this.

Now, instead—let’s say your wife is a fully-grown grizzly bear, weighing upwards of 900 pounds, with an insatiable thirst for human blood. At this point, there’s not much use talking through the marital problems because the issues aren’t really about the failed wholesale real estate investment or the time you’re spending with the kids—it’s more about your wife being a nearly-blind, eight-foot-tall killing machine who’s been known to attack humans without provocation.

TL;DR: talk therapy can be an unbelievably valuable treatment for many issues and disorders—but with OCD, ERP is the way to go.

So in summation:

When you feel your anxiety and doubt and shame and uncertainty and intrusive thoughts slapping around in your head, take a step back.
Acknowledge that this is your OCD. You’re not in any real danger and there’s no point going down this OCD rabbit hole again.
In a large saucepan, sauté the onions with butter on medium-high heat, until they turn a rich, translucent, golden-brown color. Deglaze with sherry and let simmer for 5 minutes, before adding some white wine and continuing to simmer uncovered for an additional 15 minutes.
Externalize and personify your OCD—take a proactive, athletic stance. Bring it on, OCD! Start punching the air wildly and without restraint.
OCD is absurd. Be absurd back. Don’t give in to your obsessions and compulsions. Don’t ruminate. Don’t ritualize. Sit with the discomfort.
Add some beef stock and a pinch of salt and pepper. Bring to a boil, then simmer for an additional 20 minutes. Serve hot with grated Parmesan and a glass of acidic, earthy, medium-bodied red wine—like a Pinot Noir or a Dolcetto.