Transcription
Today I'm going to be talking about how to write an ERP exposure response prevention script for the treatment of OCD and pure O. Hi, I'm Paige Pradco. Welcome to Therapy for a Better Life.
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Now, in today's topic, I'm going to be sharing an acceptance script, a sample of an acceptance script at the end of this video, so you want to hang on to hear that at the end. But let's get right in. Uh, exposure response prevention, first of all, it is the standard gold treatment for OCD. Now, when we develop ERP plans for our clients, we make a couple of choices. First of all, we could choose behavioral exposures or behavioral ERP. And an example of this would be if I have contamination OCD as my theme, I might make myself feel contaminated, and then I might go touch a bunch of things in my house, and then I would not do any of my compulsing or ritualizing. And for example, if my compulsing were washing or cleaning, I wouldn't do any of that because I'm in my exposure, my ERP exposure response prevention. That's an example of a behavioral exposure, or we call it in vivo, in real life exposure.
Now, we have another choice. We could choose to do imaginal exposures. Now, imaginal exposures are when we are imagining different scenarios and exposing ourselves to our core fear in an imaginary scenario. So the most common way that we do that is through writing scripts. Now, we could do that also by maybe looking at pictures and things like that, imagining different scenarios while we're looking at pictures. But the most common is to write a script. Now, I have my clients as an exposure in itself, write their own scripts. I usually assign about four to six scripts that I have them working on at one time, and I'm going to go into a little bit more detail about what I have my clients do. Um, but, but just like any other ERP, when they are listening to the script, they are their response response prevention part is that they are not doing any of their compulsing or ritualizing.
Now, imaginal scripts are really helpful when we're treating pure O, obsessive thoughts only, because in that case, we, we can't do it in real life. A lot of those scenarios, and we have to really imagine our core fear. And, uh, so while they're listening to the scripts, they're not doing any of their, uh, ritualizing, obsessing, avoiding, they're not seeking reassurance, they're not neutralizing the thoughts in some way. They're really staying with the thought. Now, someone can listen to the script in an active way. It's called an, you know, active ERP script, and that's where they're really engaged, really focusing, really listening, of course. Now, there's no, uh, ritualizing going on. Or they could listen to it in a passive way. There's also the response prevention part where they're not engaged in any type of, you know, whether it's rumination or avoidance or any of those things, but they're passively listening. It might be in the background, and they might be driving or cooking dinner or what, you know, but they're just playing the script on a recorder in the background.
Now, what to include in your scripts? That's an important piece. So your scripts are usually, I have my clients do about one or two paragraphs, and I want them to touch on their core fear. Now, when we get into core fears, you have to imagine what is my worst case scenario. If it's with, uh, if, if you're having obsessive thoughts, imagine like, what, what might you do? What are you afraid you might do? What might be the consequences of that? Who would know? What would happen to other people? What would happen to you? What are these core fears that are involved with your obsessive thoughts? So we are going to try to really identify those core fears and then, and then hit those core fears while we're writing the scripts. So you may have some scripts that are kind of mildly hitting the core fear, medium, and then really more challenging.
I like my clients to again write their own and write their scripts as they're very believable to them. But I don't have them write it as if I have already done this bad thing, if it's, if it involves that or something bad happening. I have them write it as if it might happen. This may happen, this might happen, and this might be the consequence. And, and so I like people to kind of write it as if it's very unknown. It might happen, it might not. You know, I, we have to hold that uncertainty and hold that unknowing and tolerate that doubt. And so I always have them also include the doubt and the uncertainty. This may happen, it may not happen, right in their scripts. Uh, when people are recording their scripts, I want them to record them as if they believe them. They have to be very believable to you when you're writing them and when you're recording them. Emphasize certain words. You can get emotional if they make you emotional. Most people do get a little emotional. These scripts have to be believable. They have to touch your core fear in order for them to work.
Now, I typically have my clients, as I said, write a couple of these scripts and then record them. Now, you can read them out loud over and over again, but I like them to record them so that they can just play. And I actually recommend listening to them for, I try to get my clients to do it two hours a day. Now, if they can just have it playing in a headset or playing in the background for more for much longer, oh, that's wonderful. I want them to immerse themselves with it. So the goal is about two hours a day, but if they can do it more, let it play in their car when they're driving, anything that's great too. Another thing that I do is I have them listening to sometimes mixing it up by listening to their scripts on repeat on maybe a headset while they're actually doing a behavioral exposure. That's really combining it. So I can get them to kind of surprise themselves and hit that core fear in different ways.
Now, let me give you an example of different types of scripts. The one I'm going to read at the end is called an acceptance script. This is what I usually start with. I have the client kind of writing a script about accepting OCD, accepting uncertainty, that I have to accept uncertainty in my life. I tolerate uncertainty in so many different areas. I can tolerate it in this area too. I'm learning to accept that I will have doubt and unknowing in so many areas of my life. Another script might be the commitment to ERP script. And this is all of the reasons on why you want to treat your OCD, why you really want to do ERP, because ERP is hard. You're going right into your core fears and you're exposing yourself to that core fear. ERP is tough. And so I like a script about why I want my life back from OCD. I want to spend time with my family and friends. I want to enjoy my time with my family and friends. I don't want to obsess about these things anymore, and I want them to write a whole script on why they are committing themselves to doing their ERP. It really helps with the motivation. Uh, I also, there could be scripts about even, even kind of encouraging yourself on, hey, I'm doing a good job. I'm doing this ERP. Even if I have a bad day, even if I have a bad ERP exposure, even if I didn't do everything perfect, I'm so proud of myself because I'm doing this and I'm fighting OCD.
Now, I did already touch on the scripts on core fears that we're working on different levels of core fears when we're writing the scripts. And when I have people record them, I have them record them all together. Now, if they're doing different levels of core fear, we're going to add different ones on different weeks of treatment. So it is up to you what you want to listen to on recording right now. Do you want to start with some mild ones and then work your way up? That's wonderful. Also, if you, as I said earlier, if you don't have a way to record them, you can read them. That works too.
Now, I'd like to read the acceptance script that I have prepared. Oh, I also wanted to point you to Jonathan Grayson's website. It's called freedomfromocd.com, and he has several scripts on his website that can be really helpful. Now, this acceptance script, you can write in any way that you'd like, but I want you to just hear it.
I have OCD. I accept that I may never get certainty about any of my anxious thoughts or obsessive thoughts. If I continue to do my compulsions, I will continue to feel miserable and have this relentless guilt and just be a slave to my OCD. I deserve to be able to enjoy my time with my family and friends. I deserve to enjoy my life. I'm willing to devote time every day to doing ERP and I'm willing to do the hard work of ERP now in order to have a happier life in the future. I'm willing to accept unwanted thoughts and feelings as I go throughout my day. I am not going to ritualize. I'm not going to compulse. I'm not going to ruminate. I'm not going to do those behaviors to make me feel more comfortable. I will tolerate the anxiety in those moments. I will not let OCD bully me anymore. It may be difficult, but I am a person of value and I deserve a life that is not controlled by OCD.
So I hope to hear in the comments what you're going to write your scripts about or if you have any questions that I can help you with on these scripts. So until next time, I will see you in session. Take care. Bye.