Matt's Audio Letter of the Week

Hey everyone, welcome to this edition of the Feel Better Letter, or the FBL.

This is Matt.
Hope everyone is having a great week.

Today, I want to talk about why I’ve changed my mind—at least to a degree—on the idea of ERP, or Exposure and Response Prevention.

If you’ve been in the world of OCD and anxiety recovery for any amount of time, you’ve heard about ERP, right? I’m not saying anything you haven’t read on a thousand different blogs, forums, YouTube videos—there are even plenty of research articles about it. In fact, in my book I talk about ERP, and in my program I talk about ERP. But the longer I’ve done this work and helped people break the loop, the more I’ve seen what’s effective and what’s not.

It’s not that ERP isn’t effective—but the common beliefs about ERP are beliefs I no longer share.

For instance, I don’t agree with the idea of extreme exposures. This refers to writing very graphic narratives or exposing yourself to extreme content, whether audibly or visually. The basic idea behind theme-based ERP is that if we desensitize someone to their theme, they’ll break the loop. But much of ERP is theme-oriented, meaning the belief is that the theme is the cause of the fear. I maintain that fear is something within—it’s being projected onto the theme. That’s why themes change all the time.

Doing theme-specific exposures is fine—you obviously need to activate the fear. But the point of activating the fear is to release it from the body and nervous system. Fear is an energy. If you do ERP from the mindset of “I’m confronting something outside of me,” and rely on extreme exposures, you might desensitize to a specific theme. But if all you accomplish is desensitizing to the theme, then the person eventually just shifts to a new one. This creates the illusion—and frankly, the lie—that this is a chronic condition you’ll have forever.

If you only address the projection and never change the projection reel—meaning the emotion, beliefs, wounds, fears—then yes, the themes will keep shifting, reinforcing the idea that this is chronic. I obviously don’t believe that.

I also don’t believe people need to do these huge, extreme exposures. In many cases, they can actually be detrimental, especially if the person doesn’t know what to do with the emotion that gets activated. If you don’t know how to release in conjunction with exposure, you’re not really doing ERP—you’re just turning a kettle on, slamming the lid shut, and building pressure.

The other thing I’ve changed my mind on is hierarchies.

When I was trying to get better, and learning all this, the standard belief was that you create an exposure hierarchy. And while hierarchies can be effective for certain things, many people write them out and fall into two traps:

1. They make exposures too small, convincing themselves they’re doing exposure work when they’re not.
   For example, someone who compulsively takes 45-minute showers might decide their “first exposure” is taking a 40-minute shower. While that’s technically progress, if someone goes at that pace, the process could take 15 years. And people will get defensive because they feel they’re trying their best. And they are—but people are capable of far more than they think. Letting someone set the pace often works against them.

   This is one reason I don’t recommend doing this journey alone. You need someone who can be objective and push you to what you’re truly capable of.

2. They assume every exposure is a 10 out of 10, which keeps them stuck and overwhelmed.

A hierarchy can be useful in specific cases—for example, if someone is terrified of elevators. Sending them straight to the tallest building in town and riding the elevator for an hour probably isn’t the best first step. It might start with looking at a picture of an elevator, then standing in front of one, then stepping on and off, then going up one floor. You can do all that in a couple of days—honestly, I could do it all in one day with someone.

But people often draw out hierarchies and slow their own progress.

I do believe in “domino exposures”—exposures that make other exposures irrelevant.
For example, if someone is afraid of stepping on grass, and they go lie down in it, then stepping on it becomes easy.

But the idea of exposing yourself to extreme content—especially violent or sexual themes—or doing things against your religious values, or intentionally creating intrusive thoughts and trying to make them worse… you really don’t need to do that. Fear is an emotion and energy in the body. The real work is teaching people how to release fear. Once fear drains out of a topic, your perspective shifts completely. This is why when you pursue certainty from a place of fear, you never get it—but when you release the fear, the answers become obvious.

So yes, I believe in ERP in the sense of preventing compulsions and experiencing fear. But the way ERP is pitched and practiced is often counterproductive. That’s why I wanted to share how my thinking has evolved.

Hope this was helpful today.
Wishing you all a great day and a great week.
If you know someone who might benefit from this, please share it with them.
And I look forward to talking with you all soon.

-Matt