Brandon Gimbel (00:00)

I've had patients tell me, many patients, I've gone to therapy before, they told me to do things that made me anxious, and I did them, but I didn't get better. What's going on?

Melanie Santos (00:08)

I'd say that ERP is more nuanced than just going and doing things that make you anxious. So often unbeknownst to people, they're engaging in safety behaviors or reassurance seeking that can make a situation seem easier in the moment, but ultimately it's reinforcing an obsessive compulsive cycle. I tell clients that if they're doing exposure without response prevention, then they're just doing compulsions. I'll pause and give a little example. So if someone were to have OCD and take a flight, and they think that the only way that they can fly safely is to text everyone in their immediate family, I love you, and receive a response from each of them in return before they take off. That's what they need to be safe. They reinforce that they can only fly if they get a response back from everyone. So if it were to arise that maybe someone didn't catch the text and so they didn't respond, that person will become increasingly anxious because they couldn't complete the thing that they deemed that they needed or their security blanket. We'd call that a compulsion.

Brandon Gimbel (01:12)

So your work is in trying to help patients get on the airplane, for example, and not engage in those safety behaviors.

Melanie Santos (01:21)

Yes, absolutely. It's to have people teach themselves that they can tolerate the uncertainty and distress without engaging in the behaviors that they'd inadvertently learned to reinforce their obsessions.