Rumination-Focused ERP Therapy

Rumination-Focused ERP (RF-ERP) Therapy is an approach based on ERP developed by Dr Michael Greenberg. You can see his website for information and articles on this approach by clicking here.

RF-ERP has some variations on traditional ERP but still involves the components of Exposure and Response Prevention practices. There is a focus on initially addressing rumination and mental compulsions. Rumination describes a repetitive type of unhelpful thinking which people with OCD engage in often in an attempt to solve a problem, figure something out or prepare for the worst.

The goal of RF-ERP is to develop a client's sense of agency and confidence in being able to choose to disengage from the obsessive thoughts without engaging in compulsions. This involves helping clients to develop their skills in identifying and stopping unhelpful thinking patterns. This can initially feel like taking a big risk as it can feel like choosing to leave an important what-if question unanswered and the problem unsolved. However, in reality the thinking is not solving the problem or it would have been solved long ago! In the long-run rumination and overthinking just perpetuate anxiety and get people more and more stuck in their heads.

We are not able to control what thoughts pop up into our minds but we can control what we do next and where we direct our attention. Engaging with and directing attention towards an OCD thought is like holding onto it, so that it is not able to leave our awareness. It is like the thought is trapped, just like a butterfly would be trapped when our hand is closed over it. Instead RF-ERP teaches clients to stop paying attention to the thought. This is like opening up your hands to allow the butterfly to fly away when it chooses, just like a thought eventually will leave our minds, when we are not continuing to pay attention to it.

Addressing emotional and relational conflicts that are underlying symptoms (Malan's Model)

RF-ERP also adds to traditional ERP by exploring the emotional and relational factors that are underlying and contributing to the urge to ruminate.

RF-ERP also incorporates elements of a psychoanalytic approach which involves the exploration and contribution of patterns of emotional avoidance to anxiety and OCD symptoms (Malan's model). For some clients it can be important to address emotional avoidance patterns by working on increasing emotional awareness and the processing of unexpressed (suppressed) or unacknowledged (repressed) feelings. If we believe that certain feelings are unacceptable, shameful or too painful we may avoid feeling or acknowledging them at all (often anger, resentment, pain or sadness). This pattern of emotional avoidance can be a contributing factor to nervous system dysregulation, anxiety and OCD symptoms. This can be addressed in treatment by working on increasing awareness of these emotions, the willingness to feel them and gradually allowing, expressing and processing these underlying feelings.

DISCLAIMER: This is my take on RF-ERP from completing training with Dr Greenberg and reading his articles. You can check out his website for yourself if you are interested in further information and articles written by Dr Greenberg by clicking here.