Oct 22, 2026 · 41 min · 14 segments
What happens when you try exposure and response prevention (ERP) therapy, do everything you're told, and still don't get better? You might be facing your fears without realizing you're also doing…
Patrick McGrathHost
Well, There's a couple of things that I wanted to go over today because I just thought it would be interesting to think about some of the fundamentals of ERP and maybe why people don't do ERP or what gets in the way of doing it.
And that can go anywhere from family accommodations that are happening that are maintaining part of the problem.
That could go from people being afraid to take the first step and being motivated Not that they're not motivated, but maybe not motivated quite enough, right? I sometimes say you're a 51-49.
49% of you wants to change, but 51% of you wants to stay the same type of thing.
So I'm wondering, let's maybe start off the chat there about how do you two conceptualize the role of things that get in the way of do ERP? How do you help people identify those? And what do you do to help people overcome those?
Brett, you didn't mention in your intro that you wrote the book on exposure therapy.
And I think it's useful for our listeners to keep in mind that this is something that you've been studying and writing about deeply for a very, very long time.
And it's also true that a lot of the things that I might have to add to this discussion are based on my readings of that book.
One idea that I want to throw out there is the idea of intention, which I think is a neglected concept because it's one thing to know that you need to make a change and that it would be good for you to make a change and that you're motivated to make a change.
But The intention is the place where we find out if you are willing to feel the thing that you've been protecting yourself from feeling.
And that is the, are you willing to lean in? or are you still trying to protect yourself? Because we all know that it's possible to do ERP while secretly protecting yourself from ERP.
Which is the same thing as possible to get a gym membership and go to the gym every day and work out while protecting yourself from exertion.
And you could do that every day and never get more fit because the key to the whole thing, it's not the gym membership and it's not going to the gym.
It's the attitude that the intention that you bring into the gym with you and the people who kick butt in ERP are the people who show up and say, all right, Let's go.
And my experience is that when people show up with that intention, It just clicks and it goes quickly and it goes very well.
So I feel like it's the intention to lean in to the stuff that you've been avoiding internally or not.
So Brett, let me jump in and let's make that concrete and then we can toss it back and forth.
Well, There's a couple of things that I wanted to go over today because I just thought it would be interesting to think about some of the fundamentals of ERP and maybe why people don't do ERP or what gets in the way of doing it.
And that can go anywhere from family accommodations that are happening that are maintaining part of the problem.
That could go from people being afraid to take the first step and being motivated Not that they're not motivated, but maybe not motivated quite enough, right? I sometimes say you're a 51-49.
49% of you wants to change, but 51% of you wants to stay the same type of thing.
So I'm wondering, let's maybe start off the chat there about how do you two conceptualize the role of things that get in the way of do ERP? How do you help people identify those? And what do you do to help people overcome those?
Brett, you didn't mention in your intro that you wrote the book on exposure therapy.
And I think it's useful for our listeners to keep in mind that this is something that you've been studying and writing about deeply for a very, very long time.
And it's also true that a lot of the things that I might have to add to this discussion are based on my readings of that book.
One idea that I want to throw out there is the idea of intention, which I think is a neglected concept because it's one thing to know that you need to make a change and that it would be good for you to make a change and that you're motivated to make a change.
But The intention is the place where we find out if you are willing to feel the thing that you've been protecting yourself from feeling.
And that is the, are you willing to lean in? or are you still trying to protect yourself? Because we all know that it's possible to do ERP while secretly protecting yourself from ERP.
Which is the same thing as possible to get a gym membership and go to the gym every day and work out while protecting yourself from exertion.
And you could do that every day and never get more fit because the key to the whole thing, it's not the gym membership and it's not going to the gym.
It's the attitude that the intention that you bring into the gym with you and the people who kick butt in ERP are the people who show up and say, all right, Let's go.
And my experience is that when people show up with that intention, It just clicks and it goes quickly and it goes very well.
So I feel like it's the intention to lean in to the stuff that you've been avoiding internally or not.
So Brett, let me jump in and let's make that concrete and then we can toss it back and forth.
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