Organized Chaos - Volume 3
What Does Habituation Mean?
by Bradley C. Riemann, Ph.D.
Many of you have probably heard about Exposure And Ritual/Response Prevention (E&RP) and its effectiveness for treating Obsessive-Compulsive Disorder (OCD).
We know that as many as 85% of people with OCD can be helped by using E&RP.
Many OCD sufferers and their families are confused by some of the terms associated with this technique. One term we have found that gives people trouble is "habituation." My goal in this brief article is to help clarify what this term means.
E&RP is based on the principle of habituation. People habituate to negative things around them.
Habituation means getting "used to" something we don't like.
For example, after being in a room for a period of time we no longer hear the hum of a fan that we found distracting. The sound does not go away. We just get used to it.
Another example of habituation we can all relate to is water temperature.
When we first jump into water we may find that the water is cold. If we stay in it long enough we find that the water has "warmed up." The water hasn't warmed up at all. We have just gotten used to it, or "habituated" to it. If you were to get out of the water for a while and jump back in, you find the water to be as "cold" as it was the first time.
The process of habituation is normal and natural. It takes no effort on our part to occur.
So what does this have to do with anxiety?
Habituation refers to the decrease (or reduction) in anxiety with nothing but the passing of time. This means our anxiety about something we fear will eventually go down without doing anything, but letting time pass. In E&RP we look for two types of anxiety habituation.
Type # 1: Within Trial
First, there is "within trial" habituation or reduction. A "trial" refers to an exposure assignment you are attempting (e.g., touching a doorknob without washing your hands). Within trial habituation is the reduction of anxiety you get holding onto the doorknob for a period of say ten minutes (e.g., anxiety reducing from a 4 to a 2 using a 10-point scale). You will get this if you give yourself long enough. Long enough to do without e.g., washing your hands), (e.g., thinking to yourself a prayer), or saying (e.g., asking if it is OK to touch a doorknob without washing your hands) anything. Your anxiety goes down with the passage of time.
The great thing is that you don't have to do anything for this to occur. It just happens.
The key to "within trial" habituation is to do the exposure exercise long enough to experience this reduction in anxiety. Or stay in the water long enough so it can "warm up".
How long is long enough? It is different for different people. It is different for different exercises. Most doctors would encourage you to do the exercise until you get at least a 50% decrease in your peak anxiety rating.
Type # 2: Between Trial
The second type of habituation we look for in E&RP is "between trial" habituation. This refers to the reduction in the "peak" anxiety ratings you experience when you repeat the exposure exercise over and over again.
"Within trial" reductions in anxiety do not last long if the exercise is not repeated. This means that if your anxiety went from a 4 to a 2 in 10 minutes on an exercise. Then you waited a week before you did it again, you probably would get an anxiety rating of a 4 to a 2 in 10 minutes the second time. It's like getting out of the water and not going back in until the next day. Chances are it will feel as cold as it did the day before. Nothing happened for the long term. It was back to square one. It takes repetition to get those 4's to start coming done from one trial to the next.
By repeating the exercise over and over again you get to the point where it will cause you minimal anxiety from the start. How many repetitions will it take before you experience minimal anxiety from an exercise? It is different for different people and different for different exercises.
"Between trial" habituation is really the effect of treatment.
Rituals or compulsions give you the equivalent of "within trial" habituation. Compulsions work, and can work to reduce anxiety quickly (e.g., driving anxiety from a 4 to a zero). The problem is they don't help in the long run. Every time someone is faced with the same situation they will have to ritualize again.
Exposure without repetition is similar. It reduces anxiety at first. If you don't keep doing it, nothing good happens in the long run. E&RP "beats" compulsions with the "between trial" reductions or habituation that occurs with repetition. The goal of E&RP is to replace the compulsions with the process of habituation as a means of reducing anxiety.
When doing E&RP remember to do the exercise long enough to get "within trial" habituation, and repeat it enough times to get "between trial" habituation. Good luck!
Bradley C. Riemann, Ph.D. is Clinical Director of The Obsessive Compulsive Disorder Center at Rogers Memorial Hospital, Oconomowoc, Wisconsin.
