Purpose 🎯

Help clients track both distress and willingness during ERP so treatment does not become solely focused on anxiety reduction.

Let’s Talk About It 🗣️

During an ERP exercise, track both:

• Distress: “How uncomfortable is this?”
• Willingness: “How willing are you to allow the discomfort without performing the ritual?”

Discuss:

• What happened to distress over time?
• What happened to willingness over time?
• What did the client learn about allowing discomfort?
• What response prevention skill was practiced?

Ask:

• Can discomfort be present while you still choose not to ritualize?
• What helped you stay willing?
• What did OCD predict would happen?

If the Conversation Gets Stuck 💡

• Are we trying to make anxiety disappear, or practicing a different response?
• What would willingness look like for the next minute?
• What value makes this practice worth doing?

Telehealth / Whiteboard Version ⚖️

Create a two-line tracking chart for SUDS and willingness. Mark ratings at the beginning, middle, and end of the exercise.

Why This Works 🌱

Tracking willingness helps clients practice acceptance of uncertainty and discomfort rather than measuring success only by reduced anxiety.

Clinical Pearl 🧠

A successful ERP exercise is not defined only by lower distress. Success can include approaching the trigger, allowing uncertainty, and preventing rituals.

Documentation Language 📝

Therapist utilized SUDS and willingness tracking during ERP to help client monitor distress, practice willingness, and strengthen response prevention skills without relying solely on anxiety reduction.

Clinical Focus: ERP Tracking, Willingness, Distress Tolerance