Exposure Response Prevention: Understanding the Treatment for OCD
Obsessive-compulsive disorder (OCD) is a treatable mental illness. However, it can be frightening for anyone who experiences its symptoms. People with OCD may feel as if they have no control over their thoughts or actions. Thoughts of germs, contaminated surfaces, violence, animals, or other disturbing images enter the mind and remain there — often prompting compulsive behavior to neutralize the anxiety or stress that these obsessions induce. OCD sufferers will perform repetitive tasks, think in certain ways, or avoid certain situations to neutralize their fears and reduce stress. Unfortunately, these rituals and avoidance only provide temporary relief; eventually they fail to assuage the anxiety caused by OCD. The person feels even more stressed and anxious than before they began the compulsion or avoidance behavior. In some cases, this leads to another round of rituals and avoidance. Fortunately, there are effective treatments for OCD that help people learn how to respond differently when facing these disturbing thoughts and feelings again in the future.
What is Exposure Response Prevention?
Exposure response prevention (ERP) is a type of exposure therapy used to treat OCD. It is the best evidence-based treatment for OCD, and the most effective treatment for OCD. This type of therapy involves gradually increasing exposure to feared thoughts, feelings, and situations related to the OCD theme. With ERP, the therapist gives the person with OCD detailed instructions for preventing their compulsive behaviors and for actively confronting their fears. In OCD treatment, the goal of ERP is to help the person with OCD experience their feared thoughts, feelings, and situations without doing compulsive behaviors. Through this process, the person learns that their feared outcomes do not happen. They learn that they can tolerate the distress that occurs while facing their fears without doing a compulsion. As the person with OCD actively confronts their fears, and experiences that their feared outcomes do not happen, they learn that their obsessive thoughts are false. This decreases their anxiety related to obsessive thoughts.
Understanding Exposure and Response Prevention in OCD Treatment
Exposure and response prevention (ERP) is a type of psychological therapy that helps people with OCD break the pattern of compulsive behaviors and excessive worry. The goal is to help the person face their fears and learn that their anxiety is not harmful and does not need to be reduced. Exposure and response prevention for OCD is based on a simple idea: If you avoid what you fear and you don’t learn that the feared outcomes don’t happen, then you’re likely to remain very afraid of those outcomes. This is why people with OCD who compulsively wash their hands because they believe they are contaminated don’t learn that their hands aren’t actually more contaminated after a thorough washing.
How Does Exposure Response Prevention Help?
Exposure and response prevention (ERP) is a type of cognitive behavioral therapy (CBT) that is used to treat OCD. It is the most effective treatment for OCD. In ERP, the person with OCD undergoes gradual exposure to their feared situations and thoughts while learning not to do compulsions. In other words, the person is exposed to the things they fear without doing their usual compulsive behaviors. People with OCD who perform compulsive behaviors believe they will get better if they reduce their anxiety and distress. Because they believe that their obsessive thoughts and fears indicate a need for action, they engage in compulsive behaviors. In OCD treatment, the therapist teaches the person to embrace their unwanted thoughts and feelings without doing compulsive behaviors. The person learns to experience their anxiety and distress without trying to reduce it or avoid it. This allows them to build their tolerance for distress and learn that their distress does not need to be reduced.
3 Steps of Exposure and Response Prevention for OCD
The first step in exposure response prevention (ERP) therapy is to discuss the nature of OCD and the therapist’s treatment goals. The therapist will also likely ask the person with OCD to complete a self-assessment questionnaire to determine their OCD symptoms. The next step is to design a therapy plan to guide the person through the process of treatment. The therapist and person with OCD will discuss the various types of therapy and decide which will be best for their treatment. The third step is to carry out the therapy plan. This often involves confronting feared situations and thoughts while the person with OCD refrains from performing compulsive behaviors. The therapist may also require the person with OCD to track their anxiety and provide them with feedback on how their responses are affecting their anxiety levels.
2 Ways to Implement Exposure and Response Prevention with OCD Patients
The first way is to provide instructions for daily exposure and response prevention (ERP). In this method, the therapist will provide the person with OCD with instructions for confronting their feared situations and thoughts. The person with OCD will then do this daily over the course of several weeks or months. This method is best for people with milder OCD symptoms and those who are highly motivated to reduce their OCD symptoms quickly. The second way is for the therapist to select situations for in-vivo exposure and response prevention. In this method, the therapist will help the person with OCD select a few situations that they fear and that are related to their OCD symptoms. The therapist will then gradually guide the person with OCD through confronting these situations while refraining from doing compulsive behaviors. This method is best for people with moderate OCD symptoms who are motivated to reduce their symptoms but may need a bit more assistance.
Limitations of Exposure and Response Prevention for OCD Treatment
The main limitation of exposure and response prevention with OCD treatment is that it can be difficult for the person with OCD to follow through with the treatment. It can be scary for someone to confront their fears, especially when those fears are related to OCD symptoms. It may be helpful for the therapist to provide support and encouragement throughout the treatment process. Additionally, the therapist could provide regular feedback to the person with OCD so that they can gauge their progress and adjust the therapy as needed. Another limitation of exposure and response prevention therapy is that it works best when the person with OCD has insight into their own thoughts, feelings, and behaviors. A therapist can help facilitate this insight by asking questions and providing feedback. Someone with severe OCD symptoms may not have insight into their own thoughts and feelings and would benefit more from a type of cognitive behavioral therapy called cognitive restructuring.
Exposure response prevention for OCD is the best evidence-based treatment for OCD and the most effective treatment for OCD. For people with OCD, this type of therapy involves gradually increasing exposure to feared situations and thoughts while refraining from performing compulsive behaviors. People with OCD who perform compulsive behaviors believe they will get better if they reduce their anxiety. Through this process, the person with OCD learns that their feared outcomes do not happen and that their obsessive thoughts are false. This decreases their anxiety related to obsessive thoughts.