Exposure and Response Prevention (ERP) for OCD

Obsessive-compulsive disorder (OCD) is a mental health condition characterized by obsessions and compulsions that interfere with daily life. Obsessions can take the form of repeated thoughts, feelings, images, or sensations, whereas compulsions refer to ritualistic behaviours or mental acts (e.g., worrying, ruminating, thought replacement, counting or repeating words or phrases until it feels “right,”) that a person with OCD will feel driven to carry out in response to an obsession. Typically, a person with OCD learns to carry out compulsions as a means to temporarily eliminate or reduce the impact of obsessions, and what’s more, not performing them causes increased distress. If left untreated, the effects of OCD can become progressively disabling as patterns become harder to break as structural changes to the brain take place. While it is true that OCD varies in severity, the WHO named OCD as one of the top ten disabling disorders. Research has found that OCD is highly associated with not only depression but also suicidal ideation, making early intervention and effective treatment all the more crucial.

So, what does effective treatment for OCD look like? Evidence-based forms of therapy for the treatment of OCD include cognitive-behavioural therapy (CBT), which is widely used to treat a multitude of disorders, and more specifically, a specialized type of CBT called exposure and response prevention (ERP). In ERP, a person with OCD, under the guidance of a trained therapist, is exposed to thoughts, things, or situations that lead to anxiety or obsessions and, in doing so, learns to not engage in habitual compulsions. This approach facilitates a gradual reduction in anxiety prompted by such thoughts and encounters so that the individual can better manage OCD symptoms and break free of the OCD cycle. ERP can be broken down into two main components:

• The exposure piece of ERP refers to purposely putting oneself in direct contact with the distress-inducing stimuli (e.g., germs, public places, elevators, etc.) that typically trigger obsessive thoughts, ritualized compulsive behaviour, fear, or anxiety.

• The response prevention piece of ERP involves getting used to tolerating the distress and not engaging in compulsive behavior when exposed to the stimuli. It also allows you to let go of intrusive thoughts after being triggered by exposure.

In addition to its efficacy in the treatment of OCD, ERP can also be an effective treatment option for eating disorders, generalized anxiety disorder (GAD), social anxiety disorder (SAD, panic disorder and other anxiety disorders. If you are wanting to explore ERP as a treatment option, you may wish to seek out a therapist who lists OCD as an area of specialization. Many clinicians offer free consultations in which you can ask about their familiarity with ERP as a treatment approach.

Beverly Reed, MACP, is trained in many areas such as anxiety and trauma, plus many more. For more information on Beverly and her work, click here to link to her full bio page.