What Is Exposure And Response Prevention Treatment For OCD?

Exposure and Response Prevention (ERP), also called Exposure and Ritual Prevention, is the most effective method of anxiety-spectrum treatment. This includes treatment of Obsessive Compulsive Disorder (OCD), phobias, social anxiety, and Hypochondria (health anxiety), just to name a few. Research supports the notion that treatment including ERP, coupled with Cognitive Behavioral Therapy (CBT), tends to produce optimal results when compared to other psychotherapeutic methods.

ERP is a behavioral approach where you work toward getting closer and closer to your fears (exposure) while resisting compulsive behaviors, such as rituals, reassurance seeking, neutralizing, and avoidance (prevented response).

If you are new to treatment that includes exposure, exposure therapy can sound overwhelming, frightening, and like the last thing you want to do. You have tried everything to avoid feeling anxious and facing your fears, so facing them directly can feel like certain death, or worse! I’m here to tell you it’s truly a liberating, empowering, and for some, an invigorating experience.

How ERP works

After working through the cognitive components of CBT, you will make an inventory of all your fears and triggers, called a hierarchy. We will work together to put them in order from the easiest item to the most difficult. This list is then used to guide our work as we design exposure exercises. While starting with the easiest items on your list, repeated exposure eventually leads to reduced anxiety, which in turn leads to greater confidence as we move up your hierarchy. Mindfulness-based approaches, such as Acceptance and Commitment Therapy, are also used alongside exposure treatment to boost your willingness to face increasingly difficult situations.

Over time, we can slowly change the way we think and feel about things; even our biggest fears. While it is unlikely that we will change the thing you fear the most into something you simply do not care about, much less likely that you’ll find that you enjoy that subject, treatment usually ends with a drastic change in your response to the subject.

ERP In Action: Public Speaking

For example, let’s say you had a fear of public speaking. This phobia is one of the most common fears shared by people across the world. Often the fear is rooted in an irrational belief that the audience will judge them, boo them, and the speaker will be humiliated.

After taking a detailed assessment and considering any thoughts and experiences contributing to the fears, we will begin facing the fear through a slow and steady process all while working to tolerate the anxiety and learning that we can handle the feelings of fear and uncertainty. ERP may begin by watching videos of people speaking in public. Then we may move onto videos of people speaking poorly, or even bombing a talk. We may then move up to writing a speech and reading it in your head, then aloud in therapy, then standing up in the therapy room, then in front of your family or other supportive loved ones. We would keep practicing speaking in front of larger crowds and venues until you are ready to take the risk to speak at your intended goal; a wedding, a class presentation, a professional lecture, etc.

At the end of treatment, you may not decide that you actually love public speaking. However, you may think to yourself, “You know, it actually wasn’t that bad,” and you may not feel as overwhelmed or anxious as you did when you started. Notice that you changed the way you thought and felt! More importantly, you were able to face your fears and start doing things that you wanted to do, but had been avoiding due to anxiety’s unhelpful influence in your life.

This process is the same across all phobias, all anxiety disorders, and all subtypes of OCD

What About Medication With ERP?

Adding psychiatric medication to your treatment can accelerate the ERP process while also making it more effective. Researchers show that supplementing CBT and ERP with medication has the most effective outcomes than just CBT and ERP or medication alone. While medication is not a “magic pill” that makes all the anxiety go away, it can provide added encouragement and confidence to behavioral therapy.  

If you are ready to make your first steps to begin ERP treatment, or would like more information on you can benefit from ERP and CBT, please contact me.