ERP Therapy UK: Treatment For OCD And Anxiety
Obsessive-compulsive disorder (OCD) is a mental illness that causes recurring, distressing thoughts (obsessions) and related behaviors (compulsions). Both can interfere significantly with daily functioning and overall well-being. According to the most recent NICE (National Institute for Clinical Excellence) estimates, OCD affects about 1.2% of the UK population, meaning roughly 12 out of every 1,000 people experience the condition. OCD can develop at any age, though it often begins in childhood or early adulthood.
Many people with OCD are able to effectively manage symptoms and improve their quality of life with professional treatment. ERP (exposure and response prevention) therapy is one of the most common behavioral therapies for OCD. Here, we’ll explore ERP therapy, its effectiveness, and its availability in the UK.
What is ERP therapy for obsessive-compulsive disorder?
ERP therapy is a type of cognitive behavioral therapy (CBT) specifically designed to treat anxiety and obsessive-compulsive disorder (OCD). It works by gradually exposing individuals to the causes of their fears and anxiety in a safe and controlled environment while preventing them from engaging in compulsive behaviours and encouraging healthy coping mechanisms instead.
What mental health conditions can ERP treat?
While ERP is most commonly associated with OCD, it can also be used to treat several other conditions, such as social anxiety, generalized anxiety disorder (GAD), panic disorder, specific phobias, and post-traumatic stress disorder (PTSD). Additionally, ERP is sometimes used to treat body-focused repetitive behaviors such as skin-picking (excoriation) and hair-pulling (trichotillomania).
How does ERP therapy work?
Mental health professionals can tailor ERP therapy to an individual’s unique needs. Still, it tends to follow a general, structured framework because the goals are typically the same: change harmful behaviors through desensitization. By repeatedly exposing oneself to stressors without performing compulsions, the brain learns that the feared outcomes are unlikely or less distressing than expected. This process is called habituation. Over time, the individual's anxiety often decreases, and they may gain confidence in managing their obsessions and compulsions. The foundational components of ERP therapy used to achieve such outcomes are as follows.
Exposure
The “exposure” part of ERP therapy involves gradually confronting specific situations, thoughts, or objects that typically lead to obsessive fears and anxiety in the client. The exposures are controlled and systematic, beginning with less challenging causes and working up to more challenging ones.
Response prevention
Response prevention involves actively resisting the typical compulsive behaviours or rituals that the individual normally performs to reduce their anxiety. Like the exposure portion of therapy, response prevention is done gradually in a controlled environment.
What to expect in ERP therapy
ERP therapy sessions typically follow a loose structure, beginning with an initial educational and assessment phase followed by exposure exercises and other activities. The therapist usually monitors the client’s progress throughout and adjusts as necessary. Here is a general idea of what to expect in ERP therapy:
- Psychoeducation: Your therapist will help you understand obsessions and compulsions and how they are connected to anxiety.
- Assessment: You and your therapist will work together to identify specific obsessions and compulsions, creating a personalized "exposure hierarchy."
- Practice: During this phase, you’ll become exposed gradually to your fears in a safe environment with your therapist there to offer support and encouragement.
- Review: You and your therapist will review your experience and what you learned.
- Homework: Your therapist might give you exposure exercises to complete between sessions to reinforce progress.
- Adjustment: As you progress up the fear hierarchy, your therapist will review your progress and adjust the treatment plan as needed.
- Relapse prevention: You might work with your therapist to create a plan to prevent relapses in compulsive behaviors.
Addressing misconceptions about ERP
ERP is an effective OCD treatment for many; however, it can be challenging. Individuals and their therapists must typically commit to the process for it to work.
In some cases, myths and misconceptions about ERP therapy create barriers for individuals who need treatment. Some common myths surrounding ERP therapy include:
- Myth #1: You must “fight” your internal experiences and responses: Treatment isn't about resisting your thoughts and emotions; it's about learning to understand and accept them in order to move past them.
- Myth #2: The goal of therapy is to “cure” OCD: The goal of treatment is to learn to manage challenging situations and develop the coping skills necessary to respond more appropriately when they arise.
- Myth #3: Exposure in ERP therapy must be stressful for it to work: The goal of exposure to a stressor is to expand the mind’s willingness to experience it, which doesn’t always lead to distress.
- Myth #4: Accepting obsessive or intrusive thoughts means learning to agree with them: Obsessive thoughts aren't typically labeled as "good" or "bad" in ERP therapy. They simply exist and are meant to be viewed with the understanding that we can't control the thoughts that arise—only how we engage with or respond to them.
The future of ERP therapy in mental health treatment
Future directions for ERP therapy are expected to include using digital tools like apps or virtual reality for exposure therapy exercises. Technology may also be used to collect real-time data on patient responses during exposure exercises to inform treatment adjustments and provide further insights into the mechanisms of ERP. In addition, the future of treating OCD might focus on tailoring ERP protocols to individual needs and preferences, considering factors like the severity of symptoms, cognitive style, and cultural background.
Research may also explore the effectiveness of combining ERP with other cognitive therapy types, such as acceptance and commitment therapy (ACT), pharmaceutical interventions, or neurostimulation techniques like deep TMS for complex cases.
How long does it take for ERP therapy to work for OCD?
Every person’s experience with ERP is unique, and how long it takes depends on the patient’s circumstances and treatment adherence. For example, individuals with more severe OCD might need more time to achieve noticeable results. On the other hand, some people may see positive changes within a few weeks of starting therapy. Overall, many people notice significant improvements in their OCD symptoms after anywhere from a few weeks to a few months of consistent ERP therapy.
Effectiveness of ERP therapy for obsessive-compulsive disorder
Overall, data suggests that roughly 50–60% of patients who complete ERP therapy experience “clinically significant improvement in OCD symptoms, with long-term treatment gains.” Note, however, that the effectiveness of ERP as an OCD therapy does depend on treatment adherence and relapse-prevention techniques.
Finding ERP therapy in the UK
Individuals in the UK can contact their general practitioner for a referral to an NHS talking therapy service, where you can specifically request a therapist specializing in ERP therapy or other forms of OCD treatment. You can self-refer online as well. Groups like OCD-UK and Anxiety UK can provide resources and referrals to help you find a trained OCD specialist.
Additionally, many independent practitioners who specialize in CBT offer ERP for a fee. If looking for an independent therapist, ensure they are qualified and experienced in delivering ERP therapy specifically for your needs. You might also search for accredited therapists via reputable organizations like the British Association for Behavioural and Cognitive Psychotherapies (BABCP).
Online treatment for obsessive-compulsive disorder
In many cases, online therapy can be an effective and convenient treatment for mental illnesses like OCD and anxiety disorders. Virtual care allows those in rural areas to receive treatment more easily. Plus, it typically offers flexible scheduling options and eliminates the need for travel to and from appointments, and online therapy is an affordable option.
Efficacy of online ERP therapy UK for OCD
Research suggests that internet-delivered ERP therapy can be as effective as in-person ERP treatment for some people. For example, 113 mental health professionals who provide ERP for adults, children, and/or adolescents with OCD were surveyed on their experiences with online ERP. The professionals reported overall positive outcomes and treatment adherence. That said, online ERP might not be appropriate for all clients with OCD. For example, children under 13 or individuals with more severe OCD may require face-to-face intervention.
Takeaway
Frequently asked questions
Which is better, CBT or ERP?
Neither CBT nor ERP is necessarily better than the other. Cognitive behavioral therapy usually treats mental health disorders by adjusting thought processes and emotions for behavioural change. It typically provides clients with practical tools they can use in daily life and is often viewed as a gold-standard treatment. It can be used for depression, eating disorders, anxiety, and more.
Exposure and response prevention is intended primarily for severe anxiety, such as phobias, and obsessive-compulsive disorder. For example, a person with OCD who has obsessions related to contamination may engage in frequent hand-washing. When undergoing ERP therapy, this individual may be exposed to situations that typically lead them to engage in hand-washing, but they will be given strategies to avoid this compulsion. Although this can be incredibly challenging, it’s often an effective treatment.
Why is ERP therapy so expensive?
ERP tends to be expensive because it’s very specialized. It can sometimes be challenging to find an ERP therapist because there aren’t very many of them, leading to higher prices.
What are the disadvantages of ERP therapy?
ERP can lead to intense anxiety and even panic attacks at first, as clients are encouraged to confront their obsessions and fears. However, over time, clients usually feel empowered to overcome these challenges. As they spend time in the safe space created by their therapist, they often realize that their unwanted thoughts are not realistic.
Does ERP rewire the brain?
This type of therapy can rewire the brain. ERP requires clients to address their fears head-on. This can increase brain connectivity and lead to a reduction in symptoms of various mental health disorders.
How successful is ERP therapy?
According to a 2019 study, “Overall, about 50–60% of patients who complete ERP treatment show clinically significant improvement in OCD symptoms and treatment gains have shown to be maintained long-term.” Many people who undergo ERP experience positive changes in their mental health and everyday life.
How long does ERP take to work?
ERP may lead to results in weeks or months. Often, it’s necessary to continue treatment for two or three months in order to experience clinically significant changes.
Is ERP the same as exposure therapy?
Exposure and response prevention (ERP) is a type of exposure therapy. This is a treatment recommended for phobias and obsessive-compulsive disorder.
How often should you do ERP therapy?
Most people benefit from weekly therapy sessions. However, it can also be important to practice exposure outside of therapy for the best results.
Does ERP work for trauma?
In some cases, exposure therapy can be helpful for post-traumatic stress disorder. There are other evidence-based treatments for PTSD as well.
What is an example of ERP therapy?
A person with checking OCD may compulsively check and recheck that they unplugged all appliances and locked the doors before they leave their house. They may frequently turn around to go back home and check again, potentially making them late for obligations and leading to severe anxiety. In ERP, their therapist may help them overcome the compulsion to check by guiding them to leave their house without double-checking that the stove is off and the door is locked. The therapist will typically give the client various strategies to use when they experience the urge to engage in a compulsion.
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