OCD Exposure And Response Prevention
When most people think of behavior therapy, they think of traditional talk therapy, where a therapist speaks with a patient to resolve and overcome mental health issues. However, for certain conditions like obsessive-compulsive disorder, (OCD), studies suggest that alternative treatments such as exposure and response prevention therapy (ERP) may work better than traditional forms of psychotherapy. This article will explain the characteristics of obsessive-compulsive disorder, OCD symptoms, and how exposure and response prevention therapy can work in treating it.
Understanding Obsessive-Compulsive Disorder (OCD) symptoms
Before we can understand the exposure and response prevention therapy techniques, we first need to understand what obsessive-compulsive disorder is and what the symptoms can look like. You can think of it this way: The body has a natural alarm system of sorts that signals to your brain when you are in danger. When someone has obsessive-compulsive disorder (OCD), their system alerts them to danger even when there isn't any.
The person is mentally “tricked” into believing there is a real danger and that something bad could happen to them and their loved ones. This causes anxiety to build, and the person then responds compulsively to "remove or counteract the perceived threat." When they continue to react to these triggers of fear and anxiety with compulsive behaviors, they reinforce the idea in their brain that the danger is legitimate. The more they react compulsively, the more the behavior(s) continue.
Examples of compulsions and their impact
For instance, for some, obsessive-compulsive disorder symptoms can manifest as a compulsion to check the stove every time they leave the kitchen and the house. The stove may not have even been used that day, but because of the mind’s overactive sense of feared outcomes, (i.e., the house burning down), the individual must check the stove.
They may even develop an added obsessive behavior of turning it on and off again multiple times to make sure it’s off. These kinds of ritualistic behaviors can cause heightened levels of anxiety and seriously disrupt day-to-day life for those experiencing the disorder OCD. Because this condition affects so many people and is so widely misunderstood, the International OCD Foundation plans an OCD Awareness Week every second week of October. It aims to promote awareness of the manifestations and behaviors of obsessive-compulsive disorder so that more people who are affected can get proper diagnosis and treatment.
What is exposure and response prevention (ERP) therapy?
Exposure and response prevention therapy is currently considered to be the most effective form of treatment for people with OCD. It’s a type of cognitive behavioral therapy (CBT), and, as the name suggests, exposure and response prevention (ERP) consists of two different parts. The first is exposure therapy, the exposure component, where the client is purposefully exposed to certain images, objects, situations, or thoughts that normally cause them a fear response and that trigger the obsessive behavior(s). The second part involves teaching the individual response and prevention techniques to avoid acting compulsively in response to triggers of their anxiety. The individual will be guided through these exposure and response prevention therapy exercises in a controlled environment by a therapist at the beginning. With repeated exposure and systemic desensitization, patients can begin to conquer the lesser fears and start working up to the greater ones. As the treatment continues, the individual will be taught how to tolerate distress and manage this compulsive disorder behavior on their own with relapse prevention planning.
For example, if the usual reaction to a fear of having left the stove on and causing a fire is to turn it on and off again, the individual will be encouraged to deliberately resist this behavior after exposure to the trigger. When their brain eventually gets accustomed to avoiding a compulsive reaction, it is known as habituation.
How exposure response prevention (ERP) therapy can work
When one experiences OCD tendencies, yielding to compulsive behavior when the anxiety is triggered feels like the appropriate thing to do. It often seems like it’s the only way to reduce the anxiety and gain control over distressing situations. To break this cycle, the individual must learn to stop responding compulsively.
As with any anxiety-related disorders, this is easier said than done, as stopping the ‘fire alarm’ of obsessive compulsive disorder and OCD symptoms can be difficult. That’s why engaging in the treatment process with a therapist trained in exposure therapy and/or cognitive behavior therapy is often beneficial. The more you practice encountering your triggers without giving in to the compulsive reaction, the more control you can gain over this alarm and your behaviors. In turn, this can help to gradually reduce your level of anxiety and fear so you can work towards reducing the triggering nature of certain events.
The process of treating symptoms of obsessive-compulsive disorder (OCD)
As an inhibitory learning approach, ERP is a slow and deliberate process. For example, if the trigger for a client is a certain object, they may need to spend time looking at the object before touching it. The strength of their fear can determine how long this process might take. After the individual is comfortable looking at it, they need to begin moving closer to it. Once they can touch it without experiencing any compulsions, they may be ready to move on to the next fear and response. Response and prevention therapy works best when patience and self-compassion are prioritized during the process.
If ERP isn’t effective enough in treating severe symptoms, medications like selective serotonin reuptake inhibitors or other treatment options, like transcranial magnetic stimulation (TMS) might also be options to consider. However, research in the Can. J. Psychiatry found that even when using serotonin reuptake inhibitors, therapy remained important for treatment outcomes, which suggests that therapy is important for treating obsessive-compulsive disorder.
How an exposure and response prevention therapist can help with OCD and anxiety
In their own mind, a patient’s symptoms and OCD obsessions can lead them to feel like a non-threatening scenario is actually a life-or-death moment. This fear can pervade virtually all elements of their daily thinking and behaviors, which is why these kinds of mental disorders can be very difficult to overcome without the help of a professional. If you or someone you care about has OCD, they may benefit from speaking to a professional who can determine the best course of treatment and diagnosis for them.
Addressing obsessive-compulsive disorder with online exposure therapy
Not everyone feels comfortable meeting with a mental healthcare provider in person, which is where virtual therapy options can be useful. With online therapy for obsessive-compulsive disorder through a platform like BetterHelp, you can speak to a licensed therapist who has experience in treating individuals with OCD and its subtypes without leaving home. Research suggests that individuals who receive virtual ERP to treat obsessive-compulsive disorder showed “significant improvement in symptoms,” so this format may be worth considering if you find it to be more convenient and comfortable.
Takeaway
Exposure and response prevention therapy, a type of cognitive behavioral therapy (CBT), involves gradual, deliberate exposure to triggers of fear that cause compulsive behaviors in those with OCD. When practiced by a trained, licensed professional, it can be an effective treatment for those who experience OCD and related mental health disorders. As with cognitive therapy, individual behavior therapy, and commitment therapy, exposure and response prevention (ERP) can typically be engaged virtually or in person depending on your preferences.
What is the best treatment for obsessive-compulsive disorder (OCD)?
Exposure and response prevention appears to be very effective in treating OCD according to research. Through ERP, an individual is exposed to thoughts, feelings, images, or situations that spur their obsessions. However, instead of engaging in compulsive behavior to attempt to neutralize the anxiety, an individual must make a conscious choice to refrain. Over time, as an individual confronts feared stimuli, their anxiety levels may decrease, which is a process called habituation.
Exposure and response prevention appears to be one of the most effective OCD treatments available. One study published in the Indian Journal of Psychiatry (Indian J Psychiatry) titled “Exposure and response prevention for obsessive-compulsive disorder: A review and new directions” found that up to 50% of individuals experience significant relief in OCD symptoms after ERP therapy, or ERP in combination with medication. In addition, research from the British Psychological Society has explored the effectiveness of group ERP for OCD.
What is exposure and response prevention (ERP) for OCD?
Exposure and response prevention is a type of therapy that involves undergoing exposure to something that will provoke obsessive thoughts and feelings of distress in the client. The response prevention part of ERP refers to learning to abstain from compulsive behaviors as an attempt to neutralize the anxiety.
What is response prevention in psychology?
This refers to the practice of refraining from engaging in compulsive behaviors, which are repetitive actions that serve as an attempt to neutralize the anxiety caused by obsessive thoughts. Seeking reassurance, avoidance behaviors, and obsessive rumination are examples of compulsions. It is important to understand that the goal of exposure and response prevention therapy isn’t to get rid of distressing thoughts or unpleasant feelings but to learn to tolerate the related discomfort without engaging in compulsions.
How do I break my obsessive compulsive disorder cycle?
When obsessive thoughts arise, engaging in compulsive behaviors only signals the brain to keep responding to the perceived threat and perpetuates the OCD cycle. Therefore, it is generally important for people with OCD to learn how to identify and sit with the discomfort of intrusive thoughts without engaging in compulsions. Seeking out the support of a licensed mental health professional who can help you establish exposure and response prevention techniques for coping with uncomfortable sensations can help you break the cycle of obsessions and compulsions. You might also find it helpful to join a support group, so you can connect with individuals who are also living with OCD.
What are the 4 types of OCD?
The four major categories of obsessive-compulsive disorder include contamination, harm OCD, symmetry OCD, and unacceptable/taboo thoughts. However, there are many other ways in which OCD can manifest. The content of obsessions is often related to what the individual values the most, which can be distressing as intrusive thoughts tend to be in direct opposition to one’s values and true desires.
Is OCD a type of anxiety?
Obsessive-compulsive disorder falls under the category of anxiety disorders. However, it is unique in the presence of both unwanted thoughts, urges, or mental images (called obsessions) and engaging in repetitive behaviors (called compulsions) to try to discard the distressing thoughts and neutralize anxiety. However, engaging in compulsive rituals fuels distress intolerance and creates more anxiety which becomes a vicious cycle.
What happens if OCD is left untreated?
If left untreated, obsessive-compulsive disorder can bring difficult challenges and become debilitating. Symptoms of major depressive disorder (such as fatigue and feelings of hopelessness) might emerge, as there is a significant link between the two.
Can you overcome OCD on your own?
It is not recommended to try to manage OCD on your own, as symptoms do not typically resolve themselves without treatment. The most effective way to break the OCD cycle is generally by engaging in exposure and response prevention therapy with a therapist trained in these psychological interventions. A qualified therapist can assist you in developing a treatment plan and learning techniques for ERP, which is largely considered the gold standard treatment for OCD.
What is an example of exposure and response prevention (ERP)?
One example of exposure and response prevention could be for an individual with OCD who experiences intense contamination fears and feels compelled to repeatedly wash their hands in response. In ERP, an individual could be directly exposed to something that elicits this response, like a public doorknob, and then gradually resist the urge to respond with their typical ritual. With a therapist’s guidance, the individual can conquer their fears gradually in a controlled environment, rather than being thrown in the deep end.
What is an example of ERP therapy?
ERP is one of the core interventions for OCD, but it can also be used for other conditions, such as body dysmorphic disorder (BDD), as noted by the National Collaborating Centre. As an example, someone with BDD might engage in exposure exercises in a therapist’s office aimed at decreasing behaviors like frequent mirror checking.
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