ERP Therapy: Exposure and Response Prevention for Obsessive Compulsive Disorder
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Exposure and response prevention therapy
One common way of treating obsessive-compulsive disorder is called exposure and response prevention therapy (ERP therapy), which involves exposure to fears. It is highly associated with the effective management and remission of symptoms. In this article, we explain how exposure and response prevention therapy works for treating OCD and what the potential benefits are.
What is obsessive compulsive disorder (OCD)?
- Obsessions are unwanted reoccurring thoughts, urges, or mental images (usually that cause mental distress and anxiety).
- The individual attempts to ignore or repress the obsessions, often through compulsive or ritualistic behaviors.
- Compulsions are repetitive actions or mental acts that the individual feels they must perform in response to the obsession, usually with rigid rules applied.
- The repetitive behaviors are aimed at reducing or preventing distress or preventing a dreaded event from occurring. However, there is either no real physical connection between performing the compulsive behavior and preventing the feared outcome or the behavior is clearly excessive.
- Ritualistic behaviors take up more than one hour every day or cause impairment socially, at work, or in other important areas of daily functioning.
- The mental condition could not be described better by the diagnostic criteria of another mental disorder, such as generalized anxiety disorder or body dysmorphic disorder.
- The disturbance is not induced by substance abuse, pharmaceutical medication, or a general medical condition.
Intrusive thoughts and compulsive behaviors are not isolated to just people with OCD and related disorders. ERP therapy may be beneficial for anyone experiencing symptoms, even if they are not formally diagnosed with obsessive-compulsive disorder. The International OCD Foundation has formulated several resources for OCD education, including treatment options, helpful links, and official symptoms. They also discuss intrusive thoughts, childhood OCD, and common myths about treatment.
What causes an obsessive compulsive disorder (OCD) cycle
Obsessions and compulsions
- Checking
- Hoarding
- Symmetry
- Finding or creating patterns
- Counting
- Repeating words or phrases
- Asking for reassurance
- Avoiding situations, places, or people
- Cleaning
- Organizing
- Engaging in repetitive religious or spiritual rituals
What causes OCD?
What is exposure and response prevention therapy? (ERP therapy)
As an OCD treatment administered by therapists, ERP therapy refers to exposure and response prevention. It is one of many systematic desensitization forms and is often considered the gold standard treatment for OCD because it has been proven more effective than any other treatment or placebo, including medication, cognitive-behavioral therapy (CBT), and other forms of treatment. It is widely used worldwide to treat OCD, phobias, and other anxiety disorders.
ERP therapy may help patients control their responses to intrusive thoughts, distress, or obsessions. They may see situations in a new light and feel in control of their mind and actions. This difference in fear response may allow them to use objects they were afraid to use before or learn new behavioral coping mechanisms to cope with anxiety if it occurs. Although OCD may not be fully treatable, it can be manageable with coping mechanisms.
Although medications may benefit some people with OCD, ERP therapy can be more effective. Anxiety medication is commonly used in conjunction with a course of ERP because it may lessen the severity of the thoughts and a person’s responses to them. However, because the medication does not address the underlying cause of OCD, it may not be a long-term solution. Using counseling in conjunction with medication may be effective.
How does ERP treatment with therapists work?
ERP therapy sessions expose patients to their fears while preventing the compulsive responses and obsessions they may want to engage in. When they first enter an ERP session, they may outline their obsessive thoughts and commonly engaged in compulsions. Then, they may mark each thought or obsession on a scale of one to 100 using subjective units of distress that indicate how much it scares them or how intense their urge to partake in compulsion is. Starting with one of the lower fear points, a therapist may help clients identify methods of exposing them to their fear.
- Holding an empty syringe in the session with the cap on
- Talking about needles, shots, and IVs with the therapist
- Watching their therapist put the needle near their arm (without putting it in)
- Holding the syringe with the cap off and looking at the needle
- Having the therapist put the syringe on the client’s arm with the cap on, in the spot where a doctor might insert it
- Having the therapist accompany the client to an appointment to donate blood, get a shot, or get an IV saline treatment
Note that exposure should not put a client in danger. If you feel that an exposure activity would harm you physically, do not partake in it. However, ERP therapy can require a willingness to confront your ideas of what is harmful and what is not. A therapist may be able to help you understand if your fears avoidance behaviors that are driving your desires to not partake in specific exposures.
- Repeating “yes, people can read my mind” in your head
- Stating out loud, “you can read my mind,” to your therapist
- Allowing thoughts to continue instead of stopping them or replacing them
- Encouraging your thoughts to continue
If you have violent, inappropriate, or unkind intrusive thoughts that scare you to talk about with your therapist, you may choose to leave these thoughts until you have taken care of other thoughts first. However, opening up about these intrusive thoughts can be beneficial. If your therapist is a trained ERP therapy specialist, they might have experience with intrusive thoughts and know they can exist, meaning they may avoid judgment when treating them.
How can ERP be effective for mental health conditions?
Breaking the barrier of the OCD cycle may involve searching for and actively approaching ideas, thoughts, and actions that scare you the most. Although it can be challenging to face these, your therapist may help you get started. In your first few appointments, let your therapist know if you want to slow the process. Credible organizations and professionals offering ERP programs may help you develop your willingness to partake in treatment and explain the process in detail.
How is ERP different than other forms of therapy?
Many types of treatment, including cognitive behavioral therapy, transcranial magnetic stimulation therapy, and exposure and response therapy, are effective at helping OCD. Cognitive behavior therapy (CBT), also known as individual behavior therapy, addresses the thinking patterns and thought distortions that lead to compulsive behaviors. On the other hand, ERP therapy is considered a behavioral approach. During ERP therapy, the goal is to create systematic desensitization to feared outcomes. This practice can help people with obsessive-compulsive disorder realize that their feared outcomes are not reality. These two therapeutic approaches may have the most effective treatment outcomes when combined.
Traditional talk therapy, including cognitive behavioral therapy (CBT) and acceptance commitment therapy, can be an effective first line treatment for OCD when combined with practicing exposure and response prevention. For example, the patient may learn coping skills in CBT to help them face their fears during exposure therapy. Talking through the experience after practicing ERP exercises might be beneficial for developing effective response prevention strategies and recognizing thought distortions such as absolute thinking.
Fears about exposure
Asking for help from OCD specialists can be a brave step. If you are unsure about ERP therapy, consider making an appointment and letting your therapist know. You can have a first session to outline your goals and decide whether it is right for you. ERP can be challenging, uncomfortable, and scary, but it has high success rates and may benefit you.
Relapse prevention planning
Relapse prevention planning is usually one of the last stages in the ERP treatment process, done when the patient is showing signs of significant improvement in their OCD symptoms. When it comes time for prevention planning, the exposure component is replaced with mostly CBT.
ERP therapy can significantly reduce the frequency of intrusive thoughts, but research has shown that intrusive thoughts are normal experiences that are not always symptoms of mental disorders. A mental health professional can work with the patient to create a plan for how to cope with intrusive thoughts and what to do if their OCD symptoms arise again in the future. Being mentally prepared and having an actionable plan for if symptoms return can help to prevent a relapse into compulsive behaviors.
ERP therapy and treatment options for improved mental health
You may be able to find a specialized exposure treatment center or a therapist trained ERP in near you in your area. Some providers offer exposure group therapy or exposure camps for those experiencing OCD. In some areas, short-term residential treatment options are available for those with an OCD diagnosis. However, you can also partake in exposure treatment online if you cannot take advantage of other methods due to cost or distance.
Therapists review
“Gerald was a great fit for my counseling needs. I have anxiety and OCD, and he helped me to learn many strategies to help with both. I was nervous to start counseling, but I am so glad that I did because now I have a new way of handling my anxiety and OCD. His approach to counseling was a great fit for me, and I would definitely recommend him.”
Takeaway
What does exposure and response prevention do?
Exposure and response prevention (ERP) therapy is typically recommended for the treatment of obsessive compulsive disorder and sometimes other conditions like social anxiety disorder. This form of cognitive behavioral therapy (CBT) exposes individuals to the source of their fear or obsession and helps them learn to respond in a healthier way, eliminating harmful compulsions or compulsive rituals.
In essence, ERP works by teaching clients to tolerate, or stop fighting, emotions associated with obsessional thoughts while engaging in ritual prevention. Rather than throwing them into the deep end, so to speak, the therapist will use an exposure hierarchy to expose clients to their fears, escalating the exposure over time. If this sounds difficult, that’s because it is. ERP can be an uncomfortable process, but it can gradually work to reduce symptoms and sometimes eliminate compulsions altogether.
What is an example of exposure and response prevention treatment for mental health?
Many people with OCD fear harming people they love. This is sometimes referred to as “harm OCD”. To treat harm OCD with exposure and response prevention, a therapist might encourage the individual to use a large chef’s knife to chop vegetables while talking to their loved one. A client with contamination OCD may be challenged to touch a dirty surface while resisting the urge to repeatedly wash their hands.
What is the difference between CBT and exposure and response prevention?
Exposure and response prevention is a type of cognitive behavioral therapy designed to treat specific mental health conditions and symptoms.
How effective is exposure and response prevention therapy?
For the treatment of obsessive compulsive disorder, ERP is only about 50% effective. It may be more effective for other conditions such as social anxiety disorder or specific phobia, for instance.
Is exposure and response prevention good for anxiety?
Yes. Exposure and response prevention has been proven effective for some types of anxiety disorders, particularly social anxiety disorder.
How long does ERP take to cure obsessive compulsive disorder (OCD)?
It varies depending on the person and the severity of the symptoms. After starting ERP therapy, you’ll likely experience an initial increase in symptoms followed by improvement. Generally, treating OCD takes between a few weeks and a few months.
Does ERP change the brain?
Yes. Brain scans indicate that neural connectivity is strengthened as a result of exposure exercises.
What are the 3 common types of exposure and response prevention?
The three approaches to ERP exercise include:
In vivo exposure: Exposure to real scenarios
Imaginal exposure: Exposure to imagined scenarios
Interoceptive exposure: Exposure to feared sensations
What does exposure and response prevention do to your brain?
You can think of the brain in terms of your body’s alarm system. OCD affects the way this alarm system works. ERP helps rewire it by exposing it to the anxiety source repeatedly so that it will gradually reduce its response. OCD remains one of the most difficult challenges for mental health professionals to treat, and further research may take therapy protocols in new directions in the years to come.
Can you do exposure and response prevention yourself?
While it’s possible to do ERP therapy work on your own, it may not be recommended. Exposure and prevention response can be an intense experience, and it may be helpful to have a therapist’s guidance.
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