OCD Basics 2: What is ERP?

OCD Basics II: What is ERP?

ERP stands for Exposure & Response Prevention, one of the most effective ways to treat OCD.

ERP is a specific type of cognitive-behavioral therapy (CBT), one that is much more focused on the “B” than the “C.” ERP aims to create new learning pathways by having clients engage in new actions, rather than trying to directly change their thoughts.

How does ERP work?

Just as there are two “sides” of OCD, there are two “sides” of ERP…

People who struggle with OCD have learned that they can’t cope with triggers without engaging in compulsions or avoidance. ERP seeks to re-train the mind by compassionately encouraging people to engage with triggering situations or thoughts (this is the ‘exposure’ part), while having them resist using their go-to ways of getting relief or protecting themselves (this is the ‘response prevention’ part).

Most people struggling with OCD understand that rationally they don’t need to be doing their compulsions to cope or stay safe, but it doesn’t feel that way. This is why standard talk therapy isn’t usually effective for OCD—the brain needs to be retrained through ACTION.

Why does ERP work?

When people engage with triggering situations without doing their compulsions, they gain new knowledge!

Exposure exercises often lead to the development of dramatic learning pathways:

·      They learn that often their fears do not come true.

·      They learn that often it gets easier if they stick with it and do the difficult task repeatedly (this is called ‘habituation”).

·      Once they learn that they can handle facing their fears, they build strength and confidence.

What does ERP look like?

While there are all kinds of obsessional themes, it’s easiest to describe treatment with a contamination OCD exposure example:

Richard worries that he could contract HIV if he uses a public restroom or touches anything dirty (this is the “obsession”), so for years he’s been avoiding any places or things that feel “dirty.” If he does come in contact with one of these things, he will immediately wash all of his clothing and take a ritualized shower, cleaning his body in a specific order multiple times for over one hour (the avoidance pattern and the shower ritual can both be considered compulsive behaviors). 

Richard and his therapist create a list of the least to most distressing triggers (the “hierarchy” or “fear ladder”), and they work together to systematically go up the list. Richard and his therapist practice touching “dirty” objects (from doorknobs in the home at the bottom of the list, all the way up to public restroom seats at the top).

 At the same time, Richard and his therapist carefully plan ways to prevent Richard from engaging in his compulsions, having him agree to hold off immediately showering (a physical compulsion), and making sure he doesn’t offer himself reassurance that he won’t become ill (a mental compulsion).

Results of ERP

Richard is surprised to learn that, if he touches the objects long enough without avoidance or washing after, his feelings of panic subside after 10-20 minutes, and he begins to really believe—not just intellectually but also emotionally—that he can survive these upsetting situations.

He no longer has to engage in all of his bathroom avoidance, so he can resume all of his old favorite activities like going to the movies and restaurants. And because he no longer has to do his showering rituals, he has many hours of new free time to get back to his favorite hobbies.

Because Richard has gotten back to all of his favorite things, he now finds that though he still experiences anxiety when doing hard things, his past depression is now dramatically reduced as well as his OCD issues.

Will ERP work for me?

While you’re reading this, you might say, “but my OCD issues are way more complicated!” And yes, while this may be true, ERP can be applied to any obsession or compulsion no matter the complexity. It may take a little more time to get it all figured out, but once the client and therapist work together to understand the client’s specific OCD struggles, the course of treatment is often quite similar to one that seems as cut-and-dry as the above example.

If you are struggling with OCD, there is hope. ERP is extremely effective. It may sound scary, but it is safe and really works.