Obsessive-compulsive disorder (OCD) is a common yet poorly understood psychiatric condition that affects the daily lives of many. It creates fear-based habits that disrupt the flow of the day, takes up time, and drain precious energy. It is characterized by the repetition of specific thoughts (obsessions) that lead to behaviors (compulsions) that need to be carried out in order to soothe intense fear around a thing, place, or act.
At SoCal Mental Health, we offer Exposure and Response Prevention (ERP) as one of our Orange County treatment services, a highly effective method designed to help those struggling with OCD overcome their fears and compulsions. The controlled, supportive community environment is the ideal place to change detrimental thought patterns and build a new life feel from rituals and compulsions.
What Is Exposure and Response Prevention?
Through classical conditioning, people experience anticipatory anxiety in the presence of environmental cues that are connected with painful or unpleasant events. The subsequent avoidance of the feared stimuli relieves people’s discomfort, reinforcing avoidant behavior via operant conditioning. Similarly, people with OCD have anxiety-provoking obsessions that are triggered by various events and then engage in compulsions or avoidance actions to alleviate the discomfort connected with these ideas.
These routine avoidance actions, paradoxically, enhance individuals’ anxiety and strengthen obsessions and compulsions. Exposure and Response Prevention (ERP) seeks to interrupt the loop of symptoms by removing rituals and avoidance, teaching clients how to bear discomfort without engaging in unproductive behaviors, and delivering “corrective information” that challenges people’s current fear reaction.
Depending on the severity of the clients’ symptoms, ERP can be administered at a variety of intensities, including outpatient, partial hospitalization, and residential treatment settings. Regardless of symptom intensity, ERP generally shares similar characteristics across situations.
How Does Exposure and Response Prevention Work?
The evaluation and treatment planning phase for ERP begins with the therapist providing education about OCD, treatment options, and gathering information about the client’s symptoms. The client and doctor collaborate to identify environmental (situations, items, people, etc.) and internal (thoughts and physiological reactions) stimuli that cause obsessive thoughts and consequent discomfort in the individual.
They also record the precise content of the person’s obsessions and compulsions, analyze their functional connection, and define the dreaded result if the rituals are not completed. One client, for example, may continually wash his hands to sanitize them, therefore avoiding the dreaded result of acquiring an infection and dying.
Another client, on the other hand, may wash her hands because she is repulsed by the physical feeling of having residue on her hands and will, as a result, continue to wash them until they feel as though they are no longer contaminated. The client and doctor then collaborate to evaluate various scenarios from least to most upsetting (as assessed by subjective units of distress), resulting in a fear hierarchy. The counselor advises the client as they repeatedly face the circumstances on their fear hierarchy while abstaining from indulging in compulsions during future therapy sessions.
For example, a person who is afraid of acquiring a disease from dirty surfaces may place their hands on numerous washroom surfaces for an extended length of time without washing their hands afterward. Clients may also participate in imaginal exposures. They imagine their dreaded outcome due to their obsessive thoughts (e.g., pushing someone into oncoming traffic and then being sent to prison). Clients learn that the results they dread do not occur through practicing both real and imaginary exposures and how to manage distress and uncertainty without participating in compulsions.
After each in-session exposure, the therapist and client participate in post-exposure processing to discuss the client’s experience, how their expectations were broken, and what they learned. Clients are also urged to perform exposures on their own as homework and to try to remove any rituals from their daily lives. Eventually, they work their way up the fear hierarchy to encounter increasingly uncomfortable events as they become used to diverse scenarios. Typically, an ERP course will end with relapse prevention planning.
Is Exposure and Response Prevention Effective?
Many studies have shown the effectiveness of ERP as a therapy for OCD since it was first recognized as such. Earlier research showed that it was more effective in reducing patients’ OCD symptoms than relaxation treatment or anxiety management. Subsequent studies have also shown its efficacy in various nations, treatment settings, and levels of strength.
According to a recent meta-analysis, roughly two-thirds of patients who underwent ERP improved in symptoms, and approximately one-third of patients were deemed recovered. Furthermore, while the majority of patients receiving cognitive-behavioral therapy (without ERP specifically) or cognitive therapy had a decrease in symptoms following treatment, ERP outperformed the other therapies. ERP, in particular, had a somewhat larger effect size and resulted in reduced OCD severity levels post-treatment compared to the other two modalities.