Exposure and Response Prevention, or more commonly called ERP or EXRP, is currently the Gold Standard for the treatment of Obsessive Compulsive Disorder (OCD). It is a subtype of the more commonly used Cognitive Behavioral Therapy (CBT). In order to understand how ERP works, we must first understand the basics of OCD.

OCD is comprised of both obsessions and compulsions. Obsessions are defined as unwanted thoughts, images or impulses that repeatedly occur outside a person’s control. Obsessions are often accompanied by intense anxiety and distress. Compulsions are defined as repetitive thoughts, actions, or behaviors that a person uses to reduce or neutralize the anxiety caused by their obsessions.

ERP is composed of both exposure and response prevention. Exposure is when you intentionally confront the thoughts, images, or objects that make you anxious, or trigger your obsessions. Working with a therapist, you would first create a hierarchy of fears or anxiety inducing thoughts, images or objects. Exposures systematically work their way up the hierarchy while increasing distress tolerance so that you can handle the larger, more anxiety inducing scenarios. The response prevention component comes into play as you experience the anxiety and resist the urge to complete your compulsions.

There are three main goals of ERP: Habituation, Disconfirmation, and Mastery.

Habituation is learning that anxiety does not last forever, will go down over time, and with a reduction in anxiety will come the reduction in the intensity of the urges to ritualize.
Disconfirmation is learning that the things OCD says will happen do not happen or are extremely unlikely to happen. And if they do happen, that you will be able to handle it.
Mastery is learning that you can tolerate doubt, uncertainty, and the presence of unwanted thoughts without having to change or suppress them, so that you feel in control, rather than OCD.

There is a lot more to ERP than can be outlined in a blog post, ERP can be scary, so it is important that you have a trustworthy competent therapist by your side. If you have ever experiences intrusive thoughts, obsessions and compulsions, feel free to reach out for a consult on my contact page.

“CURE YOUR FEAR OF SPIDERS”

Curing a fear is a bold claim for an old school arcade game. But the premise is pretty solid: exposure to the things that you fear can in fact help reduce the anxiety around them.
*This particular machine was spotted at an old school arcade in Michigan.*

Sources:
National Collaborating Centre for Mental Health (UK). Obsessive-Compulsive Disorder: Core Interventions in the Treatment of Obsessive-Compulsive Disorder and Body Dysmorphic Disorder. Leicester (UK): British Psychological Society; 2006. (NICE Clinical Guidelines, No. 31.) 5, PSYCHOLOGICAL INTERVENTIONS. Available from: https://www.ncbi.nlm.nih.gov/books/NBK56465/

American Psychiatric Association, Koran, L. M., Hanna, G. L., Hollander, E., Nestadt, G., & Simpson, H. B. (2007). Practice guideline for the treatment of patients with obsessive-compulsive disorder. Arlington, VA: American Psychiatric Association, 2007. Available online at http//www.psych.org/psych_pract/treatg/pg/ prac_ guide.cfm

Exposure and Response Prevention

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