Exposure and Response Prevention for Obsessive-Compulsive Disorder

Exposure and Response Prevention (ERP) is the gold standard for treatment of Obsessive-Compulsive Disorder (OCD). It is essential to recovery because it treats the root cause of OCD symptoms. ERP is evidence based treatment for OCD. Approximately 1 out of 40 adults in the United States will meet the criteria for OCD at some point in their lives. ADHD when present as a comorbid disorder, is associated with more severe OCD. With early treatment and the continuation of treatment from ERP, patients are associated with better outcomes. Studies reveal the earlier the symptoms present a stronger influence of genetic factors in the causation of OCD. The later the symptoms arise the more environmental conditions play a role in the presentation of OCD. The presence of unwanted and recurring thoughts or (obsessions) and/or the performance of repetitive behaviors or rituals (compulsions) categorizes OCD as a mental illness. A vicious circle of intrusive thoughts followed with attempts to neutralize them with compulsive behaviors. OCD can have mild to moderate symptoms or develop into more severe symptoms that become time consuming and debilitating. Severe symptoms can make every day life very difficult. The problem can consist with only obsessive thoughts and without any accompanying compulsive behavior. There are many themes of OCD. Examples are perfectionism, religious rituals, sexual orientation, and relationship. The development of ERP was based on behavioral theories. ERP therapy disrupts OCD's patterns by addressing both the obsessions and the compulsions. The patient exposes themselves to situations and obsessive thoughts that provoke the anxiety with the goal of resisting the urges to perform compulsions to reduce their distress. ERP was designed to allow acceptance of the uncertainty that creates fear. ERP creates space for anxiety and fear to dissipate. Over time the emotions associated with the fear become weaker and can be processed without any compulsive behavior. The goal of exposure is to provoke the intrusive thoughts. Neutralizing thoughts must not be allowed to enter during this exposure. Trying to suppress an intrusive and unwanted thought can cause it to reoccur. A thought can occur automatically when controlled suppression has occurred. The exposure to the intrusive thought gives space to understand the thought and allow time to explore the emotions that are tied to the thought. Through this process the thought can hold less power. The success of ERP often depends on consistent exposure. ERP is focused on the distress and anxiety to create tolerance with the emotion. It's not enough to tell someone an obsessive though is manageable therefore their compulsion is unnecessary. With the practice of repeated exposure and the guidance of ERP therapy, skills are acquired to create more neutral and healthy responses. With new habits and thought processes the OCD becomes more mild and less pronounced. ERP allows a child to recognize that a thought is just a thought. ERP is a process. Learning that a thought which leads to obsessive fears, that does not come true. As a result their anxiety experience lessens.