Does ERP work for OCD?

Exposure and response prevention (ERP) generally considered the go-to treatment modality for OCD, and for good reason. It has decades of strong research behind it and is one of the most effective treatments for a disorder ever created within the field of psychology. ERP falls under the umbrella of cognitive behavioral therapy (CBT), which is collection of treatments modalities that target how the client is thinking and/or acting. As the name suggests, ERP has two components: exposure and response prevention. 

Exposures

During exposures, a therapist works with a patient to practice intentionally bringing up and staying with a distressing situation or thought without compulsing, meaning without trying to figure it out or avoid it. This can sound intimidating, but it’s important to note that the level of challenge is always chosen by the patient. Additionally, the process quickly starts to feel empowering and relieving as the patient learns that they can survive what they thought would overwhelm them!

Exposures can be in vivo, wherein a patient will be tasked to sit with an observable discomfort such as touching a contaminated object or looking at an image they fear being attracted to, or imaginal, wherein a patient will be tasked to sit with a thought or premise such as “maybe I will harm someone” or “maybe I’ll go insane.” 

With the clinician’s guidance and support, the patient learns to gently make space for the distress and urges related to intrusive thoughts and feelings, rather than letting that distress control their lives. 

Response Prevention

When we do an exposure, we practice the skill of response prevention. Response prevention is the practice of resisting the urge to compulse. The more we practice this skill during exposures, the easier it gets to use response prevention in our day to day lives.

Through a combination of exposure and response prevention, we hone our skills to disempower our brain’s broken alarm system, robbing its signals of any relevance in our lives. When we stop adding fuel to our brain’s fire, our anxiety gradually decreases and our sense of clarity increases. Over time and practice, our brain’s anxious signals become weaker and weaker and our quality of life improves considerably!

That said, even the gold standard of treatment could use a little polish. In my next post I’ll discuss why sometimes even ERP does not generate results and how that can be remediated.