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Treating OCD with Exposure and Response Prevention Therapy

written by: Rene Wolf • edited by: Diana Cooper • updated: 5/24/2011

The use of exposure and response prevention (ERP) for people with OCD is a long and often times grueling experience for the individual. However, it is the most effective treatment for those who suffer with an obsessive compulsive disorder.

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    Exposure and response prevention for OCD is a form of cognitive behavioral therapy used in the treatment of the obsessive thoughts and the compulsive behaviors associated with obsessive compulsive disorder. While ERP therapy will not cure obsessive compulsive disorder, it is a favorable option to effectively minimize the behaviors associated with OCD. The goal of ERP therapy is for the individual to learn over several sessions how to confront his obsession and to learn how to prolong and eventually avoid the compulsion.

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    Images

    Germs of a dumpster may be a part of ERP therapy
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    The “Exposure” In ERP

    During treatment for OCD with exposure response prevention therapy, the “exposure” part of the process means to confront the images, thoughts, situations and objects that lead to the person becoming anxious. Individuals are exposed to these thoughts, objects and situations repeatedly until they experience an obvious relief of their anxiety symptoms. The exposure is done gradually and may take several months before they are fully confronted. For example, someone with a fear of contamination would gradually be exposed to various objects that are dirty and may contain germs. The introduction to the object must cause severe distress and symptoms of anxiety for the individual. The person will gradually begin to realize that a catastrophic event did not occur when he was introduced to the object. During this time the person is being introduced to exercises, such as breathing techniques to help him reduce his anxiety symptoms. The exposure procedure is repeated continuously over several sessions and each time the object or situation is intensified. For example the first session may include touching a light switch and the next session may include holding their hand on a doorknob for several minutes. Each session intensifies with objects that may contain excessive amounts of germs until the person is able to touch something with severe contamination such as an outside dumpster without experiencing an anxiety attack.

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    Response Prevention

    While in ERP therapy, the “response prevention” means the individual will make a choice to not follow through with the compulsive behavior (the ritual) associated with the obsession. For example, someone with a fear of germs or contamination will immediately try to wash his hands following contact with the item he perceives to be contaminated. When he is unable to wash his hands, he will experience an anxiety attack due to the fear of what may happen if the germs are not removed from his hands or body. Response prevention techniques teach the person techniques for relieving the negative feelings and to realize that by not immediately washing his hands a catastrophic consequence did not occur. During each session the person will be asked to wait a longer period of time before completing the ritual. For example, during the first session the individual is asked to touch the light switch and cannot wash his hands for one minute following contact with the light switch. Gradually the time is increased until for example, the person is asked to place his hand on the outside dumpster for five minutes and not be permitted to wash his hands for a period of ten minutes following contact.

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    Ultimate Goal of ERP Treatment

    The use of exposure and response prevention for OCD is a long but generally successful process. The individual must deal with both the exposure and the prevention sessions of the therapy in order to have a favorable outcome and reduce or prevent his symptoms of OCD. A typical ERP treatment may last between 14-16 weeks; however, the individual is encouraged to continue the techniques they learned as new situations arise. Throughout the 16 weeks an indicial is going through ERP treatment with a therapist. They are also asked to complete exercises at home without the watchful eye of the therapist. The exercises completed at home are written in a journal with detailed information. For example the person may attempt to empty a bathroom trash can and wait ten minutes afterwards before washing his hands. He will journal his thoughts, fears and feelings experienced during the waiting time, if he did indeed wait the full time, and what technique was used to help him through the anxiety. The ultimate goal of ERP treatment is for the individual to recognize the obsession (i.e. germs) is not going to cause him serious harm, to recognize that the compulsion (i.e. washing hands) when delayed will not have a catastrophic result (i.e. they did not die from the germs not being removed) and to work through the anxiety with learned techniques such as breathing exercises.