Understanding OCD and the Power of Exposure and Response Prevention (ERP) Therapy

There’s a good chance you have felt anxious at some point. Maybe that was before you

had to give a presentation in a class, or your work has been so busy that the projects are piling

up. There are plenty of good reasons that anxiety might come up for each person and lots of

ways anxiety might feel. When it comes to OCD, anxiety is a central and direct result of triggers

related to a person’s fears, or obsessions. But first, what is OCD, and how does anxiety play a

role in it?

What is OCD?

OCD is Obsessive-Compulsive Disorder, and it has two main features: Obsessions, which

are unwanted thoughts that tend to stick in the brain, and Compulsions, behaviors or mental

actions that are repeatedly done to feel less anxious. Typically, OCD triggers an anxiety cycle

that starts with an unwanted thought, image, or urge, called an intrusive thought. Those intrusive

thoughts often have a theme, like contamination from an illness or something not feeling and

looking symmetrical, and the anxious brain jumps to the worst outcome; if something does or

does not happen, then someone might get hurt. The thoughts themselves are pretty scary, so, as a

way to neutralize the distress, the brain responds with a compulsion.

For example, suppose John has OCD and experiences intrusive thoughts about touching a

doorknob and making a loved one sick. To relieve the anxiety from this thought, John might

engage in compulsive behaviors, such as washing his hands whenever he touches a doorknob.

This compulsion could also extend to washing his hands when someone else touches a door knob

when he touches a surface that someone else who touched a doorknob has touched, or even when

he just thinks about a doorknob. The intrusive thought—fearing his loved one will get

sick—becomes tied to the doorknob as a threat. This cycle of intrusive thoughts and compulsions

repeats and reinforces itself, often becoming exhausting and severely disrupting daily life

(Ruscio, Stein, Chiu, & Kessler, 2008). Those affected may find it hard to imagine living without

these compulsions.

What is ERP?

Suppose that you or someone you love was looking for help in treating OCD. Well,

fortunately, there is a therapeutic intervention that has shown a significant degree of success for

people experiencing OCD, and it’s ERP. ERP is Exposure and Response Prevention, and it

consists of two parts: gradual repeated exposure to the anxiety triggers and preventing

compulsive behaviors in response to the triggers. Referring to the previous example, by

practicing ERP, John will interact with the doorknob as an exposure exercise progressively more

directly, without washing his hands.

Where someone starts on this path will vary based on their unique anxiety hierarchy. If

John were to work with a therapist, he would start by making a list of the situations that trigger

anxiety related to the obsession, getting a loved one sick, and assign a number value to the

intensity of the distress, typically on a scale of one being not intense to ten being very intense.

So, if John describes that touching the doorknob is a ten and thinking about the doorknob is a 4,

the first exposure would probably look like thinking about the doorknob and the germs that

might be on it, who touched it last, or what would happen if they were to touch it while

experiencing the distress and resisting the compulsion to wash his hands. Over time, thinking

about it will cause less distress and urges to hand-wash; after a while, John will gradually work

up to touching the door without hand-washing!

The Results

This all might sound quite daunting, and the goal of ERP is to challenge the OCD cycle

and break it through repeated practice of triggering situations. But, the benefits of ERP are

profound. Many people who have participated in ERP report considerable reductions in their

OCD symptoms, leading to more freedom and flexibility in their daily lives, and several studies

over the years have shown how effective it can be (Valderhaug, Larsson, Gotestam, & Piacentini,

2007). They often find themselves able to engage in activities they once avoided and experience

an improvement in their overall well-being. While the process requires commitment and courage

by facing their fears and resisting compulsions, people with OCD can reclaim their lives and

build a future where anxiety no longer dictates their actions.

For more information on OCD and ERP treatment at theory and method check out our services.

References

Ruscio, A. M., Stein, D. J., Chiu, W. T., & Kessler, R. C. (2008). The epidemiology of

obsessive-compulsive disorder in the National Comorbidity Survey Replication. Molecular

Psychiatry [epub Aug. 26, 2008].

Valderhaug, R., Larsson, B., Gotestam, K. G., & Piacentini, J. (2007). An open clinical trial of

cognitive-behavioral therapy in children and adolescents with obsessive-compulsive disorder

administered in regular outpatient clinics. Behaviour Research & Therapy, 45, 577-589.