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.