Exposure and Response Prevention (ERP) refers to practicing confronting the thoughts, images, objects, and situations that make you anxious & provoke obsessions. It is a type of Cognitive Behavioral Therapy (CBT). While for many years, OCD was thought to be untreatable, fortunately, over the last few decades, ERP has been proven quite successful in reducing they symptoms of OCD. ERP is often the first line of treatment that a patient will see results with.
During ERP, a patient is essentially exposed to their greatest fears, whether it be touching a unwashed door handle, putting a volume knob on a number that makes the patient feel anxious, or voicing fears out loud, such as a loved one dying, being involved in a car crash, or having your home broken into. Basically, it places the patient in situations that they want to avoid, with the belief that the more they are exposed to it, the less anxious it will make them. Combined with the exposure, the therapist helps the patient to abstain from their compulsions, rather than give into them. ERP typically starts with the patient making a list of fears, smallest to greatest. This is often referred to as an exposure hierarchy. The therapist then begins the treatment by exposing the patient to less extreme fears, one at a time, while processing how they feel after each exposure. It’s important for the patient themselves to help choose which fears they’re exposed to, based on the level of anxiety they feel when faced with them. This method gives the patient time to work their way up to the most challenging fears. After each exposure, the therapist may ask the patient about what they feared might happen, what actually happened, and how it’s shaped the patient’s view moving forward. This can help a patient learn how to manage the uncertainty and stress that grips them when faced with something that scares them, or makes them anxious.
It’s also extremely important that the client not give into their compulsions during these exercise, as giving into them can cause OCD tendencies to worsen, or enforce the compulsions they patient previously relied on. When the client gives into their compulsions, the relief they can feel is often type misinterpreted as rewarding, which can enforce the behavior. When the reward is found in engaging in and processing the fear, and tolerating or even accepting the uncertainty or lack of control, it reinforces the work being done in ERP, making each new exposure, and it’s outcome, more successful.
Each individual exposure can take several sessions on their own. For example, a patient with a fear of driving or riding in a vehicle may start a session simply sitting in a vehicle that is parked. Once that fear has been confronted, the therapist may take the patient to the next level of starting that car and driving around a parking lot, working their way to driving a short distance, and further and further until they have found a healthy way to work through their fear.
ERP is not a one size fits all method. Because OCD triggers can vary so much from client to client, the treatment will vary greatly. Some individuals may find that just a couple of exposures will be enough to move on from their smaller fears and triggers, onto bigger, more debilitating ones. Other’s may find the first few steps the hardest, and might take the longest, but are strengthened enough by their results to move on to more extreme situations with fewer sessions than they needed in the beginning. As the client is exposed to new fears, they are able to process more and more their progress between sessions, any new triggers that come up, the coping mechanisms they’ve found most helpful, the solutions that have worked best for them, and what they’ve learned with each new exposure. Most importantly, ERP helps provide a client with new skills to cope with OCD, while also helping them understand their compulsions and why they have them.
According to treatmyocd.com, ERP is extremely effective at treating OCD, with a success rate of 65% to 80% in children, adolescents, and adults. While everyone responds to therapy differently, most see a decrease in OCD symptoms within anywhere from eight to 16 weeks; some even find that there symptoms disappear altogether. While there are some ways to treat OCD on your own, ERP should only be used with an experienced mental health provider. Attempting to administer ERP on your own, without the support of a therapist, can be dangerous, especially for an individual who isn’t ready to face the fear and uncertainty on their own. Because ERP is the exact opposite of what individuals diagnosed with OCD are used to, it’s important to find a licensed therapist to help you navigate the experience and monitor your reactions and results.
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