Does ERP work for OCD?

Exposure and Response Prevention (ERP) is often the first treatment modality for OCD that is suggested, and for good reason. It has decades of strong research behind it and is considered to be 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 are treatments and techniques 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 staying with a distressing situation or thought without ritualizing or avoiding. 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 navigate through the distress the OCD brings up, rather than having that distress control their lives. 

Response Prevention

Sitting with exposures helps the patient practice how to engage in response prevention. Response prevention is the practice of preventing ourselves from choosing a compulsive response to the OCD theme when it pops up. Because during exposures we practice resisting the urge to compulse, in our day to day lives it gets easier to apply that same skill. 

Through a combination of exposure and response prevention, we hone our skills to disempower our broken alarm system, robbing its signals of any relevance to our lives. With practice, these signals become weaker and weaker and 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.