ERP Therapy – A Good Choice For Treating Obsessive Compulsive Disorder (OCD)

Exposure and Response Prevention (ERP) therapy is a type of cognitive behavioral therapy (CBT) commonly used to treat obsessive-compulsive disorder (OCD). It involves exposing individuals to situations or objects that trigger obsessions while preventing them from engaging in compulsive rituals. Through repeated exposure without engaging in compulsions, individuals learn to tolerate anxiety and break the cycle of OCD symptoms.[1]

ERP therapy may help provide improvement in OCD symptoms, including:

• Reduction in obsessive thoughts and compulsive behaviors
• Increase in the ability to tolerate anxiety and discomfort without resorting to compulsions
• Improvement in overall quality of life and functioning
• Enhancement of sense of control over OCD symptoms
• Reduction in avoidance behaviors and increased engagement in daily activities

How ERP Therapy Works

ERP therapy overturned the traditional belief OCD does not respond to psychotherapeutic interventions. Based on current research, It is now acknowledged that ERP is an effective therapy for managing OCD symptoms, and is commonly used in clinical practice. [2] 

ERP therapy works through mechanisms like habituation and inhibitory learning. Habituation involves repeated exposure to feared stimuli, leading to a reduction in anxiety over time as individuals become accustomed to the triggers. “For ERP to be most effective, it must help clients develop strong safety mechanisms that effectively inhibit (or suppress) the original fear, a concept known as inhibitory learning.

ERP helps decrease clients’ fears by facilitating the acquisition of new safety information that hampers existing obsessional fears. The ultimate goal of ERP is to establish long-term safety mechanisms that will suppress obsessional fears.

Session Structure

Starting a new type of therapy can be nerve-racking, so it’s important to know what to expect before going in. A typical ERP therapy session structure includes:

• Assessment: The therapist conducts a comprehensive assessment to understand the individual’s OCD symptoms, triggers, and compulsions.
• Collaborative Goal-Setting: The therapist and client work together to establish treatment goals and develop a shared understanding of the exposure hierarchy.
• Exposure Hierarchy Development: The therapist assists the individual in creating an exposure hierarchy, a structured list of situations or stimuli that provoke anxiety, ranked from least to most distressing.
• Exposure and Response Prevention: During sessions, the individual gradually exposes themselves to feared stimuli or situations from the hierarchy while refraining from engaging in compulsive behaviors.
• Feedback and Evaluation: The therapist provides feedback and support throughout the session, helping the individual process their experiences and monitor progress toward treatment goals.

Dr.Brindusa Vanta, MD, says, “ERP therapy can now be delivered using virtual reality (VR) technology. Using VR, individuals can face their fears in safe, realistic simulations. Some research suggests that virtual reality exposure and response prevention (VRERP) is effective and can be used as an alternative exposure tool.”

Effectiveness of ERP Therapy

ERP therapy has shown significant success rates in treating OCD, with numerous studies supporting its effectiveness.

ERP is currently widely recognized as an effective treatment for OCD and is often considered the first choice for managing this condition.[2]

Further, a randomized placebo-controlled trial compared the medication clomipramine, exposure, and ritual prevention (ERP) and their combination in treating OCD. All active treatments were superior to a placebo at 12 weeks. ERP alone and combined with clomipramine showed similar efficacy and outperformed clomipramine alone. ERP may be superior to clomipramine in treating OCD.[4]

Recognizing When to Seek ERP Therapy

Whether you’ve already tried various forms of treatment or have never received professional help, it can be hard to know when you need to seek ERP therapy for your OCD. Knowing the symptoms of OCD, especially those that can be addressed by ERP therapy, can help guide your treatment search.

Here are some OCD symptoms that can be addressed by ERP therapy:

• Obsessive thoughts about contamination, harm, or symmetry
• Compulsive behaviors such as washing, checking, or arranging objects
• Fear of losing control or harming oneself or others
• Need for symmetry or orderliness in daily routines
• Intrusive thoughts or mental rituals that interfere with daily functioning
• Avoidance of specific situations or places due to obsessive fears

Additionally, here are some pointers for when you are self-assessing OCD symptoms and suitability for ERP therapy:

• You recognize how OCD symptoms interfere with daily life.
• You are willing to confront feared situations or stimuli without engaging in compulsive behaviors.
• You understand the importance of actively participating in treatment sessions and homework assignments.
• You are open to challenging and modifying maladaptive beliefs about feared outcomes.
• You are committed to attending regular therapy sessions and actively engaging in the treatment process.
• You are able to collaborate with a therapist and communicate openly about treatment goals and progress.

As Dr.Brindusa Vanta, MD, says, “When ERP therapy alone does not produce significant improvements in OCD symptoms, therapists may choose to combine it with other therapeutic approaches, such as Internal Family Systems (IFS) therapy.”

A Personal Story About OCD and ERP Therapy

During OCD Awareness Week this past October, I sat in front of my computer, mesmerized, as I watched a live internet broadcast of first-person OCD stories. At the same time these stories were being broadcast, there were chat rooms open where people could connect and talk about anything related to OCD. I joined right in, letting everyone know that while I was not an OCD sufferer myself, my 20-year-old son had recently recovered from severe OCD. I wanted to share our story as well as learn all I could about the disorder.

At one point during the chat, I connected with a distraught young woman who had been seeing a therapist for quite some time, but her OCD was getting worse, not better. “Is the ERP Therapy too difficult for you to do?” I asked her. “ERP Therapy?” she responded. “What’s that?”

I was stunned, though, in retrospect, I’m not sure why. Our family had floundered and then fought our way through a disorienting maze of treatments and programs, desperately trying to find the best help possible for Dan. But I had thought Dan was the only one who had been steered in the wrong direction, sent to the wrong therapists, and put on the wrong medications. It was then and there that I became an advocate for OCD awareness.

Exposure Response Prevention Therapy (ERP Therapy) is a type of Cognitive Behavioral Therapy (CBT) and, in my son’s case, a very effective treatment for OCD. In a nutshell, this therapy involves the person with OCD facing their fears and then refraining from ritualizing. This can be extremely anxiety-provoking initially, but eventually, the anxiety starts to wane and can sometimes even disappear.

 A concrete example of ERP Therapy in action would involve someone with OCD who has issues with germs. They might be asked to touch a toilet seat and then refrain from washing their hands. Treating OCD with ERP therapy has even been the topic of some reality shows over the past few years. So why do so many therapists remain in the dark?

When Dan diagnosed himself (with the help of the internet) at the age of 17, he was referred to a well-respected clinical psychologist in our area. This therapist employed traditional talk therapy, which included examining underlying issues. This form of therapy is not usually effective in treating OCD. In fact, talk therapy often exacerbates OCD. Talking about their fears over and over and reassuring OCD sufferers only adds fuel to the fire. OCD is not something rational.

It is a neurologically based anxiety disorder. In fact, a study done in 2007 showed that OCD sufferers had less gray matter in the areas of the brain associated with suppressing responses. Telling someone with OCD not to worry is like telling someone with asthma to stop having trouble breathing. It isn’t possible. And so Dan spent months in therapy, getting worse. He ended up spending nine weeks at a world-renowned residential program for OCD, and that was his and our first introduction to ERP Therapy.

You don’t have to go to a residential program to get the right help for OCD. But you do need to find a properly trained therapist who specializes in the disorder. What works for one OCD sufferer may not always work for another. You and your therapist will work together to find the right balance of therapy, medications, and stress management techniques that will give you the best chance of success. The best resource out there for finding competent therapists is the International OCD Foundation. Not only do they list healthcare providers by state, but they also give you tips on what questions to ask when “interviewing” a prospective therapist.

ERP Therapy is difficult, but with hard work, the person who suffers from OCD can improve dramatically. Three years ago, Dan was so debilitated by severe OCD that he could not even eat. ERP Therapy saved his life, and today, he is a rising senior in college with a wonderful life ahead of him. We’ve got to get the word out that this is often a very effective therapy for those with OCD. Having OCD is tough … getting the right help shouldn’t be.

Sources

1. National Institute of Mental Health. (2021, June). Obsessive-compulsive disorder. https://www.nimh.nih.gov/health/topics/obsessive-compulsive-disorder-ocd/index.shtml
2. Olatunji, B. O., Cisler, J. M., & Deacon, B. J. (2010). Efficacy of cognitive behavioral therapy for anxiety disorders: A review of meta-analytic findings. Psychiatric Clinics, 33(3), 557-577. https://doi.org/10.1016/j.psc.2010.04.002
3. Abramowitz, J. S., Franklin, M. E., Schwartz, S. A., & Furr, J. M. (2003). Symptom presentation and outcome of cognitive-behavioral therapy for obsessive-compulsive disorder. Journal of Consulting and Clinical Psychology, 71(6), 1049–1057. https://doi.org/10.1037/0022-006X.71.6.1049
4. Foa, E. B., Liebowitz, M. R., Kozak, M. J., Davies, S., Campeas, R., Franklin, M. E., Huppert, J. D., Kjernisted, K., Rowan, V., Schmidt, A. B., Simpson, H. B., Tu, X. (2005). Randomized, placebo-controlled trial of exposure and ritual prevention, clomipramine, and their combination in the treatment of obsessive-compulsive disorder. The American Journal of Psychiatry, 162(1), 151-161. https://doi.org/10.1176/appi.ajp.162.1.151