Exposure and response prevention therapy: An OCD treatment

When most people think of behavior therapy, they think of traditional talk therapy, where a therapist speaks with a patient to resolve and overcome mental health issues. However, for certain conditions like obsessive-compulsive disorder, (OCD), studies suggest that alternative treatments such as exposure and response prevention therapy (ERP) may work better than traditional forms of psychotherapy. This article will explain the characteristics of obsessive-compulsive disorder, OCD symptoms, and how ERP therapy can work in treating it.

Understanding obsessive-compulsive disorder symptoms

Before we can understand the ERP therapy techniques, we first need to understand what obsessive-compulsive disorder is and what the symptoms can look like. You can think of it this way: The body has a natural alarm system of sorts that signals to your brain when you are in danger. When someone has obsessive-compulsive disorder (OCD), their system alerts them to danger even when there isn't any. 

The person is mentally “tricked” into believing there is a real danger and that something bad could happen to them and their loved ones. This causes anxiety to build, and the person then responds compulsively to "remove or counteract the perceived threat." When they continue to react to these triggers of fear and anxiety with compulsive behaviors, they reinforce the idea in their brain that the danger is legitimate. The more they react compulsively, the more the behavior(s) continue.

For instance, for some, obsessive-compulsive disorder symptoms can manifest as a compulsion to check the stove every time they leave the kitchen and the house. The stove may not have even been used that day, but because of the mind’s overactive sense of feared outcomes, (i.e., the house burning down), the individual must check the stove. 

They may even develop an added obsessive behavior of turning it on and off again multiple times to make sure it’s off. These kinds of ritualistic behaviors can cause heightened levels of anxiety and seriously disrupt day-to-day life for those experiencing the disorder OCD. Because this condition affects so many people and is so widely misunderstood, the International OCD Foundation plans an OCD Awareness Week every second week of October. It aims to promote awareness of the manifestations and behaviors of obsessive-compulsive disorder so that more people who are affected can get proper diagnosis and treatment.

What is exposure response prevention therapy?

For example, if the usual reaction to a fear of having left the stove on and causing a fire is to turn it on and off again, the individual will be encouraged to deliberately resist this behavior after exposure to the trigger. When their brain eventually gets accustomed to avoiding a compulsive reaction, it is known as habituation.

How ERP can work

When one experiences OCD tendencies, yielding to compulsive behavior when the anxiety is triggered feels like the appropriate thing to do. It often seems like it’s the only way to reduce the anxiety and gain control over distressing situations. To break this cycle, the individual must learn to stop responding compulsively. 

As with any anxiety-related disorders, this is easier said than done, as stopping the ‘fire alarm’ of obsessive compulsive disorder and OCD symptoms can be difficult. That’s why engaging in the treatment process with a therapist trained in exposure therapy and/or cognitive behavior therapy is often beneficial. The more you practice encountering your triggers without giving in to the compulsive reaction, the more control you can gain over this alarm and your behaviors. In turn, this can help to gradually reduce your level of anxiety and fear so you can work towards reducing the triggering nature of certain events.

As an inhibitory learning approach, ERP is a slow and deliberate process. For example, if the trigger for a client is a certain object, they may need to spend time looking at the object before touching it. The strength of their fear can determine how long this process might take. After the individual is comfortable looking at it, they need to begin moving closer to it. Once they can touch it without experiencing any compulsions, they may be ready to move on to the next fear and response. Response and prevention therapy works best when patience and self-compassion are prioritized during the process. 

If ERP isn’t effective enough in treating severe symptoms, medications like selective serotonin reuptake inhibitors or other treatment options, like transcranial magnetic stimulation (TMS) might also be options to consider. However, research in the Can. J. Psychiatry found that even when using serotonin reuptake inhibitors, therapy remained important for treatment outcomes, which suggests that therapy is important for treating obsessive-compulsive disorder. 

How a therapist can help

In their own mind, a patient’s symptoms and OCD obsessions can lead them to feel like a non-threatening scenario is actually a life-or-death moment. This fear can pervade virtually all elements of their daily thinking and behaviors, which is why these kinds of mental disorders can be very difficult to overcome without the help of a professional. If you or someone you care about has OCD, they may benefit from speaking to a professional who can determine the best course of treatment and diagnosis for them. 

Not everyone feels comfortable meeting with a mental healthcare provider in person, which is where virtual therapy options can be useful. With online therapy for obsessive-compulsive disorder through a platform like BetterHelp, you can speak to a licensed therapist who has experience in treating individuals with OCD and its subtypes without leaving home. Research suggests that individuals who receive virtual ERP to treat obsessive-compulsive disorder showed “significant improvement in symptoms,” so this format may be worth considering if you find it to be more convenient and comfortable.