Exposure And Response Prevention Therapy For OCD

By: Stephanie Kirby

Updated March 05, 2020

Medically Reviewed By: Aaron Horn

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There are many kinds of mental health problems out there. Thankfully, there are multiple forms of therapy to help people overcome their challenges. The most important aspect of treating your condition can be to find the right form of therapy for you. When most people think of therapy, they think of the traditional form of talk therapy. That is when a therapist talks with a patient about their problems. They work, by talking, to discover hurts and hang-ups and how to overcome them. However, for some challenges, like Obsessive Compulsive Disorder, studies have found more effective forms of treatment such as Exposure and Response Prevention Therapy.

Understanding Obsessive-Compulsive Disorder

Before we can understand what Exposure and Response Prevention Therapy is, we first need to understand what Obsessive Compulsive Disorder, or OCD, is. Naturally, the body has a system somewhat like an alarm that lets your brain know when you are in danger. This happens so you can protect yourself from harm in a dangerous situation. It is your system working the way that it is supposed to work. However, when someone has an obsessive-compulsive disorder, their system does not function properly.

When someone has OCD, their system alerts them to danger even when there isn't any danger. The person is mentally tricked into believing there is a real danger and that something bad could happen to them. This builds anxiety. The person then responds compulsively to "remove the danger." When they continue to react to these triggers of fear with compulsive behaviors, they begin to reinforce the idea in their brain that they were in danger. The more they react compulsively the behavior continues to grow.

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Obsessive-compulsive disorder is when a person has obsessions of unwanted thoughts and ideas that cause anxiety. The person is unable to control them. The person is unable to stop the anxiety caused by the fear of danger until they respond with a certain behavior. These behaviors can take on a compulsive or ritualistic behavior.

What Is Exposure And Response Prevention Therapy?

Exposure and Response Prevention Therapy is the most effective form of treatment for people suffering from OCD. As the name suggests, it is made up of two different parts. The first is exposure. The patient is purposefully exposed to certain images, objects, situations, and thoughts that cause a fear response. These are the things that cause their anxious thoughts that kick their obsessions into gear. The second part is the response. When the patient is exposed to their triggers, they are taught to choose not to act compulsively to the anxiety.

Exposure and Response Prevention is a type of cognitive behavior therapy. It focuses on the thoughts, behaviors, and feelings of the patient and how they work together and affect each other. ERP helps the patient to begin to work through and identify their fears and what triggers them. They also work on identifying the compulsive behavior that follows the trigger. The therapist puts this information into a hierarchical map that shows the low fears at the bottom.

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Treatment begins at the bottom. The patient is exposed to their lowest fears and has to make a choice not to react compulsorily. For example, if their usual reaction is to wash their hands or turn the light switch on and off again, then they resist this behavior. When their brain gets used to the fact that they are not reacting in compulsion, it is known as habituation.

The patient is guided through these exercises by a therapist in the beginning. As they conquer the lower fears, they start working up the hierarchical map. As the treatment continues, the patient is taught how to manage this behavior on their own.

Why ERP Works

Vast research has shown that Exposure and Response Therapy is the most effective therapy that can be used, especially during the early stages of treating Obsessive-Compulsive Disorder.

When you suffer from OCD giving in to the compulsive behavior when your anxiety is triggered feels like the right thing to do. It feels like it is the only way to reduce your anxiety and gain control. To break this cycle, you have to learn to stop responding compulsively. This is easier said than done, which is why starting the process with a trained therapist is beneficial. The more you practice exposing yourself to your triggers without giving into the compulsive reaction the more control you will gain. In turn, this will help to decrease your level of anxiety and work towards eliminating the events as a trigger.

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Stopping the compulsive behavior is a decision that you need to make to start training your brain that there is no danger and to gain control over your reactions and ERP helps do just that.

What Makes It So Difficult To Do?

Taking part in Exposure and Response Prevention therapy is difficult when suffering from OCD. It can make a person feel like they are going against what is right. When your natural response to fear is an established behavior, not doing that behavior when your brain is telling you that you're in danger feels wrong.

However, it is a process that trains your brain to understand what is happening in the situation and separate unreal danger from actual danger. Therefore, the therapy begins with working at the smallest fears at the bottom of the hierarchy before taking on the fears that are more domineering.

Exposure and Response Prevention therapy is a slow and deliberate process. For example, if the trigger for a patient is a certain object than the patient may need to spend time looking at the object before touching it. Depending on how strong the fear will determine how long the process will take. After they are comfortable looking at it, they will need to begin moving closer to it. Once they can touch it without experiencing any compulsions, they are ready to move on to the next fear. While it may seem slow, every step is one if the right direction during ERP and should be celebrated.

How A Therapist Can Help

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What OCD patients experience is much more than fear. To them, it is more of a life or death situation. It is fear that changes how they can live and what they can do. It impacts their thinking, and it can be very difficult for them to overcome this fear alone.

Exposure and Prevention Therapy is a specialized technique that should be performed by a trained specialist. If you or someone you care about is suffering from OCD, they should speak to a professional who can help them in the following ways:

  • Creating a hierarchical map That guides them through the process of conquering smaller to larger fears.
  • Informing the client about proper techniques and "timing". Washing hands is a normal daily activity. A person suffering from OCD might wash their hands until the skin is pink and raw. Through role play, a therapist can guide someone by teaching appropriate skills.
  • Someone with OCD might not be able to identify their behaviors or triggers. They are used to living that way, and some of their behaviors will seem normal to them. They might not realize that other people don't experience the same thing.
  • Everyone can use support and encouragement. Having a therapist helping walk them through the process assures there is someone there that understands the progress that is being made. It is important to recognize this process to stay motivated to continue moving forward.

Exposure And Response Prevention Therapy Address The Root Problem

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When people see someone that struggles with behavior due to OCD, they think the problem is more physical. They see the behavior as the "problem." In reality, the true problem is the fear and anxiety that happens in the mind of the suffering person. The behavior is only a response to the fear and anxiety. To truly treat the problem, you must eliminate the fear. Someone can decide not to do the behavior outwardly, but still silently struggle inside. From the outside, it looks like the problem is fixed, but it isn't. ERP helps to eliminate the behavior by working towards eliminating the fear that is causing it.

If you have been struggling with OCD, you don't need to continue to live with the fear and anxiety that you have been experiencing. Contact a professional like those at BetterHelp to find a therapist that you are comfortable working with. You can be freed from the fear and anxiety in your mind.

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