How Does ERP Therapy Help With OCD?

Updated March 03, 2021

Medically Reviewed By: Sonya Bruner

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Obsessive-compulsive disorder (OCD) is not a synonym for “clean.” It’s not another way of saying “organized” or “quirky” and it is not a cute acronym for “Obsessive Christmas Disorder.” And although this disorder is primarily represented through depictions of people compulsively washing their hands, hand-washing is not the only type of compulsion that affects people with OCD. In reality, OCD is a thought disorder that can be debilitating. In this post, we will talk about what OCD is and how exposure and response prevention therapy (ERP) may help.

What Is OCD?

Obsessive Compulsive Disorder is a debilitating mental illness that affects 1-3% of the U.S. population. It is characterized by the recurrence of upsetting and unwanted thoughts and urges. It is also not limited to a preoccupation with cleanliness or organization. In fact, OCD can present in a variety of different forms; intrusive thoughts commonly center around themes such as the fear of harming another person, a need for everything to be “just right,” religious scrupulosity, or the fear that you have said or done something blasphemous, offensive, violent, or sexually inappropriate.

But no matter what type of OCD you have, Obsessive Compulsive Disorder is always a doubting disease at its core. And the OCD cycle remains consistent across the broad spectrum of intrusive themes. It starts with a trigger, usually an intrusive thought. This thought is usually so upsetting that it feels overpowering. For example, you can imagine that you would understandably be very upset if you were driving down the road and suddenly thought, “What if that wasn’t a speed bump I ran over? What if it was actually a person?” If you thought you had hit another person with your car and potentially killed them, would you feel an overpowering urge to go back and confirm your suspicions? Would you feel paralyzed with guilt and fear? Most people would probably say yes.

But what if you went back and found that it was, in fact, a speed bump? No one else is around, so you definitely could not have hit and killed another human being-- or even an animal-- with your car. At that point, most people would breathe a sigh of relief and go on with their lives without ever dwelling on that thought again. But what if the thought didn’t go away? What if it followed you home and stuck in your brain, no matter how hard you tried to push it away? What if it only grew stronger and more frightening when you tried to fight it with logic? And what if you couldn’t turn it off? No matter how many times you tell yourself, “That’s not true! I obviously didn’t hit anyone!” your brain comes back with, “You did. You hit someone with your car-- and you probably wanted to because you’re a terrible person.”

That is what it feels like when you live with OCD. As you can imagine, these intrusive thoughts can be both frightening and frustrating. Many people with OCD understand that their thoughts are illogical and they want to respond to that fact. Logically, they might understand that if a thought is irrational, surely we should be able to “turn it off” or ignore it; in fact, many people can do this very easily. But for people who struggle with OCD, it isn’t that simple. That’s because there is a reason that the “obsessive” part comes before the “compulsive” aspect of OCD. The “obsessive” part exists because these unwanted intrusive thoughts can stick in your brain, developing a hold that feels impossible to break. As much as you want that thought to go away, it digs in because it embodies your deepest fears.

People who struggle with OCD become desperate to find some relief from their thoughts, so they are willing to engage in compulsive rituals that might seem bizarre to others. These rituals are alluring because they hold the distant promise of relief; you feel as though the thoughts will go away if you can just do this one thing to get rid of them. For example, let’s say that your OCD is stuck on the horrifying possibility that you said something deeply offensive to a friend. This offensive remark might have been made at a cocktail party seven years ago, but all of a sudden, you’ve just remembered it and you feel an overpowering need for certainty; you feel as though you need to know whether you did or did not say something terrible. In an effort to obtain this certainty, you might frantically comb through your memories, trying to dissect the conversations you remember from that night in question.

If you can’t find certainty that way, you might call that friend and ask her if you made a remark that upset her. If she says no, that might calm you down for the moment, but you might feel a lingering sense of doubt and anxiety because you still don’t know for sure. And because you’re desperate for the reassurance that you’re not a horrible person and you didn’t say something offensive, you might continue your search for certainty in other ways such as calling other friends or asking your family if they think you have a history of making offensive remarks.

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What Causes OCD?

It can be difficult to pinpoint the exact cause of disorders like OCD and anxiety. At present, researchers are not yet able to identify a singular cause, but the leading theory is that OCD stems from a combination of genetic factors and a malfunction in a person’s brain chemistry. Everybody experiences intrusive thoughts from time to time; we’ve all experienced the weird sensation of passing a lake and randomly wondering, “What if I threw my keys in the lake?” It’s a wacky thought and we know we’re not actually going to act on it, so most people are able to simply dismiss their weird thoughts and move on with their lives.

But some people’s brains might be “stickier” than others, meaning that intrusive thoughts are more likely to “stick” in their brain and seem like real and valid threats. This inconvenient stickiness means that people with OCD cannot simply turn off their intrusive thoughts, so they need therapeutic techniques that can help them cope and learn to manage their intrusive thoughts. One helpful method is “exposure response prevention therapy”, commonly abbreviated as ERP.

What is ERP?

ERP is the gold standard of OCD therapy because it has been proven to be the most effective method for treating Obsessive Compulsive Disorder. A variety of studies conducted in multiple different countries have all concluded that ERP is the most effective treatment world wide. This effectiveness was determined because people who completed a course of ERP showed a marked improvement in their symptoms and in their ability to control their responses to intrusive thoughts. It’s important to pursue a course of therapy like ERP because OCD cannot be cured and medication can’t stop the intrusive thoughts from sticking in your brain. Anxiety medication is commonly used in conjunction with a course of ERP because it can help to lessen the severity of the thoughts and your responses to them. But because medication does not address the underlying cause of OCD, it’s like putting a band-aid on a broken arm; it can’t be a long-term fix for your problem. That’s why we need ERP: because ERP works to treat the underlying cause of OCD (fear) and help you reclaim control by mitigating your response to the frightening stimuli.

So, how does it do that? Well, ERP does exactly what it says in the name: it’s a way of exposing yourself to your fears while preventing the compulsive responses that you normally engage in. For example, “harm OCD” is a common theme in Obsessive Compulsive Disorder. People who battle this particular theme struggle with intrusive thoughts about harming someone else. They might worry that they have hurt someone in the past and repressed the memory (even when there is no evidence to support this thought) or that their thoughts mean they are secretly a violent, terrible person. Even if that individual has never hurt another person in their lives, even if hurting someone is the last thing they ever want to do, harm OCD can keep them in a constant state of worry, guilt, and anxiety. Crime shows can be a common trigger for harm OCD; a person watching such shows might struggle with thoughts like, “What if I hurt or killed somebody?” or “I’m just like that terrible criminal on TV.” To escape the pain of these intrusive thoughts, people with harm OCD might avoid watching crime shows altogether. Or, if they do watch them, they might subject themselves to a series of mental compulsions like combing through past memories in search of proof that they have never committed a violent crime.

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In this case, a session of ERP would involve sitting with your anxiety and avoiding your compulsions. So, while the intrusive thoughts attack you, your course of ERP would teach you to refrain from engaging with them or performing your compulsions. Instead, you would simply continue watching the show and reply to your thoughts with a common OCD coping script like saying, “Maybe I did commit a violent crime. I can’t know for certain, so I’ll have to move on with my life and stop thinking about it.” For someone who doesn’t experience OCD, this might sound very easy. But if you have Obsessive Compulsive Disorder, the pressure to engage with your intrusive thoughts can be all-consuming and debilitating. So, simple ERP tasks can be both daunting and absolutely necessary for reclaiming control of your life.

As we consider the reality of Obsessive Compulsive Disorder and the necessity of ERP, it’s also important to remember that, if you have OCD, you are not inherently violent, crazy, or dangerous. You are more than the content of your intrusive thoughts. Your intrusive thoughts are so alarming to you because they are the opposite of who you are and what you want to do. Many people with OCD struggle in silence for years before ever coming forward to seek help because they’re embarrassed or ashamed about the content of their intrusive thoughts. They’re afraid that if they say, “I’m worried I’m secretly a violent or terrible person,” that they will be judged and stigmatized. They might even worry that their therapist will report them to the authorities and say that they are a danger to themselves or others.

But please remember that, unless you have absolutely, irrefutably acted on a violent impulse and hurt someone with real and tangible consequences, you are not a bad or dangerous person. You are worthy of understanding and support; a qualified therapist will understand that and they will be equipped to provide you with the help you need. So, don’t be afraid to vocalize the themes of your intrusive thoughts. Don’t be afraid to ask for help. ERP can be challenging, uncomfortable, and scary, but it does work and it will help you reclaim control of your life.

Finding the Right ERP Therapist For You

It can be difficult to identify the right ERP practitioner in your community. With online counseling, however, you can easily access a licensed mental health professional. Public health officials have long raised alarms about the barriers to mental healthcare. But many believe that, because the online modality can satisfactorily facilitate ERP and be used to treat OCD, that remote counseling has strong potential to make a real impact on society.

If you believe you are dealing with significant issues that are caused by your OCD, you should seek help. A therapist can help you figure out strategies to help you cope with your OCD. Together, you can be able to learn how to tackle it. OCD is a challenge, but it's one that you can conquer. All you need is some time and patience. You can improve, and you can end your fears. Read what others have to say about their experiences below.

“Chelsea is incredible I always leave my sessions with a smile and feeling confident in myself she is kind understanding funny and professional I see Chelsea for religious trauma, divorce, coparenting, disordered eating, sexuality (LGBTQIA+) childhood trauma, ocd.”

“Gerald was a great fit for my counseling needs. I have anxiety and OCD, and he helped me to learn many strategies to help with both. I was nervous to start counseling, but I am so glad that I did because now I have a new way of handling my anxiety and OCD. His approach to counseling was a great fit for me, and I would definitely recommend him.”


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