Exposure and response prevention (ERP) is the first-line treatment of choice for most people with obsessive compulsive disorder (OCD). When combined with cognitive behavioral therapy (CBT), ERP can be particularly effective in the treatment of obsessional OCD, commonly known as Pure O. In this article, we’ll take a look at what ERP/CBT is, how it works and why it works, and how to go about getting help from your doctor and setting up an ERP/CBT treatment plan that works best for you.

What is Pure O?

Pure O is the term used to describe obsessions that occur without a person having accompanying outward compulsive behaviors. Pure O is in many senses a misnomer because the compulsions still exist but are not observable. That is, in Pure O, thoughts are more frequently the compulsive behaviors following intrusive thoughts. Often individuals with Pure O are engaging in entirely normal self-soothing behaviors, for example trying to talk themselves out of fear or ‘neutralizing’ ‘bad thoughts’ with ‘good thoughts.’ These behaviors, however, offer temporary relief and reinforce the intrusive thoughts continuing.

How is ERP used to treat Pure O?

Treatment for Pure O often consists of ERP, which is the process of exposing oneself to whatever triggers their obsessions, while preventing a compulsive response. For example, if one had an obsession with germs, they would touch a public surface and then not wash their hands. This process is somewhat more delicate and difficult for Pure O and very often requires an expert in exposure and response prevention. An expert can observe you as you attempt to stick with your intrusive thoughts and observe you as well as ask you questions about what is occurring for you as you experience these. They can then help you respond to your thoughts in ways that do not further your suffering over time. One should note that this process is hard and often involves enduring short term anxiety so your life can be regained from your OCD.

Is ERP treatment successful?

The effectiveness of ERP as a treatment for obsessional OCD has been demonstrated in many studies. For example, one study reported that 80% of the participants who were treated with this technique had significant improvement after one year, which is a much higher success rate than with either pharmacotherapy or cognitive behavioral therapy without exposure and response prevention. Moreover, the majority of patients who improve during intensive outpatient treatment continue to do well during follow-up periods that range from six months to five years. Intensive outpatient is not always necessary for individuals with “Pure O” but can be very beneficial for speeding along treatment and reducing opportunities for setbacks with this form of OCD. Specifically, because the ‘compulsions’ in Pure O are so difficult for both seasoned clinicians to identify and clients – its often not optimal to have large gaps in between sessions. Each gap in between sessions tends to leave you more likely to become confused about how to deal with your thoughts or whether you are engaging in exposure ‘correctly.’ If you or a loved one believe you are suffering with “Pure O” OCD, please contact us for assistance.

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