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Exposure and Response Prevention (ERP): The Treatment of Obsessional OCD

Exposure and Response Prevention (ERP): The Treatment of Obsessional OCD

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.

OCD: How to Overcome Your Fears

OCD: How to Overcome Your Fears

OCD: How to Overcome Your Fears

Obsessive compulsive disorder (OCD) is an anxiety disorder where people have unwanted thoughts and behaviors that feel out of control and cause significant distress or difficulty functioning in daily life. The condition often runs in families, suggesting that there may be some genetic component to it, but environmental factors like childhood trauma can also contribute to the development of OCD. People with this condition often develop rituals as a way to cope with the anxiety they experience; many of these rituals are repetitive behaviors, including hand washing or checking that no one has been in the house while they were gone.

What Is Obsessive Compulsive Disorder?
Obsessive compulsive disorder (OCD) is an anxiety disorder that can cause significant distress, as well as sometimes difficult to understand behaviors. In short, OCD is characterized by obsessive thoughts and behaviors that are performed in order to reduce or neutralize obsessions. For example, you may have an obsessive fear of germs, which leads you to perform excessive hand-washing or cleaning rituals. This behavior provides temporary relief from your anxiety but increases over time until it dominates your life and interferes with daily functioning.

What Causes Obsessive Compulsive Disorder?
OCD is a serious mental illness. Triggered by severe anxiety, it affects about 2.2 million American adults and impacts people of all races, ages, socioeconomic backgrounds and education levels. It’s generally treated with a combination of behavioral therapy and prescription medications (antidepressants or anti-anxiety medications). OCD may be caused by a myriad of contributing factors, including biology and environment. In many cases, no single cause can be identified. In some instances, OCD symptoms are related to an underlying medical condition that needs treatment. Regardless of the cause of OCD, a mix of behavioral and pharmacological treatment is usually most effective. Exposure Response Prevention Therapy is one type of behavioral treatment used in treating obsessive-compulsive disorder.

Are There Treatments For OCD?
Yes. There are a variety of effective treatments for OCD, with behavioral therapy being one of them. Exposure and response prevention (ERP) is an effective and common treatment that focuses on gradually exposing you to fearful situations that trigger your obsessive thoughts and compulsive behaviors, allowing you to learn how not to respond out of fear.

What Role Does Exposure And Response Prevention Play In Treating OCD?
Exposure and response prevention (ERP) is an important part of behavioral treatment for obsessive compulsive disorder (OCD). It’s a long and involved process that involves gradually exposing yourself to things that scare you until you get used to them, which allows your brain to rewire itself so you can deal with whatever it is you’re scared of without needing excessive reassurance or avoidance. Think of exposure as desensitization therapy.

Scrupulosity: When religion and morality become impairing

Scrupulosity: When religion and morality become impairing

Although most people are familiar with Obsessive Compulsive Disorder (OCD)—or at least have a general idea and may even feel that they personally have some OCD tendencies—a lesser known form of OCD exists called scrupulosity. Scrupulosity involves obsessions related to religious or moral ideals which cause an individual to be overly concerned that their actions are sinful or are violating religious or moral doctrine (International OCD Foundation, 2010). This concern is so great that it often leads to excessive praying or trips to confession, repeating rituals involving cleansing and purifying, and avoiding situations where some religious or moral error may occur (IOCDF, 2010). One effective and recommended treatment for scrupulosity is Exposure and Response Prevention (ERP); however, another form of treatment, Acceptance and Commitment Therapy (ACT) was shown to be another effective form of treatment in a recent study by Dehlin, Morrison, and Twohig (2013). Acceptance and Commitment Therapy traditionally involves accepting undesirable thoughts and feelings, reducing the meaning of and attachment to these thoughts and feelings, and working toward acting in a way that fulfills one’s values in life and has been used in the treatment of OCD.

Dehlin and colleagues (2013) evaluated the effects of ACT on scrupulosity with five adults (three females and two males) across eight treatment sessions. In order to measure the effects of treatment, researchers tracked the participants’ compulsive behaviors as well as engagement with valued activities. In addition, researchers had participants complete assessment questionnaires. Treatment sessions were 1-1.5 hours each week and consisted of activities that helped the participants incorporate the core processes of ACT. Participants also completed weekly homework assignments. Throughout treatment, participants learned to accept unwanted thoughts, separate themselves from obsessive thoughts, view the self as a context in which thoughts occur, contact the present moment, and commit to actions in alignment with values. Results of the study showed a 74% reduction in compulsions and a 79% reduction in avoided valued behaviors, and these reductions were maintained during a 3-month follow up. In addition, participants reported high levels of treatment acceptability which, combined with the positive results of treatment, makes this a promising treatment for individuals with scrupulosity.

Dehlin, J. P., Morrison, K. L., & Twohig, M. P. (2013). Acceptance and commitment therapy as a treatment for scrupulosity in obsessive compulsive disorder. Behavior Modification. DOI: 10.1177/0145445512475134

International Obsessive-Compulsive Disorder Foundation (2010). Retrieved from https://iocdf.org/wp-content/uploads/2014/10/IOCDF-Scrupulosity-Fact-Sheet.pdf