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.

Relationship OCD: A form of OCD that often damages the relationships where we most seek to be certain

Relationship OCD: A form of OCD that often damages the relationships where we most seek to be certain

Relationship OCD, or ROCD, refers to Obsessive Compulsive Disorder (OCD) symptoms centered around relationships with partners, family members, friends and co-workers. As can be seen from the symptoms below, ROCD sufferers obsess over fears that they’re not in the right relationship or that taking some step in the relationship will be the wrong step. In an attempt to protect themselves from relationship failure and ensure their happiness, individuals with ROCD may sabotage their relationships or inadvertently damage them over time.


Common Triggers
Relationship OCD symptoms are typically triggered by an event or situation in a relationship, such as asking a partner to move in together or getting married. It can also be triggered by something a partner does or doesn’t do. For example, if your partner has been spending more time with friends and family than with you, you might start questioning your place in their life. Or if they don’t respond to a text message right away, you might begin worrying about whether they still love you. If you have ROCD, any change in your relationship could potentially cause anxiety. This is because when it comes to relationships, certainty is everything. The idea of not knowing what will happen next is terrifying for someone with ROCD. Often ROCD suffers will chose to end relationships they truly value, in order to be certain not to harm the other person or to be sure they aren’t making a wrong choice that cannot be undone at a later time.
First Steps
If you suspect you have Relationship OCD, seek help from a professional with speciality in OCD. Clinicians without experience treating OCD may often inadvertently worsen the condition by providing reassurance or engaging in debates with clients that cannot come to real ‘certainty.’ This may also lead to a tendency for clients to seek out clinicians to make the important decisions in their lives for them, in order to feel more certainty or less responsibility for the outcome of their decisions. This condition should not be managed on your own. Your therapist will help you use Exposure and Response Prevention therapy to work on facing relationship fears without resorting to reassurance seeking or other safety behaviors. Don’t let Relationship OCD become a barrier to finding a healthy relationship. Recovering means learning how to face uncertainty without fear—you can do it! And remember, treatment works!

Dealing with your Anxiety
Step 1 – Reaching out for help. The first step in dealing with relationship OCD is to reach out for help. You may want to reach out to an OCD specialist prior to discussing ROCD in detail with the individuals whom it involves in your life. For example, loving partners often have great difficulty understanding why doubt exists and can sometimes take offense or behavior in ways that worsen the doubt with the best intentions. If ROCD exists, an expert clinician is likely to be willing to support you in explaining your symptoms to the individuals whom your doubt targets in ways that better help you potentially preserve the relationship and gain real support from your relationships that help you reduce your ROCD symptoms. One thing that is not typically recommended, is ending relationships simply to feel more certainty in the moment – ROCD typically attaches itself to different relationships. Therefore, ending relationships to reduce momentary discomfort can set up a cycle where symptoms arise again with a new relationship which in turn causes the individual to again end the relationship.

Moving On Through Treatment
Relationship OCD is an insidious condition in which sufferers are plagued by thoughts about their relationship. These thoughts almost always focus on whether or not their current partner is the right one, and thus cause ROCD sufferers to have a difficult time moving forward with intimacy in their lives. It is possible, however, for those suffering from Relationship OCD to move on with their lives if they address their symptoms early enough. The first step toward doing so is recognizing that you may have Relationship OCD. Treatment for ROCD with an expert therapist should involve exposures to help you face your uncertainty and may involve meetings with family or important relationships, should you want these, to help your supporters understand what you are going through.
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.

Differences in Early and Late Onset OCD

Differences in Early and Late Onset OCD

Pinto et al. (2006) defined OCD as “a neuropsychiatric condition characterized by recurrent intrusive thoughts (obsessions) and repetitive behaviors that the individual feels driven to perform (compulsions)” (pg.1 ).  The researchers sought to investigate predictors of remission/relapse among those treated for OCD.

Over five years, 293 adults were monitored and researchers measured their OCD symptoms. Researchers found those with early and late onset symptoms experience an increase in symptoms over time without effective treatment. Additional findings show a considerable amount of time between symptom onset and first initiation of treatment. Individuals in the study reported an average of 17 years from initial symptom experience to treatment initiation and 11 of delay from meeting diagnostic criteria for OCD until treatment initiation. Many clients reported spending a number of years misdiagnosed before initiating appropriate treatment for OCD.  

Researchers found the average onset for early onset OCD was 11-12 years old, while late onset OCD was 25-26 years-of-age. The first clinical symptom(s), obsessions and compulsions, 53% of participants indicated an obsession and 47% experiencing a compulsion. Interviews also found aggressive content obsessions, hoarding obsessions and compulsions as primary themes in distress. Contamination was shown as the most frequently reported subcategory for obsessions. Those with earlier onset symptoms also experienced higher rates of panic symptoms and disordered (Pinto et al., 2006).

Written by Perry Leynor, MA, LPC Associate supervised by Paula Maloney, LPC Supervisor.

Pinto, A., Mancebo, M. C., Eisen, J. L., Pagano, M. E., & Rasmussen, S. A. (2006). The Brown Longitudinal obsessive COMPULSIVE Study. The Journal of Clinical Psychiatry, 67(05), 703-711. https://doi:10.4088/jcp.v67n0503

Identifying and Treating Race-based Trauma

Identifying and Treating Race-based Trauma

Statistics indicate the United States of America (USA) is becoming more diverse and a nation of plurality. Despite statistics, USA has consistently struggled with its ability to respect, accept, and include diverse populations. Individuals of color experience direct and indirect health care disparities such as unequal access to material, social, and educational resources on a prevalent and consistent basis. They are often not able to afford health insurance, in addition, experience racist behaviors and discrimination amongst healthcare providers.

Racial and ethnic discrimination can cause negative psychological consequences that cause race-related stress and could eventually cause race-based trauma (Hemmings & Evans 2018). These psychological issues encompass feelings of helplessness, paranoia, anxiety, fear, medical health issues, numbing to their emotions, denigration of one’s sociocultural in-groups, and the onset of PTSD.

One solution is improving the health of individuals of color. Healthcare professionals would need to make better efforts to address racism when working with minorities. Research shows facilitating multiculturally competent care would require awareness of race, racism, discrimination, and how these factors contribute to subpar healthcare practices (Hemming & Evans 2018). Multicultural training within the mental health field also needs to be improved. A solution would be more effective training and treatment models for counselors to be better prepared to establish a therapeutic relationship with a person of color.

Written by Victoria Fontenot – Behavior Therapist. To seek care with us – please call 972-332-8733.

Hemmings, C & Evans, A. M. (2018). Identifying and treating race-based trauma in counseling. Journal of Multicultural Counseling and Development, (4), 20-37. https://doi:10.1002/jmcd.12090