Obsessive-Compulsive Disorder (OCD) is a debilitating mental health condition that affects people across the globe. It can manifest in various forms, which involve unwanted thoughts (obsession), repetitive behaviors (compulsion) or mental acts that significantly impair day-to-day functioning and the quality of one’s life.

Imagine a life with a persistent fear that your hands might be contaminated with bacteria. You repeatedly wash them until you get tired. Sometimes, you feel compelled to check and re-check your gas stove multiple times to prevent a house fire. These experiences are a glimpse of what OCD looks like.

For people with OCD, the distress brought by its symptoms can be overwhelming and requires immediate intervention. Among different treatment options, exposure and response prevention (ERP) therapy represents the gold standard for managing the symptoms of OCD.

Let’s take a look at it and discover how it works.

What is Exposure and Response Prevention Therapy (ERP)?

Exposure and Response Prevention Therapy is a form of Cognitive Behavioral Therapy (CBT) and is recognized as a highly effective treatment modality for people suffering from OCD symptoms. It offers a structured approach by systematically guiding the individuals to confront the objects, images, or situation while teaching them to tolerate the distress and resist compulsion as a response to the fear.

In treating OCD, ERP therapists consider the complexity of symptom presentation and the initial distress that it may bring to individuals during and between sessions. Hence, the therapist works collaboratively with the individual to ensure that the administration of ERP is relevant, effective, and suits the individual’s needs and preferences.

How ERP Therapy Helps Treat OCD

The main goal of the ERP is to expose individuals to a feared object or situation and prevent them from doing their rituals or compulsive behavior as a way to relieve distress. In general, ERP operates based on the following key principles:

Assessment and Planning: The therapist starts by conducting a comprehensive assessment to identify the individual’s obsession (fearing an image, object, or situation) and compulsion (repetitive behavior). Once identified, the therapist works collaboratively with the individual to rank the fear on a scale and create an exposure hierarchy list ranging from least anxious (e.g., thinking about the dirt) to most anxious (e.g., touching the doorknob).
Exposure: During this phase, the therapist continues working with the individual by systematically exposing him to the feared images, objects, or situations that were identified in the hierarchy list. In the early phase of the exposure stage, the individual is exposed to a specific trigger with a mild anxiety reaction. For example, the therapist might ask the individual to hold a mental image of the dirt. When the individual becomes comfortable with the first stage of exposure, the therapist continues to guide him until he progresses to a more challenging and anxiety-provoking exposure (e.g., touching the doorknob).
Response Prevention: Throughout the exposure phase, the individual is encouraged to refrain from engaging in compulsive behaviors (e.g., repeated hand washing). This aspect of ERP is vital, as it breaks the vicious cycle of OCD. When the individual is able to learn how to successfully resist the urge to do the compulsion, the anxiety decreases naturally over time.
Habituation: As the individual repeatedly exposes himself to the trigger without performing the usual ritual or compulsive behavior, the individual experiences what is called ‘habituation.’
Adaptation: With the process of habituation, the individual learns that despite the discomfort associated with the feared images, objects, or situations, the anxiety is manageable without needing to perform compulsive behaviors for short-term relief.

How Long Does Exposure Therapy for OCD Prevention Therapy Take to Work?

Typically, individuals with OCD progress over a period of several weeks to months, with regular ERP therapy sessions scheduled weekly. However, some individuals may continue undergoing the ERP session when it is deemed necessary, as evaluated by the clinician. In fact, research studies have demonstrated that longer sessions have a better treatment effect.

Generally, the duration of ERP depends largely on the following factors:

Severity and Complexity of Symptoms: Individuals with severe symptoms of obsession and compulsion may experience improvement a little bit longer than those with milder symptoms. In addition, the therapist evaluates the presentation of symptoms (e.g., the presence of multiple obsessive thoughts and compulsive behavior), which can influence the duration of the treatment.
Comorbidities: People with OCD can sometimes present with symptoms along with other mental health conditions (e.g., panic disorder, generalized anxiety disorder, major depression disorder, etc.). Treating comorbidities may affect the overall duration of ERP sessions.
Adherence and Response: Consistency and commitment to ERP therapy play a vital role in the progress of OCD symptoms. Some individuals may respond to ERP quickly, while others may take some time to manifest progress.

Does ERP Therapy for OCD Work Online?

Virtual ERP therapy is an alternative form of ERP with the end goal of making it more practical and accessible for both individuals and therapists. Virtual ERP is delivered by the therapist remotely through telehealth platforms. Some applications are also used to conduct virtual sessions, assign therapy homework, and monitor the individual’s progress. This implies that individuals can access therapy anytime and anywhere through internet connectivity. Another advantage of virtual ERP involves flexibility in schedule and the elimination of barriers related to geographical distance and transportation.

Ultimately, virtual ERP expands the opportunities for individuals with OCD to receive remote care and support.

How is ERP Different from Traditional Psychotherapy?

In navigating treatment options for a specific mental health condition, understanding the key distinctions between them is essential for both the individual and the therapist. Here’s what you need to know about what ERP sets apart from traditional talk therapy:

Theoretical Framework: Traditional psychotherapy encompasses different theoretical bases, such as psychodynamic, humanistic, existential, and integrative approaches. These strategies may explore unconscious conflicts, past trauma, and emotional problems to address various mental health conditions. On the other hand, ERP is based on the theoretical framework of classical and operational conditioning as it focuses on modifying behaviors (compulsion).
Treatment Technique: ERP therapy techniques involve exposure exercise by guiding the individual to confront anxiety-provoking thoughts or situations and encouraging the individual to resist engaging in ritualistic behaviors. However, some traditional psychotherapy approaches use techniques such as free association and early recollection to uncover internal conflicts.
Structure of Sessions: Some traditional psychotherapy often follows less structured sessions, which provide opportunities to explore a wide range of concerns depending on the individual’s needs. Meanwhile, ERP takes a structured approach to every session, with identified target goals and objectives to be achieved.

Common Misconceptions About ERP Therapy

People with or without symptoms of OCD might have misconceptions and doubts about how ERP therapy works. Addressing those misinterpretations can encourage them to make an informed decision about seeking depression treatment for OCD. Some of them include:

ERP is too harsh or traumatic: While there is an element in ERP that the therapist guides the individual in deliberate exposure to anxiety-provoking images, objects, or situations, the therapist also assesses whether or not the individual is ready for a specific level of exposure.
ERP is the same as simply conquering fears: The gradual exposure to feared objects or situations in ERP is more than simply facing an individual’s fear and apprehension. While being exposed, the ERP therapist encourages the individual to resist engaging in compulsive behaviors for instant relief.
Once ERP sessions are completed, OCD symptoms will never manifest again. ERP is an evidence-based treatment modality that brings symptom reduction to people with OCD symptoms. However, OCD can be a chronic condition that requires ongoing support to maintain progress and manage episodic symptoms.

How Can I Access Treatment for OCD?

OCD symptoms are debilitating and can massively affect the overall quality of life. From persistent intrusive thoughts (obsession) to performing repetitive behaviours (compulsion), OCD can cause significant impairment to an individual’s day-to-day functioning.

Although embarking on a journey to manage OCD remains a challenge, by seeking and accessing treatment, you are bringing yourself closer to symptom relief and greater peace of mind.

Consider connecting at Luxe Recovery and begin your mental health journey with us! We will gladly provide you with further information or guidance on our treatment options.