Exposure and Response Prevention Examples in the Treatment of OCD

Feb 253 min read

TLDR:

OCD is a commonly misunderstood diagnosis, but a very treatable condition. ERP is the gold standard in treating OCD because it has the best results. Creating exposures for clients is tailored to their individual obsessions and compulsions, and there are several examples listed below.

What is OCD?

Obsessive-Compulsive Disorder is commonly referred to, but not commonly understood. It is a mental health diagnosis where the individual experiences obsessions, or compulsions, or both. Obsessions are intrusive thoughts that are distressing and even disturbing; they often go against strongly held beliefs or values.

These thoughts are bothersome and difficult to control. They are typically very unlikely to occur and may not be based in reality. Obsessions may be about sexuality, socially inappropriate or taboo behaviors (such as committing a crime, staring, swearing, saying something mean, etc.), the devil, or contamination.

Compulsions are actions that are often repetitive and time-consuming. These actions are usually done to reduce distress or avoid a feared situation. As with the obsessions, the actions have no true effect on the outcome of the feared situation.

Some compulsions are meant to alleviate the obsessions, for example, excessive hand-washing to prevent contamination or checking that the burner is off by switching the knob 5 times to prevent a fire. And sometimes the compulsions are repetitive behaviors that aren’t related to obsessions at all, like counting.

OCD is treated through therapy and sometimes in combination with medication such as SSRIs. The standard therapy approach to treat OCD is called Exposure and Response Prevention (ERP). ERP has been shown to be more effective than any other therapeutic treatment and more effective than medication alone. Most clients will see a reduction in symptoms and some clients will experience full remission.

What is ERP?

Exposure and Response Prevention is a treatment that allows and encourages the client to be exposed to their fears while refraining from engaging in the compulsions. This works because the more someone avoids their fear, the bigger the fear becomes. As you can imagine, it can be quite distressing to be exposed to one’s fears, so before beginning exposures, the therapist will collaborate with the client to make an exposure hierarchy.

This exposure hierarchy lists the client's most distressing fears to their least distressing. Then the ERP treatment can begin with the least distressing fears and progress up through the hierarchy. During exposures, the therapist will monitor how distressing it is for the client to understand when to taper back the exposure or move forward.