Treatment for obsessive-compulsive disorder (OCD) varies from person to person, just like how OCD can present itself differently from person to person. However, the first line of treatment for OCD is Exposure and Response Prevention (ERP) therapy. ERP is a specific type of therapy that helps people regain control over their thoughts and behaviors, allowing them to move beyond their OCD. In this blog post, you’ll learn what ERP is, how it works to treat OCD, what a typical session may look like, and more. Understanding the best therapy treatment for OCD is massively helpful in knowing what support you need to find relief.
CBT, ACT, & ERP, oh my!
Before we dive into what ERP is, it is important to mention two of the most common types of behavior therapy: Cognitive Behavioral Therapy (CBT) and Acceptance and Commitment Therapy (ACT). Both forms of therapy have a similar goal, which involves addressing how our thoughts or feelings might alter our behaviors.
However, they sometimes use different language or prioritize different things in the therapy to lead a person to behavior change. Classic CBT often focuses on changing behaviors and cognitions to lower your specific symptoms. ACT explicitly focuses on changing behaviors to move you more toward your values regardless of whether symptoms are present or not. There are many therapists out there who are trained in CBT or ACT.
ERP is an even more specific type of behavioral therapy that is often delivered within the CBT or ACT frameworks. So, most ERP will come from a CBT or ACT therapist, but not all CBT or ACT therapists are trained to deliver ERP. When trying to find a therapist to help you with OCD, it is critical to ask about their experience delivering ERP. Some questions you might ask are:
- What is the main form of therapy you use to treat OCD? (If they don’t quickly discuss exposure therapy, that’s a red flag.)
- About how many of your sessions are spent doing exposure therapy on a daily basis?
- Do you ever do “out of office” exposures with your client? (For example, do you like driving with them or going outside where they may feel contaminated?)
- Are you affiliated with International OCD Foundation or have specific ERP training?
These questions are just some helpful ways to get the conversation going to ensure your therapist is well-equipped to assist you in your OCD treatment.
How ERP therapy works to treat OCD
ERP works by helping to train you to choose not to do compulsive behaviors after your obsessions have been triggered. When starting ERP therapy, you will first work on identifying your fears and the behaviors that they lead to. You will usually rank those triggers from the hardest to the easier ones, which is called making a “fear hierarchy”.
Your therapist should also spend some time going over the values that OCD is intruding upon. Over time, you will begin practicing making new behavior choices with guidance from your therapist, starting with the ones that are easiest to tackle first. This process allows you to slowly recalibrate your brain’s fear thermostat.
Historically, ERP was thought to work through the model of “habituation”. The habituation model basically theorizes that if you do something enough times, over and over again, that thing will get easier to do. As most patients with OCD will tell you, its not this simple. The human brain is too complex for simple habituation. Research is now focusing on “inhibitory learning theory“, which speaks to the importance of engaging in new and diverse experiences related to your fear. Learning from these experiences overwhelms, layers over, or drowns out the OCD fear over time.
Dr. Ryan Vidrine, our OCD Program Director, explains, “You’re building the evidence that while the thing you fear could happen theoretically, it isn’t likely enough that it should keep you from doing the things you really care about. Every single thing worth it in the world involves some sort of risk. To be risk free is to not live at all. And if the thing you feared did ever happen, you can build the tools to get through it.”
What ERP therapy looks like
ERP therapy may look slightly different based on your therapist’s practices. However, good ERP usually involves assigning some sort of practice or homework that you do between sessions. Your homework will typically involve practicing a version of what your worked on in your session. You will likely be asked to take reasonable risks, even in the face of your fears, in an increasing fashion until OCD doesn’t control you anymore.
For example, homework could look like touching the floor and not washing your hands for at least 30 minutes or crossing a bridge every day until your next session. Between your therapy sessions and homework, you put in the work to regain control of life, making choices based on values, not based on fear.
Results of ERP therapy
Because mental health is not a one-size-fits-all situation, we can’t give you a set timeline for when you would see results from ERP therapy. Your results depend on:
- How long you’ve been experiencing symptoms
- How severe your symptoms are
- Whether or not you are taking medication for OCD
- How willing you are to be treated
- How much your family accommodates your OCD
However, 60-70% of people experience an improvement of symptoms from ERP, and the results can often be improved when going through ERP with medications. Unfortunately, ERP and medications don’t work for everyone. If you find that they aren’t working for you, you can look into alternative treatments like deep Transcranial Magnetic Stimulation (dTMS). Deep TMS is a non-invasive, outpatient treatment that uses magnetic pulses to modulate the parts of the brain implicated in OCD. It can help people strengthen their ability to fight back against the OCD.
When it comes to OCD treatment, we can never expect or promise to get you to a place where you experience zero intrusive thoughts, obsessive thinking, disgust reactions, or moments of fear. That’s not practical. Frankly, that’s normal for a lot of people. You may always have a little more of that than the average person, but we can get you to do the next part, which is to resist the compulsion. And if you can resist the compulsion, you starve OCD of its oxygen, and you become less prone to big exacerbations throughout life.
ERP therapy is a great first step in helping you overcome your symptoms and regain control over your thoughts and behaviors. If you have or believe you have OCD, let us help you. Our expert team will work with you to help you find relief. Connect with us today to get the support you deserve.