Exposure and Response Prevention (ERP)

ERP is a form of behavioral therapy. It is an evidence-based practice that has been proven in research studies to be the most effective therapy in the treatment of Obsessive-Compulsive Disorder (OCD). You cannot always control your incoming thoughts and feelings, but you can control how you behaviorally respond to them. Since thoughts, feelings and behaviors are interrelated, if you change your behavior then your thoughts and feelings will follow. For example, imagine a man who is depressed and has been laying on his couch for days. He says to himself, “I will get off my couch and do something when I feel better.” If this person decides to change his behavior by getting off the couch and taking a walk, he will probably notice that his mood will lift as a result.

ERP for OCD is a ‘facing your fears’ approach. If we are exposed to anything with enough frequency, we eventually habituate to it. Habituate means ‘to acclimate to’ or ‘get used to’ something. In OCD, a person may have an obsession that he will become contaminated by touching a door knob. Another may fear that having a thought about stabbing someone may mean she will actually do it. In ERP therapy, we create exposure assignments that encourage repeated access to feared objects or thoughts, which results in a eventual decrease in anxiety, guilt and distress.

When an individual has an unwanted thought, feeling or physical sensation, he or she will often respond by engaging in compulsions or rituals to neutralize the potential of that fear occurring. When doing exposures in ERP therapy, we must also be sure to reduce your neutralizing rituals. Rituals prevent habituation from occurring. In other words, when you perform a compulsion you reinforce the idea that the fear is legitimate and that you cannot tolerate it which makes your OCD more powerful. Pairing exposure with response prevention is pivotal in teaching your brain how to respond differently when your obsessions show up. Your thoughts do not have the power to hurt you beyond just being very uncomfortable.

Cognitive Therapy

We all have distorted thinking from time to time. Cognitive Therapy focuses on changing what you say to yourself internally, so that you can change how you feel and behave. Individuals with Obsessive-Compulsive Disorder (OCD) commonly fall into cognitive traps which leads to increased anxiety, guilt and distress. We will teach you how to notice when you fall into problematic thinking patterns in regards to your OCD. Common cognitive distortions in OCD are ‘catastrophizing,’ ‘all or nothing thinking,’ ‘thought-action fusion,’ and ‘confirmation bias,’ among others.

Core beliefs are developed through life experiences and / or by membership in particular groups. People often share the same core beliefs as others in their family of origin. You share the same core beliefs as other individuals with OCD. An example of a core belief held by people with OCD is “All my thoughts are really important,” or “The world is a dangerous place.” An individual’s core beliefs are what guide his real-time interpretations of himself, others and the world around him.

When you learn to identify your automatic interpretations of your current situations, then you are then able to challenge your distorted thoughts and engage in reality-testing. Maybe your spontaneous interpretation was distorted and causes more unwarranted fear. We will teach you a technique called Cognitive Restructuring that will help you to identify and challenge your distorted OCD thinking patterns and create openness to more rational, evidence-based thinking. This can help to decrease anxiety and encourage exposure behaviors that ultimately reduce OCD symptoms.

Mindfulness

Commonly called the 3rd wave of Cognitive-Behavioral Therapy (CBT), treatment approaches that are based in eastern philosophy have been permeating the field of psychology in recent years. This is no more true than in the Obsessive-Compulsive Disorder (OCD) treatment community. A great number of the presentations at the International OCD Foundation (IOCDF) annual convention discussed Acceptance and Commitment Therapy (ACT), a mindfulness-based approach used in the treatment of a wide variety of disorders. We strongly believe in using approaches based on eastern philosophy in the treatment of OCD.

Mindfulness is the act of paying attention to the present moment (and whatever is offered in that moment) in a non-judgmental way. For someone with OCD, the moment may bring an unwanted thought or a painful feeling, or a physical sensation that causes doubt about one’s health status or sexual orientation. Mindfulness allows you to decide how to respond to unwanted internal experiences (thoughts, feelings, images, bodily sensations). It is normal to respond to uncomfortable OCD symptoms with resistance, since we are programmed biologically to avoid painful stimuli. But if you have ever heard the saying, “What you resist, persists,” you know that resistance to that which we cannot control only strengthens it.

Mindfulness helps you to change your relationship with your incoming thoughts, feelings and bodily sensations. We often hear from clients that it is liberating that they do not actually have to stop their thoughts from happening, something at which they have been failing miserably for years. These were new ideas. Maybe it is okay to have that thought or feeling. Le’ts see what happens when you allow your mind to run it’s natural course without intervening and trying to control it. People with OCD often find that when they do not resist their internal private experiences or view them as problems to be solved, the frequency and intensity of their thoughts and feelings can be reduced.

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