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.