Obsessive-Compulsive Disorder (OCD) can be a very challenging, confusing, and frightening condition. It is characterised by recurring, intrusive and distressing thoughts (obsessions), a maladaptive reliance on repetitive behaviours (compulsions), or both. In short, OCD can have a significantly damaging impact on your quality of life.
The good news is that help is available via the most scientifically-supported and effective OCD treatment. Exposure and Response Prevention (ERP) is a specific strategy within the Cognitive Behavioural Therapy (CBT) framework, and it’s used to help you face your fears in a controlled manner, reducing the frequency and intensity of intrusive thoughts and thus the need to rely upon time-consuming, frustrating compulsive behaviours.
What is Exposure and Response Prevention, and Why is it Important?
The theory behind the use of ERP in therapy for Obsessive-Compulsive Disorder is simple but powerful: expose yourself to the things that make you anxious (without any real danger, of course) and then resist the urge to perform the compulsions that usually follow.
“Hang on”, I hear you say. “Are you pretty much just telling me to stop it? THAT’S your therapy?!”
Well, no, not quite. There’ll be some work leading up to ERP. If it was as easy as “stopping it”, you’d have done it by now. We’ve offered enough therapy for Obsessive-Compulsive Disorder to know that absolutely no one wants OCD and that the efforts people go to to get rid of it are the very things that usually perpetuate it.
So before ERP commences, you’ll be educated on how OCD self-perpetuates, be helped to challenge some beliefs about how helpful your compulsions might be, be taught to gather evidence that intrusions can come and go with minimal attention, and more. Your Clinical Psychologist’s job is to help you become an expert on your OCD so you can become a co-pilot — not a passenger — in your therapy for Obsessive-Compulsive Disorder.
Here’s the education in brief. Firstly, we ALL have intrusive thoughts. Every last one of us. It’s just that some of us don’t really notice them, or we can shift our attention away from them almost automatically. Not so with those who have OCD! The intrusive thoughts are seen as threats. Accordingly, the person with OCD tries to get rid of or escape the threat. But whatever they do to get relief only reinforces that the thought must indeed be dangerous! Otherwise, why escape!? So now the person becomes super-vigilant for the thoughts and anything associated with them. And sure enough, they find them again. So they need to escape or get rid of them again. And thus, a compulsion is born, and the fear of the intrusive thought is reinforced.
So, therapy for Obsessive-Compulsive Disorder needs to involve a process that breaks this cycle of reinforcement. For example, if you have an intense fear of germs, ERP therapy might involve touching a doorknob and resisting the urge to immediately wash your hands. Over time, as you get more used to sitting with discomfort and refraining from washing, an absence of lasting negative consequences should reduce anxiety and reduce the need for compulsive behaviours. More freedom, less fear!
Research quite clearly shows that ERP is the gold-standard OCD treatment. It not only reduces symptoms, but with good adherence to exposure therapy protocols, it also provides longer-term benefits. The process can be challenging, but with commitment and professional support, lasting strategies can be developed to help manage anxiety and prevent relapse.
What’s the ERP Process?
ERP therapy isn’t about tossing you into the deep end; it’s a gradual, structured process ideally guided by a Clinical Psychologist with strong experience in providing therapy for Obsessive-Compulsive Disorder. Here's how it works:
Building a fear hierarchy: The first step in ERP is usually creating a “fear ladder” or hierarchy. This is a list of situations that cause anxiety, ranked from “I can probably handle this” to “Oh no, no way.” It's your personalised roadmap in OCD treatment.
Exposure: The next step is exposure, usually starting with those situations lower on the fear ladder. The idea is to face these fears without giving in to the compulsion. So, if the doorknob is the challenge, you’d handle that doorknob without washing your hands. (Yes, it might sound difficult, but stick with us!)
Response prevention: This is where the magic happens. While facing these fears, you resist the urge to perform any rituals or compulsions. Just hold tight. Over time, you (and that part of your brain that doesn’t like to listen to reason) learn that your anxiety reduces on its own without having to give in to the compulsion. This is the real muscle-building part of the workout, where you’ll likely start seeing progress in your OCD treatment.
Gradual progress: As you become more comfortable facing the lower-level fears, you move up the ladder to tackle the more challenging ones. It’s all about building confidence, one step at a time*, and reclaiming control from OCD.
*It doesn’t really have to be one step at a time. This is where you come in as a co-therapist for your OCD; if you’re ready, you’ll very likely be encouraged to skip a step or 3. This is important: treatment for OCD isn’t one-size-fits-all. A plan is made for your specific symptoms and circumstances.
Why ERP Therapy Works
Research has shown that ERP therapy doesn’t just reduce symptoms; it also has lasting benefits, especially when you stick to the treatment plan. It can be tough — though it’s not often nearly as tough as anticipated — but with the right support and commitment, many people find they can reduce their symptoms, manage their anxiety, and develop long-term strategies to prevent relapse.
Ready to tackle OCD? Boyce & Dale Anxiety and Mood Disorders Clinic is here to help
The clinical team at Boyce & Dale Anxiety and Mood Disorders Clinic is ready to help. They have a specific interest and plenty of experience in providing OCD treatment. Whether your obsession keeps you preoccupied with contamination, unwanted thoughts about harm or sex, responsibility, relationships, morals, existential matters, or anything else your brain has decided to throw at you, we promise we’ve likely heard it before! We can help with an evidence-based, effective treatment plan to help you manage your OCD and take back control of your life.
If OCD is making your day-to-day feel like an uphill battle, reach out to us to discuss therapy for OCD in Penrith (or via telehealth video). Contact us today to schedule a consultation or book online.
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