Exposure and Response Prevention (ERP)
Cognitive behavior therapists use an approach called Exposure with Response Prevention, or “ERP”, to treat Obsessive Compulsive Disorder (OCD). Studies of ERP show that over 70% of OCD patients who complete treatment are significantly helped. The effectiveness of ERP is so well documented that the National Institute of Mental Health (NIMH) recommends exposure as the psychotherapy of choice for Obsessive Compulsive Disorder. The television series “Obsessed” (A&E) and the Oprah Winfrey Show’s episode titled “Dr. Oz Goes to Obsessive Compulsive Disorder Camp” reveal striking demonstration of cognitive-behavior therapy in action. Viewing these shows may be useful for the prospective CBT patient.
Obsessive Compulsive Disorder A Scientific View
Cognitive Behavioral research suggests that intense, repetitive thoughts of danger or impropriety trigger, and are in turn reinforced by painful feelings such as fear, anxiety, guilt, disgust. Obsessive compulsive rituals in the form of “protective”, “neutralizing” thoughts and actions are used to “ward off” anticipated negative consequences and associated emotional pain. In the short run, these rituals may appear effective, as they can briefly reduce emotional distress, sometimes even producing feelings of satisfaction. Yet, the long term consequences of untreated OCD are starkly negative. Obsessive compulsive patterns typically evolve into fiercely guarded systems of ritual and belief. Completing a sequence of rituals can be intensely stressful, robbing the person of personal time and energy that could be directed toward other pursuits. Some obsessive-compulsive rituals themselves can cause bodily harm and/or place one at risk for accidents. Simple, everyday situations that trigger obsessive compulsive patterns come to be endured only under great duress, and eventually may be avoided altogether. As a result, over time key areas of life such as relationships, job performance and self care can suffer. As one’s range of activities and associated rewards become increasingly constricted, low self esteem and depression may result.
How Treatment Works
In cognitive behavior therapy, the patient develops emotional strength and confidence by willingly participating in situations that trigger obsessive-compulsive thoughts, feelings and urges. The key to successful treatment is the person’s commitment to participate in anxious situations without reliance on protective rituals. In this way, the patient learns that emotional distress and obsessive thoughts and urges can be controlled without the use of compulsive rituals. Through persistent hard work and effort, obsessive-compulsive patterns eventually disappear or fade to more manageable levels, and healthy strategies for managing challenging thoughts, feelings and circumstances are developed in their place.