Exposure and Response Prevention
What is Exposure and Response Prevention (ERP)
Exposure and Response Prevention (ERP) is a crucial and powerful component of Cognitive Behaviour Therapy (CBT), and is the gold standard treatment for Obsessive-Compulsive Disorder (OCD).
Obsessive Compulsive Disorder (OCD)
OCD is experienced differently for everyone. It typically involves experiencing obsessions, compulsions or both. In simple terms, these are:
Obsessions:
- Intrusive or unwanted thoughts, urges or impulses.
- They can be anxiety provoking or distressing.
- They are attempted to be ignored, suppressed or neutralised.
Compulsions:
- Repetitive behaviours or mental acts (eg repeated thoughts).
- Can be driven in response to obsessions or rules.
- Are aimed to reduce distress, but are either excessive or not really effective at neutralising distress in the big picture.
To overcome the impact of obsessions and/or compulsions, ERP is usually recommended.
Exposure and Response Prevention
Exposure and Response Prevention (ERP) has two key components.
1. Exposure to whatever it is that makes you anxious, or provokes your obsessions.
2. Preventing the response, or compulsion, that you feel driven to engage in, in response to the exposure.
For example, in someone with obsessions and fears about contamination, they may avoid touching doorknobs in public places, or they may compulsively wash their hands. ERP may involve touching a doorknob for exposure, and preventing the compulsive response (handwashing). It will also usually involve exposure to thoughts and fears that are triggered (for example, worries about what consequences might arise after being exposed germs without handwashing).
Purpose of ERP
Some of the purposes of ERP are to learn:
- Are the consequences as likely to happen as you thought? (eg does something bad happen when you touch the door handle and don’t wash your hands?)
- Does the anxiety/distress pass without engaging in the compulsions?
- Are you able to cope with the anxiety when you don’t try to avoid it?
- How to tolerate anxiety and uncertainty in other areas of your life.
What to Expect
Because OCD is different for everyone, what ERP looks like from person to person is different. Your clinician will work with you to identify what the obsessions/compulsions/triggers are that are keeping you stuck in your cycle of OCD.
At Crest Clinical Psychology, a gradual exposure approach is typically taken. This means starting ERP with exposure to something that feels a bit uncomfortable or anxiety provoking, but not impossibly so. You are in control and choose where to start. You will also typically make a hierarchy with your clinician, so you can gradually work your up to more anxiety provoking options as you become more experienced. Your clinician will support you, but you choose the pace.
You will usually start ERP with your clinician present (either in person or via telehealth), and work towards completing ERP on your own. You will be encouraged to repeat exposure to the items on your hierarchy, until the anxiety has significantly reduced.
Why would I make myself anxious?
ERP can seem a little counterintuitive, because it means making yourself anxious or uncomfortable on purpose. This is because in OCD, your fight/flight system can be triggered in response to something that isn’t really a threat. Kind of like a car alarm that goes off at the slightest touch. Your internal alarm system is telling you there’s a threat, even though you’re safe. ERP is kind of like recalibrating your alarm system.
In ERP, we need to actually face the trigger and turn on the alarm, so that you can figure out if the level of anxiety matches up to the genuine level of threat, and if your response is helping to neutralise the threat. The more that you face these alarm triggers, the more familiar and confident you can become with them, so the less they are perceived as a threat. This can help to dial down the intensity, frequency, and duration of the “alarm”/anxiety. It can also help to dial down the urge to engage in compulsions, because you’re learning to tolerate your discomfort without them, and may even learn that they’re not helping you in the way you expected. Without this experience, most people find it almost impossible to overcome obsessions or compulsions.
People may tell you hundreds of times that your obsessions or compulsions don’t make sense, and you might even believe it for yourself. You’re still likely to find no matter how illogical they seem, your alarm system takes over and the obsessions/compulsions continue. In fact, many people find that trying to think or “logic” their way out of OCD just leads to feeling trapped in cycles of obsessive thinking. This is why facing the fear in ERP, and learning through experience can be so useful in treating OCD.
Is ERP right for me?
If you’d like to learn more about OCD, and whether or not exposure and response prevention might be right for you, please get in touch with Tara Trewartha at admin@crestcp.com.au. More information on Crest Clinical Psychology can be found here.
To read more about the information above, check out the International OCD Foundation.
