Obsessive Compulsive Disorder (OCD)
OCD is a treatable disorder that affects about 2% of Australians. As the name implies, people experiencing OCD struggle with two key symptoms: obsessions and compulsions. An obsession is a recurring and unwanted intrusive thought that is experienced as highly distressing. A compulsion is a repetitive behaviour that a person feels driven to perform in order to reduce distress and/or prevent a feared outcome related to an obsession. The obsessions and compulsions in OCD can take up a significant amount of time in a person’s day and impact on their daily functioning.
ERP for OCD
Fortunately, there are evidence-based treatments for managing OCD, including Exposure and Response Prevention (ERP). ERP has been shown to be the most efficacious psychological treatment for OCD and falls under the umbrella of Cognitive Behavioural Therapy.
As the title of the intervention suggests, ERP comprises of two main components: exposure and response prevention. Exposure involves helping a person experiencing OCD to confront situations that trigger obsessional fears, but that are objectively safe or present a low risk of harm. Response prevention involves refraining from engaging in compulsive rituals that are performed in OCD to try and reduce obsessional anxiety and distress. In short, in ERP a person with OCD voluntarily exposes themselves to situations (real-world or imagined) that provoke obsessional fears without performing compulsive rituals to reduce discomfort.
It is important that ERP is practiced in a graded way. That is, not jumping straight into the deep end to confront the most feared situation! A person experiencing OCD and their therapist will work together to create an ‘exposure hierarchy’ of feared situations (i.e., exposure tasks) that can be used to build up to the most feared situation. Another essential component of ERP is that it is practiced over and over again. It is understood that through graded and repeated ERP practice a person learns that: (1) obsessions and anxiety are manageable; (2) obsessions and anxiety usually naturally reduce over time without engaging in compulsive rituals; and (3) situations that provoke obsessional anxiety and distress are not as dangerous as predicted.
Example of ERP for OCD
Let’s look an example of how ERP might work for a person struggling with obsessional fears that he would accidently hit a pedestrian while driving his car without knowing. After working with his therapist to identify exactly how this obsessional fear and associated compulsive behaviours impacted him day-to-day, it might be decided that an appropriate first exposure task is for him to practice driving through quiet streets to trigger doubts about hitting someone. He might then build up to driving through busy streets. The response prevention for these exposure tasks would involve him resisting usual compulsive behaviours, such as watching the news to check if there had been any accidents, driving slowly and repeatedly around the area to check for any injured pedestrians, and calling local police for reassurance there had not been any accidents in the area.
Final Thoughts on ERP
It is not uncommon for people experiencing OCD to report a mix of motivation and anxiety about engaging in ERP. This is understandable. Confronting OCD is challenging, rewarding, and takes personal courage. It can be helpful to remember that ERP takes a collaborative treatment approach to OCD. You and your therapist will work together to identify the types of exposure situations that are appropriate, and generally exposure sessions are typically supervised by your therapist with self-exposure practise set-up as homework between sessions.
Like what you’ve read? Get in touch for further support for OCD with ERP via our trained team of Psychologists here at Melbourne Wellbeing Group.
~ Article written by Ms Stephanie Fung - Psychologist here at Melbourne Wellbeing Group.
Sources
Olatunji, B. O., Davis, M. L., Powers, M. B., & Smits, J. A. (2013). Cognitive-behavioral therapy for obsessive-compulsive disorder: A meta-analysis of treatment outcome and moderators. Journal of psychiatric research, 47(1), 33-41.
Twohig, M. P., Abramowitz, J. S., Smith, B. M., Fabricant, L. E., Jacoby, R. J., Morrison, K. L., ... & Lederman, T. (2018). Adding acceptance and commitment therapy to exposure and response prevention for obsessive-compulsive disorder: A randomized controlled trial. Behaviour Research and Therapy.
S Abramowitz, J., & J Jacoby, R. (2014). The use and misuse of exposure therapy for obsessive-compulsive and related disorders. Current Psychiatry Reviews, 10(4), 277-283.
Jacoby, R. J., & Abramowitz, J. S. (2016). Inhibitory learning approaches to exposure therapy: A critical review and translation to obsessive-compulsive disorder. Clinical psychology review, 49, 28-40.