EXPOSURE AND RESPONSE PREVENTION THERAPY (EX/RP or ERP) for OCD

BROOKLYN HEIGHTS BEHAVIORAL ASSOCIATES: mindfulness

BHBA Treatment Options

  1. Intensive: Two treatment planning sessions, fifteen 90-minute sessions for 3 weeks

  2. Twice weekly: Two treatment planning sessions, fifteen 2-hour sessions, 2x a week, for 8 weeks

All sessions include the following:

        Exposure in imagination 45 minute

   Exposure in-vivo 45 minutes

        Homework assignments 15 minutes

What is Exposure and Response Prevention?

Exposure and Response Prevention (EX/RP or ERP) is a Cognitive Behavioral Treatment (CBT) that trains you to stop engaging in compulsions when you are anxious.  ERP trained therapists at BHBA received intensive training through Dr. Edna B. Foa’s anxiety clinic at the University of Pennsylvania and some have received intensive weekly consultation for several complex OCD cases from Dr. Marty Franklin, Director of the Child and Adolescent OCD, Tic, Trich, and Anxiety Group (COTTAGe) at University of Pennsylvania, through the International OCD Foundation (IOCDF).

EX/RP is designed to break the associations between distress and the objects, situations, or thoughts that produce this distress (obsession), as well as the association between carrying out compulsive behavior and decreasing the distress (compulsion).  Exposure involves purposely confronting objects or situations that prompt distress and anxiety, and to stay in those situations for a period of time that lasts until the symptoms decrease by themselves. Prolonged exposure without engaging in compulsions can promote habituation, safety learning, and put to rest the mistaken belief that something terrible will happen if you do not engage in compulsions.  Response prevention is practiced to break the habit of engaging in compulsions by facing your fears without resorting to compulsions, and thereby gradually becoming less anxious. Your therapist will teach you how to stop compulsions and you will learn more effective ways of coping and managing your discomfort that do not involve compulsions.

What is OCD?

OCD (Obsessive Compulsive Disorder) is a disorder characterized by the misinterpretation of intrusive thoughts as highly significant, activating the body's fight or flight response to threats.  When unwanted negative thoughts are perceived as threats, ineffective solutions such as obsessions and compulsions develop to protect us and reduce our discomfort and anxiety through avoidance or escape.  Obsessions are exaggerated thought responses to situations that pose little if any real threat, while compulsions are the excessive behaviors serving to reduce or neutralize stress. Although compulsions reduce fear in the short-term, they reinforce the misinterpretation of fears and situations therefore perpetuating thinking mistakes.

Symptoms of OCD

People with OCD spend a lot of energy avoiding situations that provoke a fear response, which includes obsessional thinking. OCD is unique to each individual.  For some, it can be as subtle as not touching a certain surface due to fears of contamination; and for others, obsessions are more overt like driving out of your way to avoid a landmark.  Obsessions and compulsions are not always obvious. At times they are covert, such as attempting to neutralize an obsessional thought by engaging in a mental ritual. Avoiding situations, people, and thoughts can severely restrict people from their normal functioning.  Compulsions are intentional behaviors meant to reduce the likelihood of harm, uncertainty, or distress. Because compulsions function as an avoidant behavior, they therefore maintain and strengthen the underlying obsessional fears. Compulsions often take the form of repeated washing, checking, arranging, repeating, etc.  Both avoidance and escape contribute to the continuance and strengthening of obsessional fears.


How to Treat OCD

Everyone has unwanted thoughts resembling obsessions, but habitual thought suppression is not a recommended solution, being one of the ways obsessions can develop.  So how do we treat OCD? Once you believe that obsessional situations and thoughts do not represent a high risk of harm, you will feel fewer urges to avoid situations or perform compulsions.  Cognitive-behavior therapy (CBT) is a treatment based on this idea and will help you to (a) correct faulty beliefs about your thoughts, (b) weaken the associations between certain thoughts and feelings of uncertainty, anxiety, and distress, and (c) reduce the urges to avoid or perform compulsions.