Exposure and Ritual Prevention treatment for OCD
The gold star, evidence-based treatment for OCD is Exposure and Ritual Prevention (ERP or Ex/RP). ExRP is a type of CBT therapy which was developed in the 1960s and has been extensively researched since, with excellent outcomes.
Obsessive compulsive disorder (OCD) causes significant anxiety/distress, affects both your thinking and behavior, tends to focus on and attempt to destroy the things that value most. OCD is characterized by the presence of either obsessions, compulsions, or both, and these obsessions and compulsions can become completely consuming without clinical intervention. The anxiety that is caused by OCD can become unmanageably distressing, and make you feel as though you are living in a state of life or death, which causes you to respond, react, and protect yourself to get rid of the distress and keep yourself safe. Unfortunately, these responses, reactions, urges, and compulsions are often misaligned with what you really want to do or what you really want to focus on in your life, and can leave you feeling stuck in a hopeless cycle of avoidance, and forced to engage in time-consuming behavioral or mental compulsions or rituals. Often, people with OCD feel very much out of control, and rituals or compulsions are an effort to help them feel more in control. Obsessions are typically intrusive thoughts that cause anxiety, while compulsions are activities or behaviors, often performed repetitively, to decrease anxiety.
Treatment principles are grounded in the following:
Confront the things you fear over and over again.
When the urge to avoid strikes, don’t. Avoid avoiding at all costs.
If you have the urge to perform a ritual, don’t. The anxiety may feel painful and you want relief, though performing the ritual will make it stronger over time.
During the course of treatment, your brain will learn that you can tolerate anxiety, even though it is extremely uncomfortable, and that your anxiety will always eventually decrease without rituals and compulsions. Your brain will further learn that the feared catastrophe often doesn’t happen, and in the rare event that it does, you would be able to find a way to handle it and manage it.
ExRP treatment includes the following:
Assessment and Psychoeducation: We’ll begin with completion of the YBOCs, in addition to a clinical diagnostic interview, which will help us identify all individual triggers, obsessions, and rituals to create a hierarchy and treatment plan, which will serve as an outline for gradually working up toward the most distressing core fears. We will provide a great deal of psychoeducation around OCD and ExRP so that you can eventually achieve the goal of becoming your very own OCD expert and ExRP therapist.
In Vivo Exposure: After identifying our exposure hierarchy and engaging in treatment planning, we will begin to expose you to real life triggers that create fear, anxiety or disgust. We will start with less distressing exposures and, as you gain confidence and build mastery that you can manage your anxiety effectively, we will move up the hierarchy.
Imaginal Exposure: This involves prolonged exposure in your imagination, with your therapist, to your worst fears without engaging in any rituals. We’ will work together to develop relevant scripts for you to write or record and review every day until you are no longer scared of the content of your thoughts and obsessions without using rituals.
Ritual Prevention: RP is the elimination of all physical and mental compulsions so you can learn you can cope with distress without doing rituals or avoidance. You will learn that even though your rituals may reduce anxiety distress immediately when performed, they reinforce anxiety after the immediate relief has passed.
Processing: We will engage in thorough and collaborative processing regarding completed exposure exercises and ritual prevention to help reinforce and cement the learning that these interventions have provided.