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Exposure response prevention - how is it used to treat OCD?

Obsessive compulsive disorder (OCD) is a serious psychiatric condition that usually causes people to experience two different types of symptoms: ‘obsessions’ and ‘compulsions’.

There are a number of different methods that can be used to treat OCD, including cognitive behavioural therapy (CBT), mindfulness, certain types of medication, and a technique known as exposure response prevention (ERP), which is discussed in more detail below.

What are OCD obsessions and compulsions?

Obsessions are characterised by persistent thoughts, images or urges that are intrusive and unwanted by the individual, and typically cause them distress and anxiety. Compulsions refer to physical or mental rituals that sufferers of OCD feel compelled to perform.

These symptoms can be extremely time-consuming and can seem impossible to stop or control. They can also have a hugely detrimental impact on a person’s ability to function in their day-to-day life.

Examples of OCD obsessions include:

  • Experiencing recurring, morally upsetting thoughts
  • Having an overwhelming fear of contamination and germs
  • Worrying that you forgot to lock a door or turn off an appliance
  • Constantly questioning your sexuality or having intrusive sexual thoughts
  • Repetitive thoughts that you may harm another person

Examples of OCD compulsions include:

  • Repeating ritualistic actions a set number of times or for a certain amount of time e.g. turning a light switch on and off
  • Continually counting or repeating certain words over and over again
  • Excessively checking that doors are locked and appliances are switched off
  • Only touching certain objects with a tissue or avoiding objects that may be contaminated
  • Bathing multiple times a day or washing your hands over and over again, regardless of whether you need to
  • Rearranging objects so they are symmetrical, aligned or ‘just so’

These symptoms can be very distressing for sufferers, and can make them feel confused and anxious. However, it’s important to understand that OCD is treatable, and with effective therapy it’s possible for individuals to regain control over their obsessions and compulsions, and resume the fulfilling and meaningful life that they deserve.

What is ERP and how is it used to treat OCD?

ERP is a therapeutic technique that encourages you to gradually face your fears until you learn to tolerate and overcome the anxiety that they cause. As an example, if you had an obsession about germs and cleanliness, ERP in this context would focus on helping you to overcome your fear of germs by encouraging you to gradually come into contact with things that you perceive to be contaminated.

You would start with things that cause you ‘manageable’ levels of anxiety, such as sitting next to a ‘contaminated’ object, and gradually work up to more difficult steps such as you touching the object without a tissue or wearing a glove.

The process of ERP teaches you to simply let your obsessive thoughts and anxiety wash over you, instead of becoming distressed and needing to ‘put them right’ or ‘neutralise’ them with a compulsion.

ERP is a fairly common therapeutic approach for OCD and is used all over the world in the treatment of this complex condition, with proven benefits.

How does ERP differ from CBT?

ERP is one of the behavioural techniques used in CBT, whereby individuals are encouraged to face their fears in carefully controlled steps.

However, the difference between ERP and CBT as standalone techniques is the fact that CBT also uses cognitive therapy as well as the behavioural elements. Rather than just letting the anxiety wash over you in gradual steps (as in ERP), CBT also helps you to test out the negative beliefs that underpin your anxiety, obsessions and compulsions.

The main form of treatment that we use for OCD at Priory is a combination of CBT and specialist medication. However, ERP forms a key component of our CBT programme for OCD, and has shown to be highly effective in helping people to address their obsessions and compulsions and regain control over their negative thoughts and behaviours.

Seek help for your OCD

It can be extremely difficult to cope with OCD, and the symptoms of this condition can become worse over time. That’s why it’s so important to seek timely help. Our expert team of psychiatrists, psychologists and therapists have a wealth of experience in treating OCD and are dedicated to helping you every step of the way towards addressing your obsessions and compulsions, and achieving wellbeing.

Blog reviewed by Dr Renju Joseph (MBBS, MD, LLM, MRCPsych), Consultant Psychiatrist at Priory Hospital Woodbourne

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