You may have heard about cognitive-behavioral therapy (CBT), which is a type of therapy that focuses on the relationship between thoughts, feelings, and behavior. CBT helps people change problematic behavior and cope better with difficult thoughts and emotions. Exposure and response prevention (ERP) is a type of CBT that has been shown to be the most effective treatment for Obsessive-Compulsive Disorder, along with medication. Research indicates that about 7 out of 10 people with OCD will benefit from ERP and/or a class of medications called serotonin reuptake inhibitors (or SRIs).
ERP involves “the systematic, repeated, and prolonged exposure to situations that provoke obsessional fear, along with abstinence from compulsive behaviors” (Abramowitz, 2006). In other words, you practice exposing yourself to the thoughts, images, situations, or things that you fear and you practice resisting the urge to engage in compulsive behavior once the anxiety or obsession shows up. This is usually challenging stuff. Most humans do not look forward to doing things that are likely to cause distress or anxiety. So, it is helpful to start EPR with the guidance and coaching of a warm, engaging, compassionate therapist who will support you and help problem-solve potential obstacles. Sometimes exposure work is done in combination with training in mindfulness skills and other coping strategies. Often, we spend time at the beginning talking about your values, how OCD is making life too small or difficult, and how practicing ERP can help you get back to doing the things most meaningful to you.
The aim of exposure work is not to force you to do anything you aren’t willing to do. Rather, the aim of doing this work is to help you live a better life. During ERP you purposely get in front of your fear so that you can start to see it more objectively and feel more in control. You will start practicing ERP exercises on your own, in-between sessions. The more you practice, the more likely you are to see a reduction in OCD symptoms. And there are many resources to help you along the way. The International OCD Foundation is a great organization for people who have OCD, their families, and the clinicians who treat them. The Mindfulness Workbook for OCD (Hershfield & Corboy, 2013) is a very user-friendly self-help CBT manual for OCD that is great to use in combination with therapy. You can find links to these and other helpful tools for OCD and anxiety on my Resources page.