Introduction

Exposure and Response Prevention (ERP) is a variant of Cognitive Behaviour Therapy (CBT) meant for people experiencing OCD symptoms. ERP helps them to modify  their response to obsessive thoughts, so that they no longer engage in compulsions and rituals. In ERP, clients are gradually exposed to stimuli which cause those thoughts, until their level of distress comes within normal range. 

Conditions Where ERP is useful

ERP is usually used with clients experiencing obsessive-compulsive disorder (OCD), where certain situations or events leads to an unwanted emotion, thoughts or feelings and the usual coping mechanism of the individual is an undesirable compulsion or ritual. A person with OCD may feel that he has got contaminated by touching another person’s hand. Another person’s OCD could be of having thoughts of hurting or killing others and he/she would experience anxiety in social conditions or when left alone with someone. OCD causes unwarranted anxiety and leads to compulsive rituals like washing hands every now and then or ruminating about troublesome thoughts. The rituals may temporarily remove anxiety but in the long run strengthen the cycle of obsession and compulsion, which prolongs the distress and reduces the quality of life. ERP helps to break this cycle. 

What Happens in Therapy

ERP could last well over 12 sessions. Initially the client, under guidance of the psychologist, is systematically exposed to objects, thoughts, situations, images that could trigger his/her obsessions. The client is trained to modify their response to the trigger by not responding through the usual compulsive behaviours. Gradually the level of exposure to uncomfortable stimuli is increased, until the clients innate ability to tolerate the distress increases without resorting to rituals and other compulsive behaviours. The sessions are held at the psychologist’s practice. After sufficient practice, the psychologist may ask the client to carry out on their own exposure and response prevention activities in real world situations and give feedback about their behaviour and level of distress in the next session. 

The Science Behind ERP

ERP uses the habituation method to reduce the anxiety that leads to obsessions and compulsions. Habituation is the process in which the individual over time becomes less physiologically aroused by repeated exposure to similar stimuli. The OCD clients are habituated to uncomfortable stimuli in a safe setting during therapy. Over time, through this process, clients learn that stimuli, thoughts and feelings that previously lead them to compulsions can be tolerated and do not result in the outcomes they were afraid of. This assurance helps them to cope with uncomfortable triggers without getting into unwarranted compulsive rituals.

Use of ERP in Our Practice

At our practice, we initially psycho-educate clients about their condition and then use Exposure and Response Prevention, CBT, Relaxation Training, and Mindfulness-based Cognitive Therapy (MBCT) to treat patients with OCD. Both ERP and MBCT are APS approved evidence-based therapies for treatment of obsessive-compulsive disorders. 

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