Exposure Response Prevention (ERP)
Dr. Martinez and her staff at SOAR use evidence-based treatment to treat OCD. The gold standard of evidence-based treatment for OCD is a very specific type of cognitive behavioral therapy (CBT) called Exposure and Response Prevention (ERP). ERP involves patients actively choosing to experience triggers associated with discomfort and uncertainty in order to create a different relationship with these triggers and feelings. Patients come to better understand the function of their compulsive thoughts and behaviors and learn new, non-compulsive ways of responding to unwanted or intrusive thoughts.
With repeated practice and complete abstinence from compulsions, this new learning becomes the patient’s default response to anxiety-provoking stimuli and the patient learns to no longer react with extreme anxiety/disgust/discomfort to the obsession.
It is important for patients to recognize that OCD is a disorder that feeds on fear and anxiety. For most people, OCD has been present for many years. Most patients have sought treatment for OCD years before they learn that there is a specific, evidence-based treatment for it. This means that most people with OCD have had years of practice performing compulsions and unhelpful strategies to reduce the distress they are experiencing from OCD. It can be very difficult to reverse behaviors that have become habitual over a period of years or even decades. When a person first starts to practice ERP instead of compulsions, the distress they experience may get worse before it gets better. It might get worse before it gets better…but 70-80% of people respond to treatment . This means that this type of treatment is very effective!
Patients can also choose to coordinate their therapist’s care with a primary care physician or psychiatrist to provide OCD medication in addition to ERP. According to the International OCD Foundation (IOCDF), approximately 70% of OCD sufferers who engage in ERP and/or medication will benefit . A study comparing ERP in association with clomipramine or placebo found that ERP plus clomipramine led to a reduction in the Y-BOCS score of 58%. This was significantly less than either placebo (11%), clomipramine alone (31%), or ERP alone (55%) . Although medication may not be necessary for all patients with OCD, combination therapy (i.e., cognitive behavioral therapy plus medication management) is considered the frontline treatment for severe OCD.
Aside from therapy, family and friends also play key roles in the patients’ road to recovery. Loved ones want to support the patient by reducing the sufferer’s anxiety. Though these actions are often well-intentioned, loved ones will often “support” the patient by enabling and sometimes even participating in compulsions. In the research literature, these behaviors are known as “family accommodation” or, simply, “accommodation” and they are associated with poorer patient outcomes. Although accommodation strategies temporarily reduce anxiety, they only do more damage in the long run. Loved ones should be able to support the patient but also recognize when that support is enabling and feeding OCD. Once patients’ loved ones realize their efforts to help may be actually harming the patient, it is important that they do not immediately and unilaterally discontinue all accommodation. It is more helpful to work with a professional and with the patient him/herself to create a collaborative plan to gradually withdraw family accommodation. A licensed professional who has an established relationship with the OCD sufferer is the best person to help you with this transition.
With time, responsibility, effort, and dedication it is possible to improve. Seeking help is already a step in the right direction so you should congratulate and be proud of yourself for coming this far and reading this through.
 Marazziti, D., Picchetti, M., Baroni, S., Ceresoli, D., Consoli, G., & Dell’Osso, M. C. (2012). Current pharmacological and non pharmacological treatments for obsessive-compulsive disorder. Journal of Psychopathology, 18(1), 5–18.
 How is OCD Treated? (n.d.). International OCD Foundation. Retrieved January 18, 2021, from https://iocdf.org/about-ocd/ocd-treatment/#:~:text=Overview,from%20either%20medication%20or%20ERP.
If you’re interested in learning more about Exposure Response and Prevention Therapy please refer to the resources below…
International OCD Foundation:
- Exposure and Response Prevention (ERP): https://iocdf.org/about-ocd/ocd-treatment/erp/
Rogers Behavioral Health:
- Exposure and response prevention (ERP): how does it work?: https://rogersbh.org/resources/exposure-and-response-prevention-erp-how-does-it-work
- Treating OCD using Exposure and Response Prevention (ERP): https://www.youtube.com/watch?v=lxEHOh9c3D8&feature=emb_rel_end
The OCD Stories Podcasts on ERP:
- Exposure and Response Prevention: https://theocdstories.com/episode/dr-steven-phillipson-exposure-and-response-prevention-ep200/
- How ERP Works, and The Power of Choice: https://theocdstories.com/episode/dr-steven-phillipson-how-erp-works-and-the-power-of-choice-ep106/
- Your ERP Questions Answered – Part 1 with Shala Nicely: https://theocdstories.com/episode/your-erp-questions-answered-part-1-with-shala-nicely-ep68/
- Daring to Challenge OCD Book recommended within podcast
- Your ERP Questions Answered – Part 2 with Dr. Joan Davidson: https://theocdstories.com/episode/your-erp-questions-answered-part-2-with-dr-joan-davidson-ep160/