Exposure therapy aims to desensitize individuals to their fears and help them learn that the feared consequences they anticipate are unlikely to occur.
Exposure and response prevention (ERP) is a cornerstone of cognitive-behavioral therapy (CBT) and is widely recognized as one of the most effective treatments for Obsessive Compulsive Disorder (OCD). Research consistently shows that Exposure Therapy effectively reduces OCD symptoms and enhances overall functioning. Approximately 50 to 60% of individuals who undergo ERP treatment experience improvement in their OCD symptoms.
In exposure and response prevention, an individual gradually exposes themself to thoughts, images, situations and feelings that may cause discomfort. While engaging in the exposure, the individual refrains from completing any compulsions. This allows the individual to confront their fears and recognize that the feared consequence actually does not happen, even when they do not complete any compulsions. The recognition that the fear is a false alarm and not accurate lowers the overall distress one feels when confronted with the triggering event.
While it may sound daunting and counterintuitive, confronting the OCD fears in a slow and systematic way will reduce anxiety. The goal of exposure and response prevention is to lessen the control of OCD and return the control back to the client so that they can no longer live life in fear, discomfort, and avoidance.
What is Habituation?
To understand exposure and response intervention, one also must understand what habituation is. Habituation is a natural and automatic process where the body returns to equilibrium. How does this occur? The sympathetic nervous system has the role of preparing the body for threat and the parasympatheric nervous system takes the task of calming the body down and resting.
When there is a danger trigger, the sympathetic nervous system releases chemicals to prepare the body for the danger. For someone with OCD, the danger trigger is a false alarm but the body still prepares for danger-causing anxiety and discomfort.
However, if the person confronts their OCD fear, the parasympathetic nervous system takes over and calms the body back to its equilibrium. If one does a compulsion during this time, the threat trigger continues to be activated and continues the anxiety rather than stopping it. During exposures, the habituation process happens naturally within 10-20 minutes. Anxiety will not last forever but habituation cannot take place without exposure and response prevention.
What Does Exposure and Response Prevention Look Like in Session?
To start, the therapist will provide the client with education on OCD, the cycle of OCD, exposure and response prevention, and habituation. It is important that the client has all this information before beginning so they are aware of what can continue the OCD cycle and what to expect.
Next, the therapist and client will work together to identify all OCD triggers and rank them from most triggering to least triggering. This process is called creating a fear hierarchy. The goal of this is to find exposures that are less triggering and more manageable. Once the hierarchy has been created, the therapist and client will collaborate to create a specific situation that will expose the client to face a specific fear. These exposures can be imaginal exposures (writing a thought, word, or story that causes discomfort) or real life exposures (touching an item OCD thinks is dirty). The type of exposure is unique to each individual and is agreed upon by the client.
Once deciding on an initial exposure, the client will complete the exposure during the session and resist completing any compulsions. When the exposure is complete, the client will work with clinician to label their OCD and challenge any thoughts that might come up. The goal is to sit with the uncomfortable feeling rather than running from it to learn that the feared consequence does not happen and their anxiety eventually goes away.
As sessions continue, the client will slowly work their way up their fear hierarchy completing exposures in session and on their own time in order to decrease the overall amount of anxiety and lessen the power OCD has. The goal is to work gradually so that exposures feel challenging but achievable and the nervous system is not too overwhelmed.
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Interested in Exposure Therapy for OCD?
If you would like to get started with Exposure and Response Prevention for the treatment of OCD, we’re here to help. Please take the first step by filling out the form below or contacting us directly at 412-856-WELL.
Our experienced team is dedicated to providing personalized and evidence-based care to support you on your journey to recovery from OCD.