How Exposure and Response Prevention Can Treat Obsessive Compulsive Disorder Symptoms
Every week, I talk with people struggling with Obsessive Compulsive Disorder (OCD) and those that love them. It’s heartbreaking to hear how lives get smaller as compulsions get bigger. Like a 24-year-old who spends hours washing a certain way out of fear of being contaminated with an illness, or a young child who believes that she can prevent bad things from happening to her parents if she touches things in a certain order around the house.
OCD is a disorder in which people have intrusive, unwanted and persistent thoughts (known as obsessions) that drive them to engage in repetitive behaviors and/or rituals (called compulsions) in order to ease or suppress their anxiety. According to the American Psychiatric Association, a diagnosis of OCD requires the presence of obsession and/or compulsions that are time-consuming (more than one hour a day), cause major distress, and impair work, social or other important function.
Professional treatment for OCD may not result in a cure, but it can help you control symptoms so that they don’t interfere with your daily life. The gold standard treatment for OCD is Exposure and Response Prevention (ERP) where you learn to gradually face your fears without engaging in rituals or behaviors to alleviate the anxiety. As one of the few providers in Northeast Ohio trained in ERP, I often get questions like:
“I’ve done Cognitive Behavior Therapy (CBT) and it didn’t get rid of my OCD. How is ERP different?”
Much like there are many different forms of yoga, ERP is a different form of CBT. ERP is primarily a behavioral intervention where you are gradually exposed to the feared situation (real or imagined) without performing any rituals to neutralize, decrease or get rid of the anxiety. The exposures, paired with different self-talk, are repeated until your brain learns the situation is not dangerous and stops firing off the alarm system. Typical CBT focuses more on cognitive interventions with some behavioral elements.
“I’ve tried ERP therapy and it didn’t work. Why?”
This is a tough one, and several could be at play. Were you using any safety behaviors during the exposures – like praying, repeating a mantra, saying a phrase or using a certain gesture – to help neutralize the anxiety? Or maybe you didn’t complete your exposure hierarchy, to name a few. It’s quite common for clients to do easier exposures, yet avoid the harder ones. According to Jonathan Abramowitz, PhD, an amazing clinician in OCD, you need to “live the CBT lifestyle” – lean into your anxiety, divert avoidance of any kind (mental or actual) and separate yourself from your thoughts.
“I’ve had my OCD for years. How can I avoid spending years in therapy?”
According to the International OCD Foundation website, it can take an individual with OCD “up to 17 years from the onset of symptoms to receive a proper diagnosis and begin receiving effective treatment.” But don’t be discouraged! Your comment highlights that OCD doesn’t “just go away” on its own. Start by contacting a trained ERP therapist – a typical course of ERP consists anywhere from 8-20 weekly sessions.
“I’m willing to try ERP, but can I keep my family out of it?”
Since OCD impacts more than just the individual, my policy is to include family members in a way that works for the client. It’s essential that everyone in a family understand what OCD is, how it works and how we’re treating it. Unless your family gets this level of support and education, you run the risk that they’ll unintentionally accommodate and even reinforce your illness.
“Can anyone who knows CBT treat OCD?”
Good question. Experts recommend OCD sufferers visit a therapist specifically trained in ERP through the Behavior Therapy Training Institute (BTTI) or other specialized group, like the Center for the Treatment and Study of Anxiety at the University of Pennsylvania (which is where I was trained). Ideally, you want to see a therapist who treats a high volume of OCD and is receiving ongoing consultation. So don’t be afraid to ask!
ERP takes effort and practice, but you’re likely to enjoy a better quality of life once you learn to manage your obsessions and compulsions. To learn more OCD and ERP, as well as other anxiety disorders and treatments, reach out to me at 216-600-8696 or online now. I can provide you with the knowledge, tools and skills for lifelong success. Let’s talk…
Joanna Hardis is a guest blogger for Northeast Ohio Parent, a monthly publication for parents in the Greater Cleveland/Akron region. Check out her Northeast Ohio Parent posts at northeastohioparent.com/author/joanna-hardis
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Photo by Ankush Minda on Unsplash