Struggling with OCD? ERP can help.

Exposure and Response Prevention “retrains your brain” to put false threats back in perspective.

Imagine this scenario—you park your car and start walking toward your office building. Halfway there, you wonder, did I lock my car? You know you locked it—you always do—but you just can’t shake the thought that your car is unlocked and terrible things might happen if you don’t go back and check.

These thoughts pop into your head multiple times a day and you find yourself checking and rechecking things to tamp down your anxiety. Part of you knows these thoughts are irrational. But that doesn’t stop them from insisting loudly and often that your car is unlocked and you’re in danger.

Illustration by Joseph Moore

It’s normal to worry from time-to-time about things like locking a door or getting exposed to germs. However, if you have OCD, your brain probably gets stuck on a thought or image (an obsession), replaying it over and over, no matter how unreasonable the thought may seem.

You may then feel compelled to do something repeatedly (a compulsion) to reduce your discomfort or anxiety. Sadly, you may spend hours repeating compulsive behaviors and your obsessions and compulsions may greatly interfere with your daily life.

While obsessions and compulsions might seem unusual, OCD is a common disorder. About 1 in 40 adults in the US will meet criteria for OCD at some point in their lives. If you are one of them, you may benefit from a specific treatment called Exposure and Response Prevention (ERP). ERP is an evidence-based, highly effective treatment for OCD that helps you get relief from your obsessions without acting on them.

What Is ERP for OCD?

Exposure and Response Prevention is a type of cognitive behavioral therapy (CBT) and is considered the gold-standard treatment for OCD.

ERP is designed to gradually reduce the anxiety that fuels your obsessions and compulsions and break the link between them. It involves two main components:

1. Exposure – Your therapist guides you through systematic, repeated and prolonged exposures to the things that trigger your obsessional fears.
2. Response Prevention – Your therapist then helps you resist the compulsive behaviors that you typically perform to reduce your distress.

How ERP Works

When you repeatedly and safely expose yourself to triggering situations, you grow accustomed to them. Through this process of habituation, once-threatening situations no longer elicit the same physiological arousal.

At the same time, you break the link between your obsessive thoughts and compulsive behaviors by leaning into your discomfort without acting on it.

For example, imagine that you typically feel compelled to wash your hands again and again after touching a public bathroom door handle. Your therapist might take you to a public bathroom and have you hold the door handle for a specified amount of time without immediately washing your hands.

In the beginning of treatment, you’ll practice ERP with your therapist. In time, you’ll learn to do ERP exercises on your own to manage your anxiety. By practicing ERP exercises again and again, you can “retrain your brain” to feel less threatened by the things that once triggered you.

How to find a qualified ERP therapist

To receive effective ERP therapy, you need a qualified ERP therapist. Here are some tips to keep in mind when looking for one.

• Make sure the therapist has received the appropriate licensure and credentials to provide mental health treatment. In states like Tennessee, you might see “HSP” or “MHSP” credentials after their degree.
• Ask whether they use ERP to treat OCD.
• Ask about their training and background in treating OCD. Do they have specialized training? What percentage of their practice involves treating anxiety disorders? Do they feel effective in treating OCD?
• Ask whether they are willing to leave their office to practice ERP with you. The answer to this question should be Yes.
• Ask how they measure progress.

Other treatment options for OCD

While ERP is highly effective for treating OCD, it’s not the only treatment option.

Medication

Specific medications can help control OCD obsessions and/or compulsions. Antidepressants are typically tried first.

Transcranial Magnetic Stimulation (TMS)

TMS is a noninvasive procedure in which an electromagnetic coil is placed gently on your head. The coil transmits electromagnetic pulses to the specific parts of your brain involved in OCD. These pulses stimulate areas within your prefrontal cortex that have likely been underactive during your illness.

Next Steps

Rachel Swan, MS

Editor
Rachel has a Masters of Science in Clinical Psychology from Vanderbilt University, where she spent 16 years as a Research Analyst in the Psychology and Human Development Department.