Exposure and Response Prevention (ERP)
Cognitive behavior therapists use an approach
called Exposure with Response Prevention, or “ERP”,
to treat Obsessive Compulsive Disorder (OCD). Studies of ERP
show that over 70% of OCD patients who complete treatment
are significantly helped. The effectiveness of ERP is so well
documented that the National Institute of Mental Health (NIMH)
recommends exposure as the psychotherapy of choice for Obsessive
Compulsive Disorder. The television series "Obsessed"
(A&E) and the Oprah Winfrey Show's episode titled "Dr.
Oz Goes to Obsessive Compulsive Disorder Camp" reveal
striking demonstration of cognitive-behavior therapy in action.
Viewing these shows may be useful for the prospective CBT
patient.
A Scientific View of OCD
Cognitive Behavioral research suggests
that intense, repetitive thoughts of danger or impropriety
trigger, and are in turn reinforced by painful feelings such
as fear, anxiety, guilt, disgust. Obsessive compulsive rituals
in the form of “protective”, “neutralizing”
thoughts and actions are used to “ward off” anticipated
negative consequences and associated emotional pain. In the
short run, these rituals may appear effective, as they can
briefly reduce emotional distress, sometimes even producing
feelings of satisfaction. Yet, the long term consequences
of untreated OCD are starkly negative. Obsessive compulsive
patterns typically evolve into fiercely guarded systems of
ritual and belief. Completing a sequence of rituals can be
intensely stressful, robbing the person of personal time and
energy that could be directed toward other pursuits. Some
obsessive-compulsive rituals themselves can cause bodily harm
and/or place one at risk for accidents. Simple, everyday situations
that trigger obsessive compulsive patterns come to be endured
only under great duress, and eventually may be avoided altogether.
As a result, over time key areas of life such as relationships,
job performance and self care can suffer. As one’s range
of activities and associated rewards become increasingly constricted,
low self esteem and depression may result.
How Treatment Works
In cognitive behavior therapy, the patient
develops emotional strength and confidence by willingly participating
in situations that trigger obsessive-compulsive thoughts,
feelings and urges. The key to successful treatment is the
person’s commitment to participate in anxious situations
without reliance on protective rituals. In this way, the patient
learns that emotional distress and obsessive thoughts and
urges can be controlled without the use of compulsive rituals.
Through persistent hard work and effort, obsessive-compulsive
patterns eventually disappear or fade to more manageable levels,
and healthy strategies for managing challenging thoughts,
feelings and circumstances are developed in their place.
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