Exposure and Response Prevention Therapy is a cognitive behavioral treatment for OCD that uses habituation as an approach. At first, patients require guidance from a therapist before practicing independently later on.
Your therapist will develop an exposure hierarchy tailored to you, beginning with things that cause only mild anxiety, and gradually increasing it over time.
Cognitive Behavioral Therapy
Exposure and Response Prevention (ERP), is the most proven, evidence-backed treatment for OCD that doesn’t rely on medication. It involves gradually exposing people to thoughts, images and situations that trigger obsessive thoughts while restricting them from performing their normal compulsive rituals or physical actions – for instance if someone with OCD fears touching public doorknobs due to germ fears, their therapist would instruct them to touch one while in a restroom but refrain from washing their hands afterwards.
CBT is one of the most studied psychotherapies and has proven its efficacy in treating a wide variety of mental health problems, from depression and anxiety to eating disorders and chronic pain conditions. CBT focuses on shifting patterns of thinking that contribute to emotional problems; and has proven itself useful against depression, anxiety, phobias, eating disorders and chronic pain conditions as well as being used effectively for PTSD/other psychological traumas and grief/loss issues. CBT can often be combined with other therapies and lifestyle modifications for maximum effect.
Habituation
Habituation is a form of learning in which our sensitivity to certain stimuli diminishes over time with repeated exposure, for instance hearing your neighbor bang their door might startle you at first; over time though, you become less sensitive and become accustomed to its sound; eventually becoming indifferent towards it altogether. Habituation allows us to filter out unnecessary information so we can focus on things which matter such as our alarm clock in the morning or smelling woodsmoke from nearby BBQ.
Habituation is defined by several characteristics. For instance:
Triggers
Triggers are anything that recalls painful memories or emotions and cause an intense emotional reaction, disrupting concentration, mood or the concept of reality for someone. Once someone is triggered they become overcome by negative feelings and may feel an overwhelming urge to self-medicate using drugs or alcohol.
Triggers for violent events may be obvious; however, other triggers may be less intuitive. For example, an individual recovering from anorexia might be set off by images of thin celebrities.
Recognizing and understanding one’s triggers requires time and introspection. Triggers may come from internal or external sources, such as people, events, places or media that trigger past memories or emotions of past experiences. People often have multiple types of triggers. Sometimes it can be challenging to identify specific ones when something doesn’t make sense: for instance some may be affected by certain sounds or smells while for others they might trigger feelings of numbness or fear.
Treatment
Exposure and Response Prevention Therapy is a type of cognitive behavioral treatment widely considered to be the gold standard in treating obsessive compulsive disorder and anxiety/phobias.
ERP involves gradually exposing people to things that trigger their obsessions or compulsions, while asking them to confront their fears and prevent any ritualistic behavior (the response prevention component). Over time, they learn that fear or distress will not follow when confronting these triggers.
ERP uses a technique known as graduated exposure for its exposure phase. Gradual exposure involves starting with less-feared situations and gradually increasing intensity until all your fears have been exposed. Your therapist will work closely with you to create your exposure hierarchy.
As part of your treatment process, you will meet with your therapist for one or more sessions over an extended period. At first, your therapist may assist in doing exposure and response prevention exercises with you; over time though, you should become proficient enough at performing them on your own.