By Hongmarie Martinez, PsyD, Licensed Psychologist | Behavior Therapy Associates | Somerset, New Jersey
While Obsessive Compulsive Disorder (OCD) can be a challenging mental health condition to cope with, there are evidence-based treatment options available for those impacted. If your OCD is resulting in significant distress or interfering in your daily life (e.g., work, school, leisure/social activities), it may be time to seek a mental health professional who specializes in OCD and a specific type of psychotherapy treatment called exposure and response prevention (ERP).
ERP is a type of cognitive behavior therapy (CBT) and is proven through research to be highly efficacious in helping those with OCD reduce and manage their symptoms. ERP can be used for all types of obsessions and compulsions and across ages. When addressing your OCD in therapy, your therapist will first gather comprehensive information about your OCD history and symptoms, including details about the obsession(s), which are the unwanted thoughts, urges, or images that repeatedly enter your mind and result in unpleasant feelings and distress. They will also want to learn about your compulsions (also known as ‘rituals’), which are the repetitive behaviors (which can include avoidance) and/or mental actions that often alleviate the unpleasant feelings from the obsessions in the short-term. Once there is a thorough understanding and awareness of one’s OCD symptoms, ERP can be started.
The exposure part of ERP involves working with your therapist to identify and gradually face a range of situations that will intentionally trigger or activate your obsessions. The response prevention component of ERP involves making an active choice to not engage in the compulsions when exposed to the triggering situation. In other words, an individual is deliberately confronting or exposing themselves to situations that result in their “OCD alarm” going off; rather than responding to the distress/anxiety with one’s compulsion(s) that their OCD has conditioned them to do overtime, the individual is refraining from performing any compulsions despite the distress felt in the moment. For example, an individual with a contamination obsession may intentionally touch items in a store that may result in a fear of developing germs and diseases but refrain from excessively washing and cleaning themselves afterwards. Or an individual with a harm obsession may intentionally use a knife in the presence of others despite wanting to avoid using sharp objects due to fear of accidentally causing harm to others.
You may be thinking, “Why would I do ERP? That sounds awful and terrifying, no way am I doing that” or “I’ve tried to not do the compulsions, but I just can’t help it. How is ERP any different?” These are common and valid reactions when first learning about ERP. There are additional components of the ERP process that may be helpful to be aware of. For instance, when engaging in ERP, your therapist will help you identify a variety of situations that trigger your obsessions and create what’s called an exposure hierarchy, where you will rank and order the situations from least to most distressing (typically rating the situations from 30-100 with 30 being a low and tolerable level of distress and 100 being the most distressing). An individual then begins ERP in session with the guidance of the therapist starting with exposing themselves to the first situation ranked on their exposure hierarchy (which is usually a low-level anxiety provoking situation that results in a distress level of about a 30-40). Each situation or step of the hierarchy is worked on repeatedly in the session and practiced outside of the session until an individual reaches a point of being able to tolerate the situation with greater ease and without doing the compulsions. Given that ERP can feel anxiety-provoking, your therapist will work at your pace and assist you in helping you to take the small or big steps that you prefer on your exposure hierarchy ladder.
Why is ERP effective for OCD? While you will likely experience anxiety in the short-term when engaging in ERP, it is a treatment process that can help you break the OCD cycle in the long- term. ERP is essentially helping to “retrain” your brain to engage in new learning, including the following:
- Teaching your brain that you do not need to engage in compulsions when the obsessions occur but rather understanding that you can tolerate the uncertainty and handle the discomfort associated with the obsessions without performing any compulsions;
- Teaching your brain that your anxiety or distress will eventually subside in the long- term;
- Teaching your brain that the feared outcomes that your OCD predicts often do not come true AND teaching your brain that you likely can handle the feared outcomes even if they do come true;
It can take time and repeated practice of exposures for the mind to adopt the new learning; thus, it is important to be patient with yourself and the process throughout your ERP treatment. For some individuals, it may be a combination of ERP and psychiatric medication that is most impactful in managing one’s OCD symptoms long-term. If one is considering psychiatric medication for their OCD, it may be beneficial to seek a psychiatrist or medical professional who specializes in OCD, can accurately assess your symptoms, and can explore with you the anticipated benefits and risks of medication treatment for the OCD symptoms. If both ERP and psychiatric medication are being sought to treat your OCD, your therapist and medical specialist can collaborate to ensure an effective treatment plan for you.
It can feel overwhelming to take steps to address your OCD, but with the guidance of mental health professionals who specialize in the assessment and treatment of OCD, the path forward to managing your OCD does not have to be walked alone.
Hongmarie Martinez, Psy.D. is a licensed psychologist in New Jersey and New York and a certified school psychologist in New Jersey. She works at Behavior Therapy Associates in Somerset, New Jersey. Dr. Martinez has the authority to practice interjurisdictional telepsychology (APIT) from the PSYPACT commission, allowing her to provide telepsychology to clients in many states. She can be reached at hmartinez@BehaviorTherapyAssociates.com and at www.BehaviorTherapyAssociates.com.
