Exposure and response prevention (ERP) is a therapy that has some of the strongest research support for treating a lot of disorders, including Obsessive Compulsive Disorder (OCD). OCD symptoms are maintained because we spend a lot of time and energy avoiding what sets off anxiety associated with intrusive thoughts, which means that people with OCD have fewer opportunities to learn that the thing that scares them is something that they can probably manage and don’t have to fear so much. With ERP, you practice slowly approaching situations that set off intrusive thoughts so that you can practice tolerating that anxiety and test whether situations are as risky as OCD leads you to believe. You also avoid doing compulsions, which are behaviors or thoughts that are done to neutralize the fear. (Examples of compulsions are behaviors like washing hands for 20 minutes after having intrusive thoughts about germs, or thoughts like telling yourself “there’s no way that anything bad will happen” when noticing worries about doing something just right.) Here’s an example that might help you understand how ERP works.
When I was growing up, my parents wanted to make sure I knew how to swim, so we took swimming lessons. I have a very distinct memory of a swimming teacher telling me to jump into the pool and assuring me that she would catch me. I jumped in, but was terrified when she did not immediately catch me and let me flounder a bit underwater before pulling me back to the surface, spitting and coughing. After this, I was pretty scared of putting my head underwater. My brothers and I spent a good amount of time in the water in the summers, and I eventually learned how to swim so I didn’t come out of the water choking. But one of the things that still scared me for a long time was the diving board, and this was a problem for 8-year-old me, because it looked like a lot of fun! All the other kids, including my youngest brother, jumped off the diving board with no problem, cannonballing into the water with splashes that I couldn’t possibly create by only jumping off the side of the pool. I would climb the ladder, then climb back down. Climb the ladder, then walk a little ways down the board, then climb back down. I would climb the ladder, walk to the end of the board, stare into the water, try to force my legs to jump, then climb back down. I would do this over and over, until one day I finally was able to make my feet move and I jumped into the water and had a blast for the rest of the summer competing with my brothers and friends to see who could jump in the highest, silliest, splashiest ways.
In a way, I was doing exposure therapy so I could overcome my nervousness to do something fun. It wasn’t easy, it felt really scary, and it was a little embarrassing to have to climb down from the diving board when everyone could see me. But it helped me slowly build my confidence and see that jumping from up high into the water was something I could do.
Of course, exposure therapy for OCD is a little different than what 8-year-old me was trying. I work collaboratively with clients to build a scaffolded set of steps, called an exposure hierarchy, to slowly get you in contact with whatever it is that OCD keeps you from doing and slowly move closer to the scariest activity to help build your confidence.. We also talk about different ways of approaching the anxiety that comes up as you move through these steps. For some people, their exposure hierarchy might work toward spending time alone in a crowded place, touching something that feels germy, or driving on the highway during rush hour.
I will be honest- ERP seems intimidating to a lot of people because it can be a deeply uncomfortable experience, especially at first. But what I’ve noticed when doing ERP with most clients is that the first few exposure practices feel really scary, but they get easier as the client builds more confidence. Often, exposure practices that they predicted would be unbearable become much less intimidating. One of my favorite experiences as a psychologist is when a client completes their exposure hierarchy- it means they have intentionally and bravely faced situations that they expected would induce the most intense feelings of fear. It gives people the ability to live their life more freely, without feeling that they have to follow whatever OCD tells them to do.
Here’s more resources on ERP: https://iocdf.org/about-ocd/treatment/erp/
https://my.clevelandclinic.org/health/treatments/erp-therapy
Ideal Self Therapy, LLC 