Exposure And Response Prevention For OCD

Obsessive-compulsive disorder, or obsessive-compulsive disorder (OCD) is a mental disorder that involves obsessions (thoughts, images, or impulses) and compulsive actions. Coercive actions are the mental or physical actions that OCD patients take to neutralize the anxiety that their obsessions provoke and to prevent an imagined threat. Exposure and response prevention are an effective method of treating OCD.

When thoughts are unhealthy

Everyone experiences obsessions at one time or another. As conscious beings, our minds create absurd, unrealistic or exaggerated scenarios and ideas. When this happens, most people do not add any value or meaning to these thoughts. They let them pass, then they continue with their day. Most people know that they are thoughts, and nothing more than that. They know they have nothing at all or very little to do with reality.

However, people with OCD are not able to look at it this way. In fact, it is quite the opposite. OCD patients worry a lot about their thoughts and give them too much value.

These thoughts cause a lot of anxiety. Even though people with OCD are bothered by these thoughts or do not identify with them, they still believe in them. As a consequence, they feel a need to do something that will neutralize their anxiety and prevent the perceived threat that is approaching.

You know that thoughts in themselves can not cause an actual threat. But it is this thought pattern that exists in the minds of OCD patients, and this they follow to the letter. As a consequence, OCD patients become exhausted and lose hope because they are never completely free from their obsessions.

In light of this, Exposure and Response Prevention (ERP) is perhaps the most successful intervention that experts have come up with to treat OCD.

The importance of exposure to obsessions

In general, exposure tends to be the treatment one chooses for disorders that involve high levels of anxious behavior. Anxiety is a common emotional response that appears when you perceive a fact, situation or stimulus as threatening and that you think may compromise your life or someone else’s life. In this sense, anxiety is an ally that can help you face many of life’s problems.

However, the same anxiety that can be helpful in certain situations ceases to be functional when you are in a situation that poses no particular danger. This is when this type of anxiety becomes a problem. It’s because it’s not a response to real things: it’s actually a response to an unrealistic expectation.

When a person has obsessions, they mistakenly think that something is going to happen that can either cause harm,  be immoral or reflect a lack of responsibility. These obsessions are not real, there is no evidence of them. However, OCD patients cannot get them out of their minds without resorting to coercion.

Getting used to it

The idea of ​​Exposure and Response Prevention is that patients will be able to tolerate, manage and control their obsessions without coercion. They do this through a process called habituation.

ERP means to show patients that nothing will happen if they press the buttons in the elevator, for example. Through ERP, reality cuts through their expectations over and over again, until they finally stop.

So, if a person with OCD always performs coercive actions, there is no way to disprove their unrealistic thoughts. This is because they believe that their coercive actions are what prevent bad things from happening. In reality, however, what they fear does not happen because it is irrational.

Exposure and response prevention for OCD

Studies show that ERP is the treatment that has the best results in people with OCD. It works best with patients who perform obsessive rituals.

What is so challenging about implementing ERP is that OCD patients are reluctant to go through the high levels of anxiety that ERP causes in the beginning. However, anxiety is actually a sign that the treatment is working, because it means that the patient exposes himself and does not hide the anxiety.

To begin, the patient must go through a hierarchy of anxiety-producing stimuli. The therapist must be the one who decides how the hierarchy is set up, because if the patient does, they may be too kind to themselves. The list must include things that actually cause anxiety. The patient must rate triggers based on the Subjective Units of Distress Scale (SUDS), which range from 1 to 100.

Ideally, the patient will start with the things that have an intermediate SUDS score (40-50). The patient’s anxiety must be reduced by at least 50% in the therapist’s office. If it does not, you move on to the next thing. Otherwise, there is a risk of further sensitizing the patient to the stimulus instead of accustoming them to it.

Challenges in Exposure and Response Prevention

ERP is very effective, but it can be difficult for people with OCD to go through with the treatment. They are incredibly reluctant to tolerate the anxiety that their obsessions trigger when they are unable to perform their rituals.

The key is to offer good quality mental education, and to create a good therapeutic relationship with the patient so that they trust the treatment. The patient must commit as much as possible to the process and do all the exercises correctly both during and after the session.

It is also helpful to work with the patient’s family, partner, or friends to make sure they do not reinforce any coercion. Having a co-therapist who is close to the patient can help them with recovery by motivating them to avoid their rituals and instead do the ERP correctly.