Cognitive behavioral therapy (CBT) with exposure and response prevention (ERP) is considered the treatment of choice for obsessive compulsive disorder. ERP is supported by a large body of research and studies show that most people with OCD respond favorably to this type of treatment.
Exposure is a main component of ERP and involves approaching the thoughts, images, objects and situations that incite anxiety and trigger obsessions. While exposure can initially produce distress, the key to ERP that makes this treatment more manageable is the structured difficulty levels of the exposures. For instance, with the support and guidance of a trained therapist, individuals with OCD will create a “hierarchy of exposures,” or a list of feared and avoided situations due to obsessions. The top of the hierarchy contains the most difficult, avoided, or feared situations, followed by decreasingly difficult to approach situations. The bottom of the list will contain situations that will be relatively easy to face, which will help build confidence and assurance in the exposure process. Think of the hierarchy as a pool and the individual with OCD as someone who does not know how to swim. The goal is to swim in the deep end. Instead of plunging directly into the deep end, the individual will start by dipping their toes in the shallow end and work their way over, gradually and with assistance, to the deep end.
The second main component of ERP is response prevention, or resisting the urge to carry out a compulsion to reduce the distress associated with the exposure. It is crucial that the individual completing the treatment fully experiences the distress associated with each exposure, which will decrease the level of anxiety associated with each situation over time. To do this, the individual must stay engaged in the exposure exercise for a prolonged period, remain distraction free while completing the exposure, and resist the urge to complete a compulsion. Consider the pool example. To really learn how to swim, a person cannot simply touch the water for a few seconds then run away from the pool. They also cannot learn to swim if they are not paying attention to what they are doing. Similarly, they are not really swimming if they are sitting on a float above the water. Learning to swim involves time, full attention, and direct contact with the water without resorting to use of flotation devices. Just like learning to swim, repetition and practice is necessary to decrease distress. Each step on the hierarchy is repeated until the exercise no longer evokes substantial anxiety or compulsion urges. Once this level of de-sensitization is achieved, the individual will move on to the next item on the hierarchy, or a more difficult exposure. Additionally, home and other out-of-office exposure sessions are often important components of treatment.
For more information about OCD or to schedule an appointment with an OCD treatment specialist at Austin Anxiety and Behavioral Health Services please call (512) 246-7225 or email us at firstname.lastname@example.org. We are currently accepting new patients at our Round Rock and Austin therapy offices.