Exposure and Response Prevention Therapy (ERP)
The premise of ERP is that OCD and anxiety based disorders have a cyclic nature.It often starts with a trigger which leads to intrusive thoughts or worries that often have a consequence associated with it. For example with contamination obsessions hearing a coworker cough may lead to an intrusive thought about how they may be contagious which could lead into a consequence of you getting sick. From there an urge to fix the situation will come up. This could be a physical compulsion that with contamination may be to avoid the coworker, wash hands, call out sick for the rest of the day, or ask the coworker if they are sick. It can also lead to mental compulsions such as tracking where the coworker has been, mentally reviewing all the information you have about that coworkers recent activities and/or symptoms, and planning for rituals you will complete after work such as reassuring yourself that you will shower before you touch anything when you get home. Compulsions can also show up as avoidances which means not doing activities that you would be doing if the intrusive thoughts/worries weren’t present. With the contamination example this may include not going to work the next day, not spending time around that coworker like you normally do, and you may avoid shaking hands with others in the office that day. Some people experience a level of relief with compulsions, for others this is not the case. Most of the time the compulsions lead to further intrusive thoughts and/or worries. After hearing the coworker has asthma and is not contagious, the doubt may come in that the coworker may still be getting a cold and just not aware of it yet and you might even remember a time you got sick and didn’t know it until the next day to back up this worry. This then feeds into a new cycle and this “cycling” or “looping” as it is better known can go on for a very long time and often leads to exhaustion, fear, and frustration. Every person with OCD and/or anxiety based disorders has their own unique cycles and the first part of ERP therapy will be to become familiar with your unique cycle.
The second part of ERP is where exposures and response prevention begins. Exposure is just like it sounds: it's exposing yourself to the perceived threat. Response prevention means that as you are exposing yourself you are going to actively try to decrease compulsions. If you are facing OCD and/or an anxiety based disorder, I don’t have to tell you the way it takes more and more from you in order to feel like you are safe and overtime the cycles happen more and more and so much time, energy, and effort is spent trying to feel better. ERP is all about getting your freedom back and being able to live your life and move towards the goals that matter to you by taking those risks and helping your brain see that you are capable and can handle those situations.
