ERP Therapy: The Treatment of Obsessive Compulsive Disorder

Exposure and response prevention is the highly recommended behavioral therapy for obsessive-compulsive disorder. And also been given along with serotonin reuptake inhibitors, ERP therapy has been proven quite effective therapy. For those who don’t know what obsessive-compulsive disorder is, it’s a psychiatric condition in which the person experiences intrusive and distressing thoughts and the repeated behaviors to suppress that distress.

Hence, the people with OCD do few things repeatedly, because they are trying to get over the distress, and the unpleasant feelings, and not because they just want to behave differently or they think that their behavior makes some sense.

So,  I hope you get what OCD is and how important therapy is for this to get over. Let’s discuss ERP therapy in more detail like what involves it and how it is done.

ERP therapy

As the name says exposure and response therapy, includes provoking the person’s obsessions and the resulting responses and reactions to any particular situation. So, it’s like confrontation of one’s fear and complexes making them analyze how their behavior and thoughts are irrational. ERP therapy aims to prevent people from the cycle of obsessions or compulsions, so they can live normally and peacefully.

Prevention of response is important because anything which gets rid of distress makes it impossible to become habitual with it. When people don’t get to compulsions, they start learning to accept their obsessions rather than acting differently to neutralize them. That means the thoughts may be difficult at times, but no longer appear as a big issue.

Psychologically, the process of getting used to some feelings or situations or anything is called habituation. And the patient gets habitual to the feelings their obsessions bring up and no longer depend on compulsions. Thus, now spend less time and energy avoiding pain.

Also read: what is Alzheimer’s disease 

So, ERP doesn’t aim to make people habitual of their obsessions and work on the orientation to unpleasant thoughts and feelings instead.

When we can handle the pain or discomfort, obsessions are no longer held up by avoidant behaviors which make them feel that the context of their thinking is important as well as reflective of their true nature. So, when we don’t feel overwhelmed by our thoughts like the need to be a certain way, about our future, and a lot about the position and status we need to have, then we can live peacefully and free from all the unnecessary suffering.

However, ERP therapy was developed in the 1970s and is led by the American Psychological Association and other organizations for its wealth of scientific evidence. But why is it recommended as a treatment of OCD?

Why is ERP used in OCD?

Studies revealed that every person with OCD experiences intrusive thoughts often, and it could be anything even the silliest thing you may think during OCD episodes, like what if this or what if that? Generally, people without OCD can write the intrusive thoughts as strange and unnecessary and random kicks of the brain, while the person with that condition will feel urged to neutralize them.

Obsession and compulsion both support one another because it looks like a thought that had to be avoided with a compulsion. Mostly the symptoms associated with OCD do not go on their own.

The traditional approach of CBT- cognitive behavioral therapy, involves asking the patients to challenge their obsessions. By doing this, we are reinforcing the belief that thoughts are important and only we are responsible for the type of thoughts we encounter. However, cognitive interventions could be useful in many ways, comparatively, ERP is suggested as more effective for OCD.

The behaviors that involve the obsession, for e.g asking for reassurance, rumination, avoidance somehow reinforces it. ERP thus by preventing these types of behaviors aware people that they can tolerate their distress without turning on the compulsion. Thereby works as draining the obsessions. Particularly, when accompanied with medications and other therapies, ERP is shown as the best and effective treatment for OCD.

Now how ERP works is to go through the NOCD app on android and IOS.

ERP therapy at home

Many people may have this thought of doing the ERP therapy at home, on their own, however, it is quite challenging and unnatural though. But it would not be cool to start and continue. ERP on your own is not the best way in any way to manage your OCD. I will tell you why.

ERP therapy is stressful to start 

Initially, it can be stressful and even the members on the NOCD team that have had OCD have shared that this exposure therapy will leave your symptoms worse at the beginning, that’s why you need to have a professional OCD therapist to start your journey to the treatment. Because the experienced therapists would know about the reactions people generally give during the therapy, and you will more likely to stay motivated and calm.

You will need a custom therapy plan

The OCD professional therapist will provide you with ERP therapy training which will be the most successful. A professional therapist will take his time to notice your symptoms and will treat you accordingly. On the other hand, if you start this on your own, you are turning up yourself to the exposure you are not ready for, just like pulling a heavyweight without proper form.

Only professionals could tell you how to resist all compulsion

The experts say that ERP therapy without response prevention is waste. When you try it on your own, the probability is high that you would identify the easy way that is the safest-seeking behavior which could make your intrusive thoughts even worse. You can put yourself at risk while trying to avoid compulsions without detecting them properly and you can make it worse.

ERP feels unpleasant

Yes, you read it right, that it may be unpleasant for you in starting or all along with the treatment. You can compare it with a golf game, where regularly you wake up, go to the golf club, and hit the ball daily, but still not making progress. But in the same place, if you play it under the supervision of an instructor, you would make progress eventually. The unnatural way is treating yourself on your own and getting no progress will find yourself wind up in the loop. This is not to discourage you but rather to awaring that why you shouldn’t practice it on your own at home.

Why does ERP feel unnatural when we practice by ourselves?

This is because you will have to confront the thoughts, images, and urges which oppose the fundamental character yours in your head and you will try to resist them. But a professional OCD therapist will ensure ERP therapy is natural to you in more ways and prevent your reactions as much as possible.

A lot of people take a long time to get rid of this disorder, and the right psychiatrist is important to observe your symptoms and who will confidently treat you.

Now, when we know what ERP therapy training is, the quick pop-up occurs: how will it be treated if the person would have to deal with the thoughts and things which bother them?

So you are not the only one to feel so. It’s quite an empathetic point that why would we go with pain. Although, it’s normal to feel a little anxious about some things, so what the matter of telling yourself again and again that you are not right or you may have a psychiatric issue. It is kind of strange that to treat this condition, you constantly tell yourself that you might lose yourself. People might go through a lot of pain and struggle during the turn-up of negative or intrusive thoughts. And ironically the treatment also involves the confrontation of the worst emotions and thoughts for a better life.

So, there is a temporary pain the patients are willing to have. Hence, in ERP a little pain and discomfort are inescapable and it’s the hard truth. But contrarily, the ERP experts and clinicians like the NOCD team, say that the pain during treatment eventually becomes insignificant as compared to untreated conditions, the people would go through the anguish over the thoughts that are not even worthy of any attention.

So you can say that ERP therapy is short-term pain for a long-term benefit. But the only condition is to treat with a professional therapist to whom you respect and trust. It will be wise if you calculate the pros and cons first, like why do you want this therapy? And are you ready for the healthy pain that this therapy is going to give you for the short term though or do I have enough support from outside for continuing this? So, through some questions with yourself, you will get a clear-cut answer, yes or no.

A large number of people won’t feel like having therapy due to societal issues, like what will be my image after this? Everybody will think I’m a psycho or something. Usually in our society pedophiles are considered the worst and a shameful person, and the people undoubtedly weigh anguish over their thoughts. So, the person whose OCD revolves around pedophilia is called “pedophilia OCD” by the therapists. However, they don’t enjoy their thoughts and want to get rid of them. Pedophiles often feel shameful and sad, though they won’t experience those thoughts contrary to their real values and character. We all need to understand that thinking about something and wanting to do something is not the same.

Moreover, pedophilia obsessions may appear a severe case, they are not. Nonetheless, OCD takes every disturbing episode. This is no evidence that a person having a form of typical disturbing  OCD suffers more than other people whose symptoms are not worth considering. So, in OCD there are no obsessions that are unnoticeable or less than the others.

ERP therapy intrusive thoughts are more effective when the therapist is experienced enough with the other OCD patients and training in OCD. At NOCD all the therapists are experienced in OCD and get ERP-specific training as well. Feel free to talk to your respective therapist about any of your doubts.

Conclusion

ERP therapy is an effective treatment for an obsessive-compulsive disorder characterized by intrusive thoughts and an urge of compulsion due to a particular obsession. However, there are other treatments like CBT-cognitive behavioral therapy for behavioral disorders, but ERP is considered more effective comparatively and works on by preventing the response and aims to confront the person to their obsessions in a natural way.

Frequently Asked Questions

 

How does ERP therapy work?

So, ERP therapy aims to make the participant understand their intrusive thoughts by taking care of their response prevention. In other words, the affected OCD patient will need to confront their obsessions or intrusive thoughts. By doing this the therapist ensures that the response in the form of compulsion will bury down with the successive training. As soon the patient starts accepting their obsessions, they will feel less triggered to compulsions.

How long does ERP therapy take?

ERP therapy depends on the severity of the OCD symptoms. So, the duration of the therapy might differ from person to person. For an average person, it takes 12-20 sessions to observe a bit of improvement, but still, there are other factors to consider about the therapy.

What is the difference between CBT and ERP?

Cognitive-behavioral therapy- CBT is often considered as a single type of therapy, but it isn’t. This is the combination of two therapies, cognitive therapy, and behavioral therapy. But these both therapies often overlap in these situations.

While ERP therapy involves behavioral change and exposing yourself to anxiety-provoking situations rather than avoiding them. Then they stop showing compulsive behaviors while they approach anxiety-provoking situations.

Can ERP make OCD worse?

Yes, the team members of NOCD have shared that the ERP will initially feel stressful and will make your OCD worse. That is why you need a professional therapist to prevent your response and will help you manage the stress in the beginning. But a little discomfort at the beginning is crucial to overcome the disorder.

Does ERP really work?

ERP is considered more effective as compared to CBT in treating OCD, with favorable outcomes of 65-80% in children and adults. Although ERP responds differently in everyone, most individuals show improvement in eight to sixteen weeks, while some feel disappears symptoms altogether. Thus, ERP does take effort.

What is ERP for anxiety?

ERP therapy or exposure-response prevention is a kind of therapy that makes you confront your obsessions without setting them right or neutralizing them with compulsions.

Does ERP work for anxiety?

Exposure-response prevention therapy makes the participants face their obsessions and is designed to desensitize them to their obsessions and fears. This treatment is more effective than others and shows a prominent outcome, allowing the OCD sufferers to face their fears.

How much does ERP therapy cost?

ERP will cost you $300 per 45 minutes session. Yes, it’s quite expensive to follow and the biggest obstacle between an OCD patient and the right treatment is the distance of lands. In rural areas, it’s difficult to find such therapists and usually, there is a shortage of psychotherapists.

Does ERP work for everyone?

No, it’s not for everyone and you should consult a professional therapist before moving forward. This therapy involves the introduction of awareness of intrusive thoughts of the sufferer to them.

Is OCD a type of anxiety disorder?

Yes, obsessive-compulsive disorder is an anxiety disorder and is observed by intrusive and unnecessary thoughts and repetitive behaviors known as a compulsion.

 

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