Exposure & Response Prevention for OCD: Don’t Cheat Yourself or Someone You Love Out of Its Benefits

Exposure and Response Prevention (ERP) is a form of cognitive behavior therapy (CBT) that is highly supported by many years of OCD (obsessive-compulsive disorder) research. Based on these findings, ERP is central to successful OCD treatment for most people, from children to adults. ERP is true to its name – it is a process of repeated, challenging exposures to OCD fear triggers and preventing responses that provide relief or escape from them. This formula somehow creates the sweet spot where the ERP magic happens.

The word magic is just for effect, but it is somewhat apt. We know that ERP works, but exactly how is still being debated. The notion that ERP helps people to habituate (adapt) to OCD fear triggers is not nearly as accepted as before. Some researchers now theorize that ERP works because it allows people with OCD to learn new safety information that overrides OCD fears. ERP is also thought to build acceptance and experiential tolerance for uncertainty and emotional distress triggered by upsetting thoughts, images, or sensations, i.e., obsessions.

Another newer theory is that ERP works because actions that challenge those with OCD to oppose OCD fear responses – like touching a doorknob when every fiber in your body wants you to flee - puts pressure on the brain to change and reorganize (neuroplasticity) that translates into an increased capacity to manage OCD fears in everyday life. Notice its similarity to opposing pressure from weights (resistance training) to build bigger and stronger muscles.

But regardless of how it works, certain people need to take this adage to heart to get the most out of their ERP experience: when you cheat, you are only cheating yourself. Or perhaps it’s your child or another loved one who winds up being cheated, directly or indirectly, if you do not approach ERP with integrity. While it is understandable why cheating in ERP is tempting, it’s still no excuse. Is cheating in ERP common? There is no exact data on this problem, however, it would only be surprising if it weren’t common – dealing with OCD fears is no joke!

People cheat in ERP for many reasons, but probably mostly to escape from anxiety. Plus, it may take time for the distress from ERP to be outweighed by treatment progress. In that respect, ERP is like many difficult but ultimately rewarding tasks where things will worsen before they improve. However, some people resent OCD treatment and cheat in ERP to provide false evidence that everything is hunky dory and that they don’t need help. At the same time, it must also be mentioned that it is not constructive to be excessively self-critical if you cheat just a little; nobody is expected to do ERP perfectly. In fact, for people with OCD-related scrupulosity (over-conscientiousness), a little cheating in ERP just might be prescribed as an exposure!

Cheating in ERP comes in many flavors, such as sneakily seeking reassurance that undermines the process, overstating a present stressor or emotional state as a reason not to participate in ERP "right now," fudging that you are doing exposures when you are not, minimally participating in exposures, or undoing exposures when you think your clinician isn’t looking or as soon as you’re out of their sightline. Further examples of cheating in ERP are not being open and honest about your OCD symptoms to prevent this information from “being used against me” in exposures, wasting valuable exposure time with delay tactics like changing the subject, defocusing on minor issues, arriving late for ERP sessions, or canceling at the last minute. This list could go on further. Some forms of cheating in ERP are obvious, while others are subtle and difficult to catch.

Parents and relatives may also cheat in ERP, usually not from bad intentions but because they are susceptible to guilt trips, have anxiety issues, or it is hard on them emotionally to see a loved one in distress, even if it is for a very good reason. How do they cheat? By not holding their loved one accountable, undermining ERP by continuing to over-accommodate OCD, buffering and rescuing their loved one from OCD’s natural consequences no matter how many times they are asked not to, or playing an ill-advised “hero” role by being overly critical of the treatment team in front of them.

Finally, cheating is a loaded word. It is being used here rhetorically to get your attention. Too strong? Synonyms for cheating include escape, avoid, evade, dodge, duck, etc., so you make the call. If you feel offended, however, feel free to use “hedge” or “hold back” instead; the upshot is the same. However, the more you can make cheating in ERP s unacceptable based on your value system, the better. If cheating in ERP is consistent with your value system, however, there is another problem at hand that needs to be addressed pronto.

The main takeaway from this article is that cheating on ERP plays right into OCD’s hands. At best, it wastes time or slows ERP down; at worst, it may derail a valuable opportunity to make real progress. “Cheaters never prosper” is an oldie but goodie that hopefully drives this point home. Consider following the steps below if you believe this topic applies to you and are sincerely willing to change your ERP cheating ways. Remember, it’s never too late to make a U-turn if you are heading in the wrong direction.

1. Come clean by identifying one to three ways you may cheat in your approach to OCD regarding yourself or a loved one. Note how cheating in ERP goes against your values. Putting it in writing will give it more impact.

2. Write down a specific action plan to address each way of cheating you’ve recognized. Make a serious commitment to this plan and a timeframe for implementing it. To reinforce your progress, cross each type of planned action to remedy cheating in ERP off your list as you’ve accomplished it.

3. Bust yourself by going public and admitting to your treatment team about how you are cheating in ERP. OCD may call you a stool pigeon, but your treatment providers and those who care about you won’t. On the contrary, they will applaud you for informing on yourself (even if they know it all along) because they realize that admitting that a cheating problem in ERP exists can be a game-changing step toward success in overcoming OCD.