Dr. Jonathan Hoffman
What Is the Best Therapy for OCD? Is ERP the Best Treatment?
Updated: Jul 19, 2022
Hands down, research findings show that Exposure and Response Prevention is the gold standard psychotherapy for Obsessive Compulsive Disorder (OCD). However, the complex nature of OCD warrants much more than one single treatment modality. Simply put, even Exposure Response Prevention is not necessarily enough to disrupt a complicated neurobiological condition like OCD.
What is Exposure and Response Prevention (ERP) Therapy?
More commonly known by the initials ERP, the magic–– er, science–– happens as the individual with OCD practices engaging in feared behaviors or soliciting feared thoughts while refraining, as much as possible, from performing rituals or engaging in avoidance (cue the “response prevention” part!).
By practicing ERP consistently, the ability to face fears grows stronger and fears weaken. While it may sound simple, like someone saying “just do it,” ERP has many layers of strategies. In order to implement it correctly and to achieve the best results possible, ERP requires the guidance and support of an experienced and competent provider.
A few examples of ERP that incorporate both the exposure and the response prevention parts are:
Using a fork that you think has a spot on it.
Not washing excessively if you come into contact with a person who you think has an illness.
Walking away from your front door while obsessing that it’s unlocked and you will be robbed.
Having a thought that you could magically harm someone and not neutralizing it by engaging in a mental ritual.
CAN I HAVE OCD TREATMENT WITHOUT DOING ANY EXPOSURE THERAPY?
This question is similar to asking a doctor if a bacterial infection can be treated without using an antibiotic. It’s very understandable if an individual with OCD wants to try anything but ERP given how scary it sounds. However, it would be a shame for them to not receive the treatment proven to be effective for OCD.
Some individuals are ready to tackle fears with ERP from the get-go, others need to increase the “readiness for change” more gradually. In either case, correctly implemented ERP can be highly effective.
Nevertheless, confronting your fears is a daunting task. Therefore, it’s important to know that the pace of ERP is set in the structure of a strong partnership between the patient and the clinician who has a deep understanding of when the sufferer is ready to take needed steps and when more patience is the correct therapeutic approach. Learning the art of ERP can take many years for a practitioner to truly master.
IF I’M GETTING ERP, DO I HAVE TO TAKE MEDICINE?
This is a decision that should be made entirely between the patient and their clinical team. That said, it is a complicated question, especially in child and adolescent cases. However, the reality is that ERP is often used in combination with medications. The combination approach is considered the gold standard for OCD treatment when OCD symptomatology or co-occurring depression is severe. Most experts would not recommend a medication alone approach for OCD.
WHAT OTHER THERAPIES ARE USED IN CONJUNCTION WITH ERP?
Other psychotherapies can be utilized alongside ERP. Acceptance and Commitment Therapy (ACT) can be invaluable in finding a compelling reason or a personal value that increases commitment to enduring the discomfort that ERP entails. Cognitive Therapy can help address core OCD issues such as intolerance for uncertainty, over-inflated sense of responsibility, and perfectionism.
Sadly, many OCD sufferers will never receive correctly implemented ERP. Some have never heard of it, others have received misinformation that scares them away, and still, others have had a bad experience with a poorly trained practitioner. Alternatively, many individuals with OCD will get caught up in a spin cycle of indecision about whether they should try ERP or not, or in trying to find the “just right” therapist or time to begin treatment and, ultimately, never get the help they need.
It takes dedication and hard work to succeed in ERP. But most OCD sufferers who give ERP a chance find that it’s well worth the effort, and so many have found it nothing short of life-altering.
Contact Neurobehavioral Institute for more information regarding treatment options for Obsessive Compulsive Disorder (OCD).
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