Exposure and Response Prevention (ERP) is a research-based type of Cognitive Behavioral Therapy (CBT) that treats anxiety disorders and, most commonly, Obsessive Compulsive Disorder (OCD). It is widely considered the “gold standard” for treating OCD for people of all ages.
ERP encourages individuals to gradually confront fears and change their response to them. The exposure component involves confronting the thought, object, or situation that triggers the obsession. The response prevention goal is for the individual not to follow the obsession with a compulsive behavior.
For someone struggling with OCD, the concept of facing an obsession without performing the compulsion can be very scary. At OptimalLife Wellness, our therapists understand this apprehension. We move at each individual’s pace and always work to build trust with our clients so that each session is a safe space.
The Begging Dog Analogy
To help people better understand OCD, we use the “Dog at the Dinner Table” analogy.
A dog is begging at the dinner table. The food smells good, and the dog can’t resist. You are annoyed with the whining and pawing, so you give in and throw the dog a bite from your plate. This just reinforces the relentless begging that frustrates you, and, therefore, the dog begs again, and to alleviate the frustration, you throw him more food.
OCD works similarly. The obsession is the whining, which triggers distress. Throwing the dog food is the compulsion that alleviates the distress. The dog in this analogy is OCD, and to break the cycle, you must stop giving OCD what it wants.
Breaking this cycle can seem nearly impossible and incredibly anxiety-inducing, but ERP is proven to help people with OCD get that nagging dog to just go lie down.
How ERP Works
Once we have determined that you have OCD symptoms, we perform an assessment to determine which areas of your life the obsessions and compulsions are impacting. This process increases your awareness of the various types of obsessions and compulsions that you might not realize are a part of OCD.
The next step to ERP involves building a Fear Hierarchy with your therapist in which you rank obsessions and compulsions based on how distressing they are to you, using the Subjective Units of Distress scale (SUDs). The least distressing exposure challenges will be worked on first, followed by gradually more distressing scenarios. This approach takes baby steps to help you build your confidence and resilience and become better and better at facing your fears.
