CBT/Exposure and Response Prevention (ERP) for Obsessive-Compulsive Disorder (OCD)

Cognitive-behavioral therapy (CBT) is a research-backed treatment for both children and adults with Obsessive-Compulsive Disorder (OCD).

CBT involves learning how thoughts, behaviors, and emotions are linked:

Exposure therapy is a type of CBT that involves gradually facing one's fears in order to tackle unhelpful anxiety. Gaining exposure to the fear trigger helps someone to challenge unhelpful thoughts and behaviors. This is how they get back into life and keep the fear from disrupting school/work, family/home life, their social life, health, or other important areas of functioning. Read my previous post for more detail.

OCD is a condition in which someone experiences intrusive thoughts, images or urges [obsessions] that lead them to engage in repetitive or ritualistic behaviors [compulsions]. This lasts for hours per day and gets in the way of the person's either day-to-day life or important areas such as their social life, school/work, etc.

Common obsessive themes include:

• Contamination: fear that something is dirty

• Just Right: discomfort with something being not right/imperfect/out of place

• Harm: fear of hurting oneself or others

• Scrupulosity: worry about doing something bad/wrong/immoral

• "Taboo" Themes: fear of harming a child/doing something illegal/inappropriate

• Relationship: fear that someone's partner is not right for them

• Existential: worry about the nature of the universe/existence

Compulsions might include: washing hands for a long time, engaging in a ritualistic behavior for a routine such as showering, checking that the door is locked or stove is off, checking that you weren't involved in a hit-and-run, praying a specifically worded prayer, making sure you didn't harm someone although you have no memory of it, and many more.

People with OCD think their obsession is the problem, but it is actually the compulsive behaviors that are messing up their lives. Exposure and Response Prevention (ERP) treats OCD by helping someone to confront their feared situation without engaging in compulsions over and over until their brain learns that they do not have to do compulsions to keep the fear from coming true. This is what helps them get back to their lives! For children, parents are involved by learning more about OCD, helping the child engage in exposures, and praising them when they resist compulsions.

My favorite thing is teaching people that exposures do not have to be torture! If you confront your fear of singing karaoke, you might find yourself actually having fun! Exposures are challenging but sometimes the activities are enjoyable in themselves or someone can achieve a real sense of pride and accomplishment by facing their fears. As a therapist, I'm there with my patient every step of the way, cheering them on and building their confidence in doing hard things.