Exposure Response Prevention (ERP): is an evidence based modality branched from cognitive-behavioural therapy (CBT). It is based on the premise that confronting feared situations or stimuli gradually and without engaging in compulsive behaviours can help individuals overcome their obsessions/compulsions and the fear/anxiety associated with it.
Principles of Exposure Response Prevention Therapy:
Exposure: involves deliberately exposing one to the thoughts, images, objects, or situations that trigger the anxiety or obsessions. Exposure can be in vivo (real-life situations) or imaginal (mental imagery or visualization).
Prevention of Response: During this stage, individuals are instructed (in a guided/directed way) to refrain from engaging in compulsive behaviours or rituals that they typically use to alleviate their anxiety. This prevention of the usual response is crucial for breaking the cycle of anxiety and compulsions.
How ERP Works:
Assessment: Here we work together to identify specific obsessions, and compulsions you are struggling with. Understanding the nature and severity of the symptoms helps tailor the ERP treatment plan to your needs.
Hierarchy Creation: A hierarchy of feared situations or stimuli is developed in a structured, guided and directed way. This hierarchy helps us have a baseline and serves as a roadmap for our treatment plan and goal.
Exposure Exercises: Together we create an exposure plan based on the hierarchy created in previous step and work our way up the ladder. The exposure may involve facing actual stimuli or imagining them, depending on the nature of the fear. But don’t fret, we will do this TOGETHER!
Response Prevention: Throughout the exposure exercises, I will guide you to resist the urge to engage in the compulsive behaviour or rituals. This process allows one to learn that anxiety naturally decreases over time without the need for rituals.
Reinforcement and Support: As a therapist it is my job to guide the process. We will be doing exposures together in a supportive, yet encouraging and fun manner. A portion of individual therapy sessions will be dedicated to doing in sessions exposures, and continuous daily exposures need to happen between sessions. Positive reinforcements, and acknowledgement of the progress and achievements can go a long way in beating OCD.
Effective: ERP and medication are the two evidence based and most effective treatments for OCD, with research demonstrating significant reductions in symptoms.
Long-lasting Results: Unlike some other treatments, the benefits of ERP tend to be long-lasting, as individuals learn skills to manage their anxiety independently. Just like anything else, we know that OCD can also get agrivvated under stress, and it can change forms throughout one’s life; thus some touch up from time to time might be needed.
Empowering: ERP empowers individuals to confront their fears and regain control over their lives, fostering resilience and confidence. Individuals describe a sense of freedom, where their minds feel less busy and stuck as a result of treatment; thus having more space to do what they love.
Exposure Response Prevention therapy offers a structured and evidence-based approach to overcoming anxiety, particularly OCD. By gradually exposing individuals to feared stimuli and preventing the use of compulsive behaviors, ERP helps break the cycle of obsessions and compulsions, leading to improved quality of life and long-term symptom relief.
It is important to note that OCD can also impact families and relationships. It is important to recognize, assess and acknowledge when this is happening. When appropriate, with family gaining knowledge through psycho-education about OCD, and by being given guided direction/support they can become a big ally in the powerful togetherness of facing the OCD.
Things to keep in mind about ERP therapy is that it is an anxiety provoking type of treatment; thus, it is important to assess where things are at. If the extent of anxiety is too high that is impacting the individual’s daily life and functioning it might be difficult to introduce EPR therapy without the support of medication. It might be helpful to seek medical advice.
Given that ERP therapy is a guided/structured type of therapy, it requires consistency and commitment. It will be difficult to see results if ERPs are happening once a week in total, if anything, it might even be harmful. It is highly recommended that a number of consistent sessions (about 10-12 weekly) is dedicated to ERP therapy while simultaneously doing exposures at home and between sessions on a daily basis (for about 20 minutes a day).
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