When you’re living with obsessive-compulsive disorder, it can feel like an endless cycle of distress. Many forms of OCD therapy seem to perpetuate this cycle. Take traditional cognitive-behavioral therapy, for example. CBT asks you to challenge the validity of your intrusive thoughts.
In CBT, you ask yourself things like, “Is it realistic that I would pick up that knife and stab my partner?” You reason with yourself, presenting realistic arguments, like, “I love her,” and, “I didn’t stab her the last time I had this thought.”
The problem is, when you engage with an intrusive thought, you give it power. You tell your mind that if a thought is worth having a conversation with, it must be important and the fear must be valid. The next time you see that knife and can’t get rid of the thought, you’re likely to engage in compulsion and be back to square one.
Because of this cycle, many people with OCD feel like they’ll need therapy forever. You can never permanently get rid of intrusive thoughts. Eventually, one will creep in — and you won’t know what to do with it, because you’ve only ever tried to escape.
Exposure and response prevention (ERP) therapy is an OCD treatment that offers an alternative to typical OCD therapy.
What is ERP therapy?
Exposure and response prevention therapy is the gold standard for OCD treatment. It’s a targeted approach that exposes you in a controlled way to your anxiety triggers, then challenges you not to respond with compulsive behaviors.
ERP therapy is a uniquely effective approach. Instead of demanding that you eliminate your obsessive thoughts, it teaches you to accept those thoughts and focus instead on choosing how you respond.
As soon as you start accepting your thoughts instead of trying to get rid of them, you learn that you can handle them. You don’t feel the same desperation to do a compulsive action, and those obsessive thoughts start to feel less overwhelming.
How does ERP therapy work?
When you start ERP treatment, you and your therapist work together to list situations that trigger your anxiety. Using this list, your therapist and you will develop customized exercises to expose you to your fears in a controlled and manageable way.
Most people face multiple anxiety-inducing situations throughout ERP therapy. You’ll usually start with something middle-of-the-road in terms of distress level, working through it with the help of your therapist. As you get more comfortable, you’ll work your way up to more distressing stimuli — always with support and guidance on your first practice.
With each exercise, you practice experiencing your anxiety without escaping into a ritual. Most people notice that as they learn to tolerate OCD fears and make non-compulsive choices, their anxiety becomes less intense and easier to manage.
As they learn to tolerate OCD fears and make non-compulsive choices, their anxiety becomes less intense and easier to manage.
ERP therapy is short-term therapy. Unlike some approaches that can have you discussing and reflecting for years, ERP therapy lets you start applying management strategies and seeing results in just a few sessions.
How long does ERP therapy usually take?
Keara Valentine, Psy.D. — a postdoctoral fellow in the OCD and related disorders track at Stanford University School of Medicine — estimates that most people will need 12 to 20 sessions of ERP therapy to start feeling better.
That number may be higher or lower depending on the person. People with less severe OCD might be able to get quick results with ERP therapy alone. Another person with more extreme symptoms might need a more intensive program before starting ERP.
Therapy is a process. When you stop ERP therapy will depend on how manageable you feel your OCD is becoming, and whether you feel ready to create and engage in ERP consistently without the help of continuous check-ins with your therapist. You may complete one round of ERP and be able to face your symptoms independently for the rest of your life. Or you may find that later on, you need to return to ERP therapy for a refresher.
Think of it not in terms of meeting a deadline but reaching a goal. ERP therapy helps you to manage your symptoms so you, not your OCD, can choose how you live.
What’s the bottom line with OCD treatment?
As with any new skill, practice makes progress in ERP therapy. The more you apply the therapy techniques you work on with your therapist, the easier it will become to face your fears in the real world.
Schedule your free introductory 15-minute call today at NOCD, and you could start to see results within eight weeks. The more you use your response prevention skills to avoid compulsive behaviors, the more freedom you gain over your life. You feel better faster — and in time, if you feel ready, you can start to think about terminating therapy.