What You Should Know About Exposure and Response Prevention (ERP)

Did you know that there’s a treatment for Obsessive Compulsive Disorder (OCD) that’s been shown to be effective for up to 80% of people with OCD? It’s a type of Cognitive Behavioral Therapy (CBT) called Exposure and Response Prevention (ERP).

What is Exposure and Response Prevention (ERP)?

ERP was developed to treat OCD, and it can be an incredibly effective form of treatment for folks dealing with obsessive thoughts and compulsions. 

To understand ERP, it can help to understand more about how Obsessive Compulsive Disorder works. OCD involves intrusive thoughts that are disturbing and unwelcome. Often, these thoughts create a lot of distress for the person who is experiencing them. When these thoughts pop up and cause distress, people with OCD attempt to relieve the distress through compulsions, which may work briefly. 

After a while, though, the thoughts come back, and the cycle starts again. The compulsions that a person uses to relieve their discomfort eventually become part of their daily routine, which can get in the way of work, family, and other relationships. 

When we think of OCD, we often think of someone who is obsessed with cleaning, but that’s not actually how most people experience the disorder. People may have recurring, unwanted thoughts about harming people they care about, or that something bad will happen if they don’t follow through with their compulsions. Some people experience intrusive sexual thoughts, or thoughts of doing something violent or illegal. These thoughts are not in the control of the person experiencing them, and they can be extremely frightening. 

To try to lessen the fear they feel from these thoughts, people with OCD may develop compulsions or rituals like checking to make sure the smoke detectors work, making sure the baby is still breathing, making sure that the emergency brake is on, or checking that the security system is on. The overwhelming feeling is that if they don’t practice these compulsive rituals, something terrible will happen, and that can be an exhausting way to live. ERP was designed to interrupt this cycle and reduce the anxiety that feeds these intrusive thoughts. 

How does ERP work? 

There are two parts to ERP - the exposure and the response prevention. Within the safety of a therapist’s office, you’ll be exposed to the triggers and thoughts that cause you distress. Then, you’ll practice resisting the urge to perform the corresponding compulsions or rituals. 

First, you’ll work with your ERP therapist to determine what all of your triggers, intrusive thoughts, and compulsions are, so you can work through them in a safe place. This helps you and your therapist determine which triggers and obsessive thoughts cause you the most distress, so you can work your way up from lower levels of distress to higher levels over time. Exposure and Response Prevention works gradually. You aren’t going to be asked to confront your worst fears right away. As you move up the hierarchy of distress, you’ll gain confidence and experience, which help when it comes to the more distressing levels. 

As you’re exposed to your triggers or your intrusive thoughts in ERP therapy, you’ll learn skills from your therapist to help you learn how to sit with discomfort and resist your compulsions. Working with a therapist can help ensure you avoid replacing one compulsion with another, in addition to teaching you skills to help lower your distress level when the unwanted thoughts come up. 

Exposure and Response Prevention works for two reasons - habituation and inhibitory learning. Repeated exposure to your triggers will help you learn to tolerate your distress and discomfort more effectively, which reduces your overall distress level over time. This is known as habituation. Inhibitory learning happens when you learn that your intrusive thoughts don’t always come to pass when you’re exposed to your triggers. ERP helps to prove your obsessions wrong, which helps to lessen their impact. 

What are the benefits and drawbacks of ERP?

ERP is generally known as the gold-standard treatment for OCD, because research has shown that it can be extremely effective. However, it’s important to note that Exposure and Response Prevention takes work, and it’s not always easy. 

Confronting the things you’re afraid of can be terrifying. Effectively learning how to break the cycle of obsessions and compulsions requires work in between therapy sessions, which can be intimidating, especially at first. Folks with OCD are practiced at avoiding discomfort, so learning how to be okay with discomfort takes time and practice. 

Can ERP help with anything else?

Yes! ERP can help with disorders besides OCD, including: 

• Anxiety

• Eating disorders

• Phobias 

How to find an ERP therapist

If you or someone you know is struggling with intrusive thoughts, ERP might be a good fit. Our clinicians at Hope+Wellness have experience supporting clients who have Obsessive Compulsive Disorder. We serve the McLean, Great Falls, Falls Church, Arlington, Alexandria, and the greater Washington DC regions, as well as offering online services in DC, MD, VA, and all PSYPACT states. 

If you would like to talk to one of our therapists, please contact info@hope-wellness.com or get in touch with us here.

5 Myths to Unpack About Obsessive Compulsive Disorder

What comes to mind when you think of Obsessive Compulsive Disorder (OCD)?

Many people who don’t have OCD imagine that it is a disorder that compels you to keep things neat and organized. This common misunderstanding of what OCD actually is can be traced back to the way it’s portrayed in the media, especially on TV. 

Characters on TV are often written as “a little OCD” for a laugh. Obsessive Compulsive Disorder isn’t a comedy bit, it’s a common mental health diagnosis impacting millions of people in the United States. 

What is OCD?

Obsessive Compulsive Disorder is a disorder characterized by a person experiencing distressing, unwanted intrusive thoughts. These thoughts are unwelcome, and are often disturbing to the person experiencing them. The distress caused by these thoughts is often relieved through behaviors called compulsions, which only help temporarily. According to the National Institute of Mental Health (NIMH), around 2.3% of adults in the United States will develop OCD during their lifetime. 

There are two aspects of OCD - obsessions and compulsions. 

Obsessions in OCD are the repetitive, distressing, and unwelcome thoughts and fears. Compulsions are the actions taken to help relieve the distress of obsessions. Sometimes a person with OCD will experience obsessions more strongly than compulsions or vice versa. 

Compulsions can help relieve the distress and anxiety that the person is experiencing, but usually not for long. When the distress returns, the cycle begins again. Eventually, the compulsions that are used to relieve distress become a habit, and they can often get in the way of everyday life. 

For example, someone with OCD might have repetitive, unwelcome thoughts about experiencing a break in control and hurting themselves or someone else. Unwanted thoughts like this can be very disturbing and scary. To deal with the intensely distressing emotions brought on by the thoughts of harming themselves or others, they might check repeatedly to make sure that the oven is off, or that the car is in park, or that the doors are locked, or that everyone is safe. The amount of time and energy that it takes to keep up this cycle can have a huge impact on other areas of life, like work or relationships. 

So, what isn’t OCD? Let’s unpack these common misconceptions about Obsessive Compulsive Disorder:

OCD means you clean a lot or are organized

Chances are, when you think of OCD, you think of this misconception because it’s so popular. On TV or in movies, we often see characters identify as “so OCD” because they keep things clean. Remember that OCD is a disorder, not a personality trait. People commonly mistake OCD for being neat and organized. While some people who have OCD do experience compulsions around cleanliness, many do not. 

You can be “a little OCD”

You either have Obsessive Compulsive Disorder, or you don’t. It’s not something you can have “a little” or only experience once in a while - it’s a serious disorder that has a major impact on people’s lives. It can be frustrating for people with Obsessive Compulsive Disorder to hear people who don’t deal with the distressing aspects of OCD claim to have the disorder just because they’re a little Type-A. 

OCD is a slight inconvenience or something to laugh about 

Everyone experiences things differently, but for many folks OCD is much more than a slight inconvenience, the way it’s portrayed on TV. OCD can be extremely debilitating and impact all areas of a person's life. OCD is not something to laugh about, even though it’s commonly played for a laugh on the screen. 

Statistics from the NIMH show that 50.6% of people with OCD had serious impairment, 34.8% of adults had moderate impairment, and 14.6% had mild impairment. It’s difficult to cope with a disorder that causes so much distress, and it can be upsetting to people with OCD to constantly see their struggle downplayed. 

Stress causes OCD

Some people believe that OCD pops up in moments of stress, and goes away when your stress level goes down. In fact, OCD is present with or without stress. Eliminating stress won’t make OCD go away, if you even can eliminate stress. Being a human is inherently stressful, so it’s going to be hard to be completely stress-free at all times. Like many mental health disorders, stress can exacerbate symptoms, but that doesn’t mean that the stress itself is causing the symptoms. 

There’s nothing you can do about having OCD

Since the seriousness of Obsessive Compulsive Disorder is commonly misunderstood, many people believe there’s little to nothing that you can do about having OCD. In fact, OCD is very treatable. Therapy and medication are two of the ways that OCD can be treated. The therapy approaches that counselors typically use for people dealing with OCD include: 

• Exposure and Response Prevention (ERP), which helps the person confront the intrusive thoughts in a controlled environment.

• Cognitive Behavioral Therapy (CBT), which can help you to identify negative patterns in your thinking and redirect your thoughts in more positive ways. 

Are you struggling with intrusive thoughts or other symptoms of OCD? Our clinicians at Hope+Wellness have experience supporting clients who have Obsessive Compulsive Disorder. Contact us today for more information or to make an appointment! 

6 Ways to Deal With Intrusive Thoughts

Have you ever had a thought pop into your head that was distressing to you? 

You probably have, because you’re human and as humans we have to deal with something called intrusive thoughts. Sometimes intrusive thoughts are about something scary or violent or otherwise socially unacceptable. Intrusive thoughts often cause extreme distress and worry, and they can be difficult to deal with in the moment. 

What are intrusive thoughts?

Intrusive thoughts are unwanted ideas, images, or urges that seem to pop into your head with no rhyme or reason. The harder you try to ignore the intrusive thoughts, the more difficult it is to block them out and focus on something else. 

We all have intrusive thoughts from time to time, and they don’t last forever. When intrusive thoughts begin to get in the way of your daily functioning, though, it can be distracting and upsetting. Many people who struggle with intrusive thoughts on a regular basis also deal with mental health conditions like anxiety, depression, or OCD. If intrusive thoughts are interfering with your daily life, it may be time to seek support from a mental health professional or your primary care doctor. 

Why are intrusive thoughts so upsetting?

One reason that intrusive thoughts are so distressing is because they can cause you to question yourself and fear your own mind. Often, intrusive thoughts are vivid ideas or images of something upsetting or an urge to do something that upsets you. When an upsetting thought or mental image comes into your head, it can make you fear that you unconsciously want to act on that thought, even when that’s not the case.

Just because you think something doesn’t mean you want to do it or that you’re a bad person. Many people struggle with their intrusive thoughts because they cause so much shame, it feels like they can’t confide in anyone about what is going on. In reality, it’s normal to have thoughts of all kinds, even upsetting ones, and you’re not alone in your experience. You might be surprised to find out that many people deal with intrusive thoughts, and there are things that you can do to help lessen the distress that they cause. 

So, how can you cope with intrusive thoughts? Here are 6 strategies to try the next time you have an upsetting intrusive thought: 

Acknowledge that they’re there

The first step to coping with your intrusive thoughts is to acknowledge that they exist. Have you ever tried to ignore something specific when it’s already on your mind? It’s really hard! Trying to ignore something makes it impossible to get out of your mind, and it will feel like a losing battle to try to pretend the intrusive thoughts aren’t there. 

Acknowledging the thoughts doesn’t mean that you are okay with them being there, it just means that you don’t have to struggle to pretend they’re not happening. Acknowledging your thoughts can free up the energy that you use trying to ignore them so you can do something to make yourself feel better. 

Focus on what’s true

There’s a skill that’s used in Dialectical Behavioral Therapy called “Check the Facts” that helps you to assess a situation to figure out what is true and what is not before you take action. It is especially helpful in situations where you’re overwhelmed by your thoughts about a situation and need help clarifying what is actually going on without your own judgments getting in the way. This skill helps you regulate your emotional response to a situation, and it can be helpful in moments where intrusive thoughts are overwhelming you. 

The next time you find yourself overwhelmed by intrusive thoughts, take a moment to slow down before reacting. It will take some practice to remember to pause and question yourself about what’s going on. Try to keep a list of questions to ask yourself when you’re trying to cope with intrusive thoughts such as: 

• Is this true? 

• What is the evidence that I have that this thought is true? 

• What is the source of this worry? Is it coming from me or someone else?

• What is the worst case scenario, and what can I do if that happens? 

Remember it won’t last forever

Take a moment to calm down and remind yourself that the distress you are feeling in this moment will pass. Your intrusive thoughts won’t last forever, and you won’t be stuck in this moment forever, either. Thoughts are temporary. Try repeating a mantra like “This too shall pass,” or “It came, so it can go,” to remind yourself of this. 

Distract yourself 

Sometimes distraction isn’t a helpful coping skill, but in situations where you’re extremely distressed, distraction can be exactly what you need. There’s nothing wrong with trying to focus your attention on something else until the upsetting thoughts have passed. 

Try to distract yourself with things like playing with a pet, listening to music, going for a walk, creating art, or working on a puzzle. Pick something that you can get immersed in, so it will be easier for you to distract yourself until the thoughts have passed. 

Try a grounding exercise

Intrusive thoughts take you out of the present moment and lead you to worry or ruminate over something that’s not happening right now. Using a grounding technique or even a mindfulness practice can help you feel more connected to the present moment instead of getting pulled away by the intrusive thought. Use a grounding exercise like the 5-4-3-2-1 technique, where you name 5 things you see, 4 things you hear, 3 things you feel, 2 things you smell, and 1 thing you taste to help reorient yourself to the present moment. 

Get help from a therapist

Intrusive thoughts can be very upsetting and working with a therapist can help you explore what’s going on. Therapy can help you find strategies to cope that work best for your situation, and can help you be compassionate with yourself in the moment. It takes practice to cope with intrusive thoughts effectively, and therapy can be a helpful source of support as you practice these new skills. 

If you’d like to speak with a therapist about your intrusive thoughts, our therapists in DC, Maryland, and Virginia have appointments available! Get in touch with our office today to set up an appointment!