Exposure And Response Prevention For Obsessive-compulsive Disorder

Exposure and response prevention are an effective method of treating obsessive-compulsive disorder. But what is it about and why does it work?

Obsessive-compulsive disorder is a mental illness that involves obsessions (thoughts, images or impulses) as well as obsessive thoughts.

Obsessive thoughts are the mental or physical actions that the victims must perform to neutralize the anxiety that the obsessions give rise to and prevent an imaginary threat.

When thoughts are unhealthy

Everyone experiences obsession at one time or another. As conscious beings, our senses sometimes create absurd, unrealistic or exaggerated scenarios and ideas.

When this happens, most people do not attach any value or importance to these thoughts. They let them go over and continue with their day. Most people know that they are thoughts and nothing more. They know they are not reality.

However, people with obsessive-compulsive disorder can not reason like that. On the contrary, they worry a lot about their thoughts and attach too much importance to them. These thoughts cause a lot of anxiety.

Even if they are disturbed by these thoughts or do not identify with them, they still believe in them.

As a consequence, they feel they need to do something to neutralize the anxiety and prevent the perceived threat on the horizon.

You know that thoughts themselves cannot generate an actual threat. But it is the thought pattern that characterizes a person with obsessive-compulsive disorder, and it is a pattern that the person follows to the letter.

As a consequence, the individual becomes exhausted, because she never feels really free from her obsessions.

With this in mind, exposure and response prevention (ERP) is perhaps the most successful treatment method that experts come up with for this condition.

The importance of exposure to one’s obsessions

In general, exposure tends to be the preferred treatment for conditions involving higher levels of anxiety-laden behavior.

Anxiety is a normal emotional response that occurs when you interpret a fact, situation or stimulus as threatening, and you think that something could endanger your or someone else’s life.

In this regard, anxiety is an ally that will help you cope with life’s problems.

But the same anxiety that can be helpful in certain situations ceases to be helpful when you are in a situation that does not pose a danger. This is when anxiety becomes a problem.

This is because it is not an answer to real things; it is a response to an unrealistic expectation.

When a person has obsessions, he mistakenly believes that something will happen that can either cause harm, be  immoral or reflect a lack of responsibility.

These obsessions are not real and there is no evidence to back them up. But patients with obsessive-compulsive disorder can not get them out of their heads without turning to obsessive-compulsive disorder.

Getting used to it

The idea behind exposure and response prevention is that patients should be able to tolerate, manage and control their obsessions without coercion. They do this through a process called habituation.

With exposure and response prevention, reality constantly hijacks expectations, over and over again, until they finally cease.

If a person with obsessive-compulsive disorder constantly follows his obsessive thoughts, there is no way to disprove the unrealistic thoughts. This is because they believe that coercion is what prevents the bad from happening.

The reality, however, is that fears do not strike because they are irrational.

Exposure and response prevention for obsessive-compulsive disorder

Studies demonstrate that ERP is the treatment that gives the best results for patients with obsessive-compulsive disorder. It works best with patients who perform compulsive rituals.

The challenge with implementing ERP is that patients oppose the high levels of anxiety that treatment generates in the beginning.

However, anxiety is a sign that the treatment is working, as it signals that the patient is exposing themselves to, but not covering up, their anxiety.

To begin with, patients must undergo a hierarchy of anxiety-producing stimuli. The therapist must take care of the hierarchy, because if the patients have it, they may be too kind to themselves.

The list must include things that actually induce anxiety. The patient will rate the triggers according to the Subjective Units of Distress Scale (SUDS), which ranges from 1 to 100.

It is best if the patient starts with stimuli in the middle of the SUDS scale (40-50). The patient’s anxiety must be reduced by at least 50% at the therapist’s reception. If this is not the case, move on to the next point.

If you do not do this, you risk making the patient even more sensitive to the stimulus you use, rather than getting used to it.

The challenges of exposure and response prevention

ERP is very effective, but it can be difficult for people with obsessive-compulsive disorder to undergo treatment. They oppose tolerating the anxiety that their obsessions trigger without performing their rituals.

The key is to offer high-quality psycho-education and establish a good therapeutic relationship with the patient so that he trusts the treatment.

As far as possible, the patient must indulge in the process and perform all exercises correctly, both during and after the sessions.

It is also very helpful to work with the patient’s family, partners or friends to ensure that they do not reinforce compulsive behaviors.

Having an assistant therapist who is close to the patient can help the person recover by motivating them to avoid their rituals and perform the treatment correctly.