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

What is obsessive compulsive disorder (OCD)? It is a disorder of both the brain and behavior. People with OCD experience obsessional thoughts, images, and or impulses that come back to them again and again. They do not want to experience these obsessions and they have a very difficult time stopping them, if they can stop them at all. They experience severe anxiety and often suffer from lack of confidence in themselves and sadness. The anxiety they experience is a state of unrest in the mind and body. Each person perceives anxiety differently but typically it involves certain patterns of thinking (“what if …?” or, “I don’t feel ‘just right’.”). Also, many people feel anxiety in the body (e.g., muscle tightness, rapid heartbeat, shallow breathing, facial flushing, digestive changes, etc.). They begin to rely on compulsive behaviors (or rituals) to reduce the anxiety in the short term but this strategy doesn’t work in the long term. People with OCD begin to feel compelled to do rituals and while this provides temporary reduction in anxiety, they start to notice the rituals ultimately don’t serve them because the obsessions, urges, and anxiety always come back. We are members of the International OCD Foundation and a local affiliate organization in Georgia. The international organization maintains a website with detailed information about OCD found here.

OCD keeps people from living the life they want to live. People with OCD avoid situations that seem to prompt anxiety or do compulsive behaviors (or mental rituals) to lessen anxiety. The more a person engages in these rituals and/or avoids situations that make them anxious, the more they lose confidence and their natural ability to know when situations and thoughts don’t present real danger; they live in a cycle of fear and avoidance (and sometimes ritualizing). Over time, life becomes smaller, less enjoyable, and the person may feel sad or depressed.

The right treatment can help a person get back to living the life they want to live. Decades of research has identified the most effective treatment for OCD. It is a specific type of cognitive behavioral therapy (CBT)  called Exposure and Response Prevention (ERP). During ERP, a trained therapist helps a person understand and then change thoughts, feelings, and behaviors to achieve therapeutic goals. Compared to some other forms of psychological treatment that might be more confined to talking in the therapy room, it is an “active” treatment. People who engage in ERP complete “homework” tasks designed to apply what they learn in the therapy office to their lives, where real change happens. Research suggests that people who actively participate in ERP experience reductions in anxiety, situational avoidance, compulsive behavior, depressive symptoms, and improvements in overall quality of life. We have specialized training in use of ERP from the International OCD Foundation/Behavioral Therapies Training Institute to help people overcome OCD. We integrates mindfulness training with ERP to help clients learn to pay attention, on purpose, in the current moment, non-judgmentally in order to cultivate the mindful awareness necessary to recognize when they have choice points to engage in rituals and or follow the demands of urges. If this is an appropriate treatment for you, we will discuss various options. For example, some of clients greatly benefit from an intensive approach that we build together, factoring in their availability and resources. In these cases, we offer multiple sessions per week and greater collaboration with medical professionals to “fast track” recovery. More specifically, clients may come for 2 hour daily sessions for several weeks or 2 hour sessions a couple of times per week for several months. In these cases, home visits can be very helpful for me to understand the client’s particular challenges and goals.

What about medication? Some people who have OCD are prescribed certain medications called benzodiazapines and/or antidepressants. These medications can help to relieve anxiety, especially in the short term. However, research suggests, for long term relief from anxiety and situational avoidance, it is important to change the way one thinks, feels, and behaves in life. In other words, anxiety often comes back after the medications are stopped unless a person has learned new skills and ways of thinking through ERP. So, research suggests that ERP either in combination with medication treatment or alone, leads to more long-lasting benefits than medication alone. Because of this, if you choose to take medications while engaging in ERP with me, we will gladly work with your prescribing physician to coordinate care with your permission.