What is ERP Therapy?
ERP is a type of behavioral therapy that exposes people to situations that provoke their obsessions and the resulting distress while helping them prevent their compulsive responses. The ultimate goal of ERP is to free people from the cycle of obsessions and compulsions so they can live better.
Response prevention is key, because anything that gets rid of distress makes it impossible for us to get used to it. When people don’t turn to compulsions, they learn how to accept their obsessions instead of acting desperately to neutralize them. The thoughts are still difficult sometimes, but they no longer seem like a huge problem.
This process of getting used to something is what psychologists call habituation. As we habituate to the feelings the obsessions bring up and reduce our reliance on compulsions, we spend less time and energy avoiding pain.
ERP is fundamentally about shifting one’s orientation to unpleasant thoughts and feelings- not about getting rid of them.
When we feel able to handle discomfort, obsessions (which used to create a sense of profound uncertainty) are no longer reinforced by avoidant behaviors that teach them the content of their every thought is both important and reflective of their true nature. And when we don’t feel an overwhelming need to be certain about ourselves, the future, and our standing in the world, we can live with less unnecessary suffering.
Why is ERP Therapy the recommended treatment for OCD?
Studies show that everyone experiences some of the intrusive thoughts involved in OCD. Maybe you’ve thought I could drive off the road right now or What if I don’t actually love my significant other? People without OCD are usually able to write off distressing thoughts as strange and random occurrences, but those with this condition feel compelled to neutralize them. Obsessions and compulsions reinforce one another because it seems like a thought that had to be avoided with a compulsion must have been pretty important (and worthy of more fear). In most cases OCD symptoms do not resolve on their own.
A cognitive approach– traditional CBT, for example– asks individuals to challenge their obsessions. This can actually reinforce the belief that thoughts are significant and that we’re morally responsible for the content of our thoughts. Although cognitive interventions can be useful in many ways, recent studies comparing ERP and CBT suggest that ERP is more effective, specifically for OCD.
Any behavior that engages with the obsession– e.g. asking for reassurance, avoidance, rumination– reinforces it. By preventing these behaviors, ERP teaches us that we can tolerate the distress without turning to compulsions. It thereby drains obsessions of their power. Especially when paired with medication and other types of therapy, ERP is consistently demonstrated to be the most effective form of treatment of OCD.
Isn’t ERP kind of messed up?
You’re not alone if you think therapy that asks people to do things that really bother them is kind of unfair or strange. And this suspicion comes from a place of empathy– why make people go through pain? Isn’t it okay to be anxious about things, and why wouldn’t you be bothered by something as disturbing as a thought about harming someone you love?
In ERP a fair amount of distress is inescapable, and that’s an unfortunate fact. But clinicians and advocates of ERP suggest it because the pain of treatment usually ends up insignificant compared to the drawn-out suffering of untreated people who go through their lives in anguish over thoughts that aren’t actually worth a ton of attention.
ERP is about shorter-term pain for long-term gain. But it has to be done carefully, with an experienced clinician you respect and trust. It’s good to weigh the pros and cons beforehand: What do you value, and how can ERP help you get there? What are your goals? And what are your limits for the amount of distress you’re prepared to go through? How long do you want to be in treatment? How’s your support system outside of therapy? These questions can help guide you as you decide whether or not ERP is the right fit for now.
ERP is most effective when the therapist conducting the treatment has experience with OCD and training in ERP. If you have questions or think that you may need ERP therapy for your OCD, please feel free to contact me for a free initial consultation.