Exposure and Response Prevention (ERP) for OCD in Philadelphia and across the US
Cycles of intrusive thoughts and compulsions in OCD can make a person feel anxious, stuck, and can take time away from relationships and activities you value.
ERP can help to break the cycle of obsessions and compulsions and re-engage in the life you want to live.
What is OCD?
Obsessions are unwanted intrusive thoughts, images, or impulses that are distressing. Obsessions can include fears related to a sense of over responsibility, control, perfectionism, and difficulty tolerating uncertainty.
Compulsions are behaviors or mental acts that a person does to neutralize the distressing feeling or threat from the obsession. Although they provide temporary relief, often distress often continues in the long-term.
When a person experiences intrusive thoughts and compulsions they can feel anxious, uncomfortable, and like their behavior is out of their control which can begin to impact important relationships and other aspects of their lives. Although OCD can be overwhelming, there are treatments to help! ERP is designed to help you free yourself from the cycle of obsessions and compulsions, tolerate emotional responses and uncertainty in life, and approach life with more confidence.
What Does OCD Feel Like?
A desire for something to look or be perfect or right
A sense of over responsibility for self or others
Struggling with uncertainty or doubt
Fears related to who you could be inside or what you might do
Overwhelming thoughts about harm coming to loved ones, including your baby (postpartum OCD)
Fears or disgust related to dirt, germs, and contamination
Feeling stuck performing rituals and having trouble breaking the cycle
These thoughts can be overwhelming, but therapy can help you to begin to make choices that align more with what you want from life and less in line with anxiety. Overtime, you gain more confidence and freedom to make values-driven choices for your life.
What is ERP?
Exposure and Response Prevention is an evidence-backed approach to treating OCD. It involves:
Exposure: gradually and collaboratively approaching feared situations for the purpose of learning about your ability to experience uncomfortable emotions, that feared outcomes are unlikely, and to live with uncertainty. Over time, this greatly reduces distress and helps build confidence.
Response Prevention: Reducing rituals or compulsions until you no longer need them to cope.
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Exposure and Response Prevention is an evidence-backed approach to treating OCD that involves gradually approaching feared stimuli (situations, thoughts, feelings, bodily sensations) that have been typically avoided and are relatively safe. It aims to help you learn that these situations are safer than previously thought, that distress often goes down without needing to engage in compulsions, and that it is possible to stay engaged with important activities and relationships in your life. After a course of ERP, people often feel more confident in their ability to tolerate distressing emotions.
In ERP you and your therapist collaborate on creating an exposure hierarchy (list of situations you want to approach) that is based off of your values and desires for your life and work through it gradually at your pace. This helps you feel more confident and capable to resist compulsions.
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ERP is aimed at learning important lessons that help you combat fear and distress such as that you are able tolerate uncomfortable feelings, that the feared outcome does not occur, and that the uncomfortable thoughts do not need to control your life.
As you approach feared situations repeatedly, the fear decreases naturally, your mind can better differentiate actual threat from perceived threat, obsessions carry less weight and become less upsetting, and you learn to tolerate a range of emotional responses. I find that as people move through ERP, they learn to trust themselves, their minds, and their emotional responses again, learn to accept and live with uncertainty, and can prioritize what they want in their lives. After a course of ERP, many folks I have worked with enjoy deeper exploration of their values, relationships, identity and other enriching aspects of their lives in therapy and I often transition from ERP into an ERP informed, person-centered and explorative approach.
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My approach to ERP is compassionate, supportive, and encouraging. My hope is to help you tolerate uncomfortable feelings so that you can make meaningful changes and move toward the life you want. I integrate ACT-based strategies emphasizing exposures that take into account your values and desires for your life and includes mindfulness or defusion techniques to help unhook from compulsive thought loops. My hope is that ERP is a collaborative endeavor where we work together to make the best treatment plan for you.
For clients presenting with primary misophonia, I often take an acceptance-based approach to treatment with gradual exposure and distress tolerance included. The hope is to make the presence of distressing noises and sounds more palatable so that you can move through life with more ease.
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Dirt, Germs, Contamination fears
Harm-related concerns about self or loved ones
Taboo thoughts or concerns about morality
Need for symmetry or exactness
Relationship concerns and indecision
Pure “O” involving mostly obsessive thought loops
Perinatal OCD
Other concerns (eg Past Event, social concerns, intrusive sounds, etc)
Misophonia (May be separate from OCD and require a slightly modified treatment approach).