Exposure and Response Prevention Therapy (ERP)
Online Therapy for Obsessive-Compulsive Disorder (OCD)
Obsessive-compulsive disorder is an exhausting, time-consuming, and unique mental health disorder that does not respond to typical forms of talk therapy. In fact, talk therapies such as psychodynamic, traditional CBT, and humanistic therapy can actually make OCD symptoms worse.
Luckily, there are highly effective, research-based treatments available for OCD. Exposure and Response Prevention Therapy (ERP) and anti-depressant medications have both been shown in multiple research studies to be extremely effective in treating OCD whether used alone or in combination. It is fine to start with either or both at the same time- completely your preference.
What is OCD actually?
Obsessive-Compulsive Disorder is an extremely misunderstood mental health issue, even in the mental health field. And, because of that, it takes on average 17 years after symptoms first develop to receive an accurate diagnosis. That is 17 years of unnecessary suffering! Oftentimes, it takes even longer.
Most people with OCD first develop the disorder in childhood or adolescence. OCD affects 2.5% of people throughout the course of their lifetime (that’s a lot of people- it’s the population of New York City).
OCD involves experiencing both obsessions and compulsions. Obsessions are thoughts, images, or impulses that are unwanted and distressing or anxiety provoking. Compulsions are behaviors or thought patterns that are intended to reduce anxiety and/or prevent a catastrophe (the feared outcome of the the obsession) from happening.
OCD is an extremely time-consuming mental health disorder, and people with OCD frequently spend hours each day attending to their obsessions and compulsions. Most people with OCD are aware that at least some of their obsessive thoughts and compulsive behaviors are not “normal.”
Most people with OCD don’t talk about their obsessions because they can feel so shameful or as though sharing them with other people will result in a horrible reaction or consequence. Because of this, people with OCD often suffer silently for a very, very long time.
What are common obsessions experienced in OCD?
Fears of contamination
Fears of illness
Fear of causing harm to themselves or committing suicide
Fear of causing harm to others
Intrusive, distressing, and unwanted sexual thoughts
Excessive doubt
Religious fears
Ordering or arranging
Feeling as though things just aren’t right
Perfectionism
What are common compulsions experienced in OCD?
Excessive washing and/or cleaning
Repeated checking
Repeating tasks, rereading, or rewriting
Counting
Performing behaviors based upon lucky numbers
Seeking reassurance
Confessing
Mental compulsions (excessive self-reassurance, mental review, mental checking, praying, counting, list-making, neutralizing thoughts)
Online OCD treatment with exposure and response prevention therapy can help you:
Stop living your life based upon OCD’s rigid rules
Learn how OCD operates and why it is so hard to treat OCD without ERP therapy
Recognize you’re not alone in your OCD struggle, and you are not a bad person for having distressing OCD thoughts
Communicate with your partner, friends, and family about your OCD symptoms so that they can better understand and support you in your recovery from OCD
Learn what mental compulsions and rituals are fueling your obsessive thoughts
Learn effective strategies for coping with OCD during therapy and long after therapy comes to an end
Get support from a therapist when confronting the terrifying thoughts that present in OCD
How does exposure and response prevention therapy work?
Exposure and Response Prevention Therapy (ERP) is a form of Cognitive-Behavioral Therapy (CBT). While traditional CBT will make OCD worse, most people with OCD who receive ERP therapy improve. In fact, ERP has an approximately 75% success rate for clients who complete it.
For people who complete ERP therapy, ERP therapy is more effective than medication alone in treating OCD. And, even better, after ERP you will have the skills you need to confidently manage future symptoms of OCD.
Exposure and response prevention therapy involves:
Identifying both past and current obsessions and compulsions
Identifying the time spent on obsessions and compulsions as well as the associated distress and interference in your life
Confronting your obsessions while refraining from engaging in compulsions
Practicing exposures both in and out of weekly sessions
ERP is conducted weekly during either 60- or 90-minute therapy sessions. It typically takes 17-36 sessions to complete ERP successfully. If you are able to participate in 2 sessions/week, that has been shown to be an effective way to see results more quickly (17-36 sessions are still needed).
What about Pure O?
You may be wondering about “Pure O.” “Pure O” is a hot topic on mental health social media right now. It’s the idea that someone has OCD with only obsessions, not compulsions. Many people with OCD identify with having “Pure O” because they don’t have external compulsions like washing their hands or locking a door multiple times.
Despite the popularity of this term, “Pure O” doesn’t actually exist. The compulsions in OCD are always present. They are what fuel the obsessions, and you can’t really have one without the other.
What people with “Pure O” most likely have is OCD with only mental compulsions, or they may be simply unaware of their external compulsions because they are such a normal part of their routine. Mental compulsions are extremely common in OCD. They can include mentally reviewing past behaviors, reassuring yourself things are ok, counting, praying, list-making, and trying to neutralize (or cancel out) obsessive thoughts.
If you believe you have “Pure O,” ERP therapy can help. During ERP therapy, either myself or your ERP therapist can help you identify the mental compulsions are fueling your obsessions so we can treat them.
I know that ERP therapy can sound intimidating
I know that the thought of confronting your obsessions can sound awful. Trust me, I really do get it. I also have obsessive-compulsive disorder, and I really empathize with how terrifying the thought of not living life according to OCD’s rules can be. I can also tell you that receiving effective treatment for OCD is life-changing and very possible.
While working together, I’ll be your biggest cheerleader, and I will never force you to do anything you aren’t ready to do. You are in the driver’s seat and get to decide what you’re willing to do and when you’re ready to move on to something a bit more challenging. My role is to educate you on what your options are, share what works and what doesn’t, help you gain the courage to do scary things that will help, and support you throughout the process.
I know the obsessions in OCD can feel impossible to talk about. OCD attacks the things that we care about, which is why the obsessions can feel so shameful. But, I promise you, whatever your obsessions are, they do not mean you are a bad person. The content of your obsessions is truly out of your control. I’ll never judge you for what OCD looks like for you. And, I promise, your obsessions are probably a lot more common than you think.
How is ERP therapy different from talk therapy?
ERP therapy is a very structured and specific form of therapy that addresses OCD symptoms specifically. That means, while working together in ERP Therapy, we will only focus on treating the OCD. We won’t be catching up about work stress, relationship issues, or talking about events from your past unless they are directly related to your OCD symptoms and/or the exposures we are working on.
It is absolutely fine (and beneficial) for a client to complete ERP therapy for OCD and then end therapy. It is also fine (and beneficial) to continue to work together after ERP therapy ends to explore relationship issues or other concerns. It is entirely up to you and what you feel would be most helpful.