How Does Therapy Work for Obsessive-Compulsive Disorder (OCD)?

Exposure and Response Prevention (ERP) is the “gold standard,” or the treatment of choice, for Obsessive-Compulsive Disorder (OCD).  At ABC Behavioral Services, I use a combination of evidence-based approaches to treat OCD which include Cognitive Behavioral Therapy (CBT), Exposure and Response Prevention Therapy (ERP), and Acceptance and Commitment Therapy (ACT). I also use a family systems and relational approach in my work, as OCD often impacts family relationships and loved ones close to the individual with OCD. It’s important to treat OCD with a qualified professional, as OCD won’t go away or get better by itself.

How Does Behavior Therapy and Exposure and Response Prevention (ERP) Work?

With Exposure and Response Prevention (ERP), I will start by reviewing in a detailed manner a description of your obsessions and compulsions, which are then ranked collaboratively with your input from least to most distressing. Then imagine a ladder as an approach to treatment. We will start at the beginning with the least distressing OCD events and work in small steps towards overcoming your OCD in a step-by-step manner. I provide support the entire way! Sessions will include coaching and ERP in sessions. Then you will be guided in how to do ERP outside of therapy sessions. This is an important part of the treatment as we want your OCD busting skills to translate into the real world and your daily routines where OCD can get quite powerful and bossy. You will be supported by me throughout the entire OCD journey inside and outside sessions.

ERP sessions include:

  • We will come up with collaborative ERP goals together.
  • Sessions will gradually expose you to the situations that trigger your obsessions and compulsions. Sometimes we do actual live exposures in session or sometimes we may use imagined exposures, visualizations, pictures, or video exposures in sessions for ERP exercises. Once you have been exposed to your fear (obsession), we then work to prevent your anxiety-driven response (compulsion).
  • Over time, you will learn to respond differently to your OCD triggers.
  • Responding differently from the compulsion (the response prevention part of ERP) is the key to getting unstuck from the OCD cycle.
  • Gradually, this response prevention piece will lead to a decrease in the frequency of compulsions and the reduction in the intensity of obsessions. When this is successfully repeated over time, the associated distress and anxiety also decrease. The goal is for OCD to have less power and control over how you are thinking, feeling, and acting.
  • With effective treatment, your OCD symptoms will become more manageable and less intrusive in your daily life.

Cognitive Behavior Therapy (CBT) & Acceptance Commitment Therapy (ACT) for OCD

In addition to ERP, effective treatment for OCD should include the evidence-based approaches of Cognitive Behavior Therapy (CBT) and Acceptance and Commitment Therapy (ACT). Using CBT and ACT approaches integrated into ERP, helps you identify triggers and learn tools for how to manage the discomfort, anxiety, uncertainty, and distress that is cultivated in the OCD cycle. Working together, we will unpack the faulty messages OCD tells you and you will learn to recognize how to respond to the stuck patterns of thought OCD traps you in. This may include learning to challenge your OCD thoughts and respond to them differently. Or through the ACT approach, you can learn how to tolerate the uncertainty and distress but still learn to respond to OCD differently by moving towards actions and behaviors that are closely aligned to your core values and the life you want to live.

How often do you need to meet to do ERP?

Most treatment starts with weekly sessions on an outpatient basis, but how we set up visits is completely individualized based on family and individual needs. Sometimes we can start with every other week’s sessions but this is determined together and collaboratively based on OCD severity and tailored treatment needs. All visits will include exposures in session with coaching on how to do homework ERP outside of sessions daily in between therapy visits. If we find you need more support than this, then I can help find another provider who can offer more intensive services.

How Do I Find A Therapist?

It is highly recommended you find a therapist who is specifically trained in CBT and ERP. You can locate providers in your area at The International OCD Foundation (IOCDF).

As always, if you have made it this far in my post, thank you for spending your valuable time reading this OCD-related blog. If you would like to schedule a FREE-30 minute phone consultation to hear more about ERP and OCD treatment, please be sure to contact me!

Be well,

Dr. G

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