Exposure and Response Prevention (ERP)

 

There is a reason why talk therapy doesn’t work for OCD.

The part of the brain responsible for our fight-flight-or-freeze response is called the amygdala. Each of us needs the amygdala to alert us to threats so that we can stay safe and avoid danger. However, in those who have OCD or anxiety disorders, the amygdala frequently misfires and initiates the fight-flight-or-freeze response when there is no real threat.

The amygdala has been part of the human anatomy since the days of the caveman, and it does not have the capacity for language. We can’t use logic or reason with the amygdala because it simply won’t understand. Those with OCD do not have a logic or reasoning problem — they often understand that their fears are irrational, but the physiological response to fear and stress still feels very real. Since we cannot tell the amygdala that there is nothing to be afraid of, this is where experiential therapy comes into play.

By using Exposure and Response Prevention, we expose the brain system to the perceived threat over and over until the brain learns that there is no need to take the alarm so seriously. We also learn that it’s possible to carry on living with this alarm system in the background. The key goal of ERP is not to get rid of anxiety, but to get better at living with it.

By engaging in ERP, clients are empowered as they learn how to overcome OCD symptoms and regain control of their lives. Components of ERP include:

  • Gaining insight about your own thoughts, feelings and behaviors

  • Monitoring your obsessions and compulsions

  • Gradually learning how to cope with obsessions and distress without engaging in compulsions

  • Re-evaluating the accuracy of beliefs about what will happen if you do not perform compulsions

  • Learning how to manage this disorder long-term in order to prevent relapse of symptoms

Acceptance and Commitment Therapy (ACT)

 

Used in conjunction with ERP, Acceptance and Commitment Therapy can help us accept inner experiences, such as obsessions and anxiety, as part of our lives. Obsessions and anxiety are not inherently bad, but the sufferer often sees them as such. The harder we try to push “bad thoughts” or “bad feelings” away, the more they seem to fight back which can be stressful and distracting. Distress is a natural part of human experience. ACT focuses on learning how to allow obsessions, anxiety, and distress to come and go without interfering with the way we live our lives.

A commonly used metaphor in ACT is seeing our thoughts as passengers on a bus. We are the driver of the bus, and passengers will get on and off. Despite how the passengers try to influence us, it is up to us to keep steering the bus in a direction that is consistent with our values, understanding that arguing with the passengers will only lead to them getting louder and more aggressive. ACT encourages us to accept the thoughts and feelings as they are without allowing them to influence what we do.