Symptoms
Numerous clinical trials support the efficacy of exposure and response prevention (ERP) for the treatment of obsessive-compulsive disorder (OCD). Accordingly, ERP has been formally recognized as a first-line, evidence-based treatment for OCD.
Causes
Exposure and Response Prevention (ERP) therapy is a cognitive-behavioral treatment approach that has been proven to be effective in treating Obsessive-Compulsive Disorder (OCD). ERP involves exposing individuals to situations or objects that trigger their obsessions and teaching them how to resist compulsions.
Prevention
Yes, ERP effectively treats various anxiety disorders, including OCD, Generalized Anxiety Disorder (GAD), and Social Anxiety Disorder (SAD). ERP therapy teaches individuals how to tolerate anxiety without resorting to compulsive behaviors. How does Exposure and Response Prevention change your brain?
Complications
Storch EA, Merlo LJ, Bengtson M. et al. D-cycloserine does not enhance exposure– response prevention therapy in obsessive–compulsive disorder. Int Clin Psychopharmacol;2007. 230–237. doi:10.1097/YIC.0b013e32819f8480 [PubMed] [CrossRef] [Google Scholar] 33.
Is exposure and response prevention an effective treatment for obsessive-compulsive disorder?
What is excessive exposure and response prevention therapy?
Does exposure and response prevention work for anxiety?
Does D-cycloserine enhance exposure– response prevention therapy in obsessive–compulsive disorder (OCD)?
Who created exposure and response prevention?
Later in the 1970s, Stanley Rachman developed exposure and response prevention while working with people experiencing obsessions and compulsions. In this method, people were encouraged to conjure up obsessive thoughts and then refrain from performing anxiety-reducing compulsions or behaviors.
Who discovered obsessive compulsive disorder?
Obsessions and compulsions were first described in the psychiatric literature by Esquirol in 1838, and, by the end of the 19th century, they were generally regarded as manifestations of melancholy or depression.
What is response prevention in OCD?
Exposure and Response Prevention, commonly referred to as ERP , is a therapy that encourages you to face your fears and let obsessive thoughts occur without 'putting them right' or 'neutralising' them with compulsions.
What is exposure and response prevention technique?
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.
When was OCD first treated?
One of the first known public presentations of what we now call OCD happened in 1691 when John Moore (1646–1714), the bishop of Norwich (later Bishop of Ely) preached before Queen Mary II on “religious melancholy” describing good moral worshippers who are tormented by “naughty and sometimes blasphemous thoughts” ...
What is the history of obsessive-compulsive personality disorder?
OCPD was included in the first edition of the Diagnostic and Statistical Manual of Mental Disorders in 1952 by the American Psychiatric Association under the name "compulsive personality". It was defined as a chronic and excessive preoccupation with adherence to rules and standards of conscience.
Is exposure and response prevention CBT?
It is possible that you may have heard of Cognitive Behavior Therapy (CBT) before. CBT refers to a group of similar types of therapies used by mental health therapists for treating psychological disorders, with the most important type of CBT for OCD being Exposure and Response Prevention (ERP).
Who created exposure therapy and systematic desensitization?
Systematic desensitization was developed by South African psychologist Joseph Wolpe. In the 1950s Wolpe discovered that the cats of Wits University could overcome their fears through gradual and systematic exposure.
How long is exposure response prevention?
It depends highly on the severity of your symptoms, as well as on the subtype of OCD that you might be experiencing. On average, people need somewhere between 12 to 20 sessions of ERP to start seeing marked improvements, but that number still varies depending on a multitude of factors.
When was exposure and response prevention created?
The History of Exposure and Response Prevention Techniques In 1958, another famous behavioral scientist, Joseph Wolpe, developed a form of systematic desensitization. This technique's basis was in relaxation training. Its goal was to use an exposure to reduce sensitivity to situations that caused fear or dread.
Is exposure therapy effective for OCD?
Exposure-based therapies offer an effective way to reduce symptoms of OCD, but they require patience and you have to be willing to give them a chance to work. Learn the best ways to manage stress and negativity in your life. National Institute of Mental Health.
Is ERP the only way to treat OCD?
Research shows ERP and medication are the most effective treatments for OCD, with about 70% of people benefitting from one or both.
What is obsession compulsive disorder?
Approximately 2.3% of adults – 1 out of 40 adults – in the United States will meet the criteria for OCD at some point in their lives.1OCD is a chronic psychiatric condition characterized by the presence of unwanted, recurring thoughts (obsessions) and/or the performance of repetitive behaviors or rituals (compulsions ). Compulsions are typically performed in an attempt to alleviate discomfort and/or anxiety arising from obsessional thoughts or a general sense of incompleteness. Obsessions and compulsions are distressing and disruptive to day to day life. Obsessive compulsive disorder has been ranked as one of the top 10 leading causes of disability in the world2and has been associated with diminished quality of life,3significant functional impairment,3and high healthcare costs.4
How does exposure therapy work?
Exposure therapy involves procedures that prompt for extinction. Habituation, or a natural decrease in fear elicited by a stimulus with repeated exposure (and no escape or avoidance behavior), has been described as one method to achieve extinction. In a habituation model, the primary goal of exposure is anxiety reduction. As suggested, extant studies have shown that anxiety declines during exposure trials.8–10The habituation model was further supported by initial studies that found habituation to be predictive of treatment outcome.11However, in a review of the scientific literature, Craske et al12noted that although habituation does occur during exposure, the decline in anxiety is not predictive of treatment outcome. More recent research supports this notion, finding no relationship between within-session habituation and treatment outcome13,14and that successful response to exposure can occur in the absence of habituation.15
How does family accommodation help with OCD?
Family members and significant others may inadvertently contribute to the maintenance of the patient’s OCD symptoms by assisting in rituals and providing frequent reassurance.66,67Prospective, longitudinal investigations demonstrate that parental accommodation predicts OCD symptom severity at long-term follow-up in children with OCD.68Not surprisingly, high levels of family accommodation have been found to predict worse ERP treatment outcome in pediatric OCD.53For adults, individuals with OCD may intentionally involve their significant others in managing their distress or significant others may willingly accommodate patients’ symptoms.66Addressing family accommodation in ERP has the potential to improve the short- and long-term effects of ERP. Indeed, developmentally tailored interventions that address family accommodation promote more robust decreases in OCD symptoms compared to treatment as usual in children with OCD.69
What is ERP in OCD?
Exposure and response prevention (ERP) is a first line treatment for OCD.5,6ERP is a form of cognitive behavioral therapy (CBT) that involves providing psychoeducation to the patient, helping the patient confront fears or discomfort related to their obsessional thoughts (exposure), and having the patient resist performing compulsions (response prevention). Patients can be exposed to actual situations (in vivo exposure), imagined situations (imaginal exposure), or the physical sensations associated with anxiety or discomfort (interoceptive exposure). The goal of ERP is to challenge how a patient responds to distress and to eventually learn that feared stimuli are safe. In this review, we will discuss the theoretical background of ERP, factors related to the efficacy and effectiveness of ERP, and treatment utilization and dissemination.
Does NMDA help with extinction?
N-methyl d-aspartate (NMDA) receptors in the amygdala have a role in the extinction process.26Since the activation of NMDA receptors inhibit extinction ,27it has been postulated that NMDA receptor agonists have the potential to enhance extinction learning in combination with ERP. Animal studies have indicated that d-cycloserine (DCS), a partial agonist, can facilitate the extinction of conditioned fears.27,28Moreover, two clinical studies demonstrated patients with phobias who received DCS showed greater reductions in anxiety after exposure treatment compared to controls.29,30Based on these initial findings, DCS appeared to be a promising pharmacological agent to use in conjunction with ERP for OCD. However, randomized controlled trials (RCTs) comparing ERP + DCS to ERP + placebo have yielded inconsistent results on whether DCS can augment extinction learning. Wilhelm et al31found that OCD patients receiving DCS showed greater improvement in OCD symptoms following ERP than those receiving placebo. In contrast, Storch et al32and Andersson et al33found no significant differences between the two groups, suggesting that DCS does not improve the process of extinction in ERP for OCD. Methodological differences in the studies may explain these mixed results. Variables such as dosage, timing and frequency of DCS administration, and number of ERP sessions may influence response.31,34Additionally, Andersson et al33found a significant interaction between antidepressants and DCS that may impair treatment response. This is consistent with animal literature suggests that long-term use of antidepressants can downregulate NMDA receptors which can interfere with the standard effects of DCS of enhancing fear extinction.35Thus, DCS may only be beneficial for a subset of patients. Larger prospective studies optimizing DCS administration based on this growing body of research will help determine whether the inclusion of DCS can improve extinction learning in those undergoing ERP.
Is ERP a first line treatment for OCD?
Accordingly, ERP has been formally recognized as a first-line, evidence-based treatment for OCD. This review discusses the theoretical underpinnings of the treatment from a behavioral and neurobiological perspective and summarizes the evidence supporting the efficacy of ERP across child and adult populations. Next, we discuss predictors of ERP treatment outcome and discuss implementation strategies designed to improve feasibility and adoption. Finally, strategies to improve treatment dissemination are discussed.
Is ERP effective for OCD?
Although the mechanisms contributing to the process of extinction continue to be discussed, the efficacy of ERP for OCD has been well established through several well-powered RCTs.36–39In adults, ERP is as efficacious, if not more efficacious than existing, first-line pharmacological treatments for OCD (eg, serotonin reuptake inhibitors (SRIs)). For example, in a randomized placebo-controlled trial, Foa et al37found that ERP alone and ERP + SRI were both superior to SRI alone in the treatment of adults with OCD. Notably, there was no significant difference between the combined treatment versus ERP monotherapy.37Moreover, whereas 45% to 89% of patients treated with SRIs have a reoccurrence of OCD symptoms after medication discontinuation,40,41improvement after ERP tends to persist long-term.42Further, adult patients who are nonresponsive to medication have shown significant improvement in OCD symptoms when given ERP.43Unlike adult studies, research in children and adolescents supports a combined approach to treatment. Several RCTs have documented the superiority of ERP + SRIs compared to ERP alone for youth with OCD.39,44Though the literature on older adults is more limited, several case studies have documented success using ERP to reduce OCD symptoms in geriatric patients.45–47Researchers have considered augmenting ERP to improve treatment outcome.48,49However, results from small RCTs comparing mindfulness-based ERP and acceptance and commitment therapy enhanced ERP, respectively, to standard ERP have found no significant differences in outcome.48,49Behavioral augmentation of ERP through these methods does not appear to improve the treatment’s efficacy. Overall, about 50–60% of patients who complete ERP treatment show clinically significant improvement in OCD symptoms50–52and treatment gains have shown to be maintained long-term.42
Abstract
Numerous clinical trials support the efficacy of exposure and response prevention (ERP) for the treatment of obsessive-compulsive disorder (OCD). Accordingly, ERP has been formally recognized as a first-line, evidence-based treatment for OCD.
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What is exposure and response prevention?
Exposure and Response Prevention (ERP) is a form of psychotherapy intended to help those with obsessive thoughts refrain from responding with compulsions or rituals. ERP, which gradually exposes clients to stimuli that induce their maladaptive responses, belongs to the category of treatment known as cognitive ...
Where do therapy sessions take place?
Sessions take place within a therapist’s office but may also incorporate a location that normally triggers symptoms. Eventually, a therapist may direct the client to engage in exposure and response prevention activities on their own.
What are the effects of OCD on the body?
In OCD, these frequent, uninvited thoughts provoke anxiety and lead to compulsive rituals —such as excessively washing one’s hands or ruminating about troubling matters. The compulsive rituals may temporarily reduce anxiety, but in the long term, they promote a cycle of obsession and compulsion that prolongs distress.
Do clients learn over time that the stimuli, thoughts, and feelings that prompt compulsions are more bearable?
Further, clients learn over time that the stimuli, thoughts, and feelings that prompt compulsions are more bearable than they anticipated and do not actually lead to feared outcomes. They come to recognize that they are capable of coping with the triggers without resorting to compulsive rituals .
Can OCD touch a doorknob?
A person with OCD may touch a doorknob in a public restroom and worry intensely that she has been infected; another may have intrusive, taboo thoughts about violent or sexual acts and fear that he may cause someone harm.
What is the basic premise of escape response?
Basic premise: As individuals confront their fears and discontinue their escape response, they will eventually reduce their anxiety.
Where is the center for anxiety?
The Center for Treatment and Study of Anxiety at the University of Pennsylvania in Philadelphia, PA offers workshops on EX/RP.
