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OCD Concepts Part 4: Exposure and Response Prevention

Also known as ERP or Ex/RP, this is the front line best practice treatment for Obsessive – Compulsive Disorder (OCD).  Part four of OCD Concepts will deconstruct what ERP means for those living with OCD.  

The “E” component of ERP means exposure: to purposely trigger an obsession.  Recall, obsession is the illogical fear maintaining OCD.  In ERP, we purposely trigger the illogical fear in a therapeutic context, over and over again, sitting with the fear and uncomfortable feelings until a) habituation occurs; or b) inhibitory learning occurs.  

Habituation occurs when the fear is no longer bothersome.  Imagine watching the same scary movie repeatedly.  Will you still jump the third time you watch it?  How about the tenth time?  We can’t be bored and scared at the same time.  

Inhibitory learning occurs when another emotion overrides or contradicts the fear response.  What was once scary may now be funny or may elicit boredom.  

The “E” and “P” components in ERP refer to response (or ritual) prevention.  It is not enough to provoke the illogical fear; we must prevent any response in the form of rituals from occurring.  If one ritualizes after the exposure, it undoes the hard work because habituation and/or inhibitory learning cannot occur.  

The only way to overcome fear is to face it.