Unwanted or alarming thoughts creep into everyone’s head from time to time. Many people are aware of these thoughts and recognize that they are meaningless and temporary. People with obsessive-compulsive disorder (OCD) often experience these thoughts as intensely frightening and extremely real. As a result, they often develop ritualized responses or avoidance in order to lessen the discomfort and as a perceived way to decrease the chances of a feared outcome occurring.

For example, when a loved one leaves your home, you might think, “I hope they return home safely.” In a typical circumstance, you probably would not think much more about it. A person with a fear of harm OCD would likely experience that same situation very differently. They might experience an exceptionally intense fear that harm will befall their loved ones, a feeling that will be persistent and convincing that danger is imminent. They might even experience intrusive images in their mind of something terrible happening to their loved one. As a result, they may engage in checking compulsions, such as checking the weather forecast repeatedly or checking the news for stories of a tragedy involving their loved one. They might experience brief relief each time they refresh the weather forecast but the urge to check will quickly return. They might even call or text their loved ones to check on them, often repeatedly and urgently. This loved one might kindly reassure them that all is well, unaware that reassurance actually perpetuates and worsens OCD. This is where Exposure and Response Prevention Therapy has proven results.

Exposure and Response Prevention (ERP) Therapy provides deliberate and graduated exposure to situations that provoke obsessive thoughts, and the resulting distress while helping to prevent their compulsive responses. It also provides supported opportunities to learn new patterns of behavior without avoiding feared situations. This functions to increase an individual’s distress tolerance and opportunities to learn how to cope effectively. It also simultaneously allows someone with OCD to realistically test out the likelihood of a feared outcome and potentially develop a sense of self-efficacy about coping with a feared outcome. 

ERP leads to a change in one’s relationship with anxiety-provoking situations, thoughts, and intrusive images. Such change often leads to an eventual decrease in symptoms of anxiety and OCD, an increase in functionality, and an ability to engage in the world rather than isolate and avoid.

About the Author:

Brittany Little, LICSW, is a Clinician at Mountain Valley Treatment Center. Brittany has a BA in Music Therapy and her MSW from the University of North Carolina. She is intensively trained in Dialectical Behavior Therapy, Cognitive Behavioral Therapy, Exposure and Response Prevention and other evidence-based anxiety treatments.