ERP Therapy for OCD | A Complete Guide | #PaigePradko, #OCDwithPaige, #OCD

Summary

In this video, Paige Brad Cope explains Exposure and Response Prevention (ERP) therapy, the gold standard treatment for OCD. She outlines the process of facing obsessive thoughts and urges without performing compulsive behaviors to reduce anxiety. Through structured exposures, anxiety naturally decreases over time. Paige details how to identify triggers, rate anxiety levels, and progressively challenge yourself with increasingly difficult exposures. She also provides tips to enhance ERP effectiveness, including working with trained therapists, combining it with cognitive therapy, and avoiding safety behaviors. ERP can lead to long-term relief from OCD when practiced consistently and committedly.

Takeaways

• 😀 ERP (Exposure Response Prevention) is the gold standard treatment for OCD, involving exposure to obsessive thoughts and preventing compulsive behaviors.
• 😀 The goal of ERP is to break the OCD cycle by not reinforcing obsessive thoughts with compulsive actions, allowing anxiety to decrease naturally over time.
• 😀 The process begins with identifying triggers that cause obsessive thoughts and anxiety, and assigning each trigger a subjective discomfort score (SUDs).
• 😀 The triggers are then ranked by severity, with the most distressing at the top, and exposures are practiced starting from the least distressing.
• 😀 In ERP, exposures are practiced in real life (in vivo) or imagined (imaginal), and participants are required to resist compulsive behaviors to reduce anxiety.
• 😀 A key part of ERP is staying in the exposure until the anxiety drops by at least 50%, measured through the SUDs score, which is reassessed throughout the session.
• 😀 Consistent daily practice of exposures helps reduce anxiety and ensures progress, and the hierarchy is adjusted as lower-level exposures become less anxiety-provoking.
• 😀 To avoid regression, clients continue practicing previously completed exposures, even if they no longer trigger anxiety, to prevent recreating fears.
• 😀 Combining ERP with cognitive therapy and addressing cognitive biases (like interpretation bias) can enhance the effectiveness of OCD treatment.
• 😀 For ERP to work effectively, it is essential to avoid safety behaviors, secondary gains, and relaxation techniques during exposures, as they can reduce the exposure's effectiveness.

Q & A

What is ERP therapy and how does it work?

ERP (Exposure and Response Prevention) therapy is a form of cognitive-behavioral therapy used to treat Obsessive-Compulsive Disorder (OCD). It works by exposing individuals to anxiety-provoking triggers (obsessive thoughts, images, or situations) and preventing the typical compulsive responses (rituals or behaviors) that are usually done to reduce anxiety. Over time, this helps reduce the anxiety associated with the obsessions.

What is the role of the 'response prevention' in ERP?

The response prevention part of ERP involves not performing compulsive behaviors when triggered by obsessive thoughts or fears. By resisting these behaviors, anxiety gradually decreases on its own, without reinforcing the obsessive thought or behavior.

How does the anxiety level change during ERP?

In ERP, when a person is exposed to a trigger, their anxiety spikes initially. However, by not performing the compulsive behavior, the anxiety naturally decreases over time. With repeated exposure, the anxiety associated with the trigger lessens and eventually may not spike as high.

What are SUDS scores and why are they important in ERP?

SUDS (Subjective Units of Discomfort Scale) scores are used to rate the level of anxiety a person feels in response to a trigger on a scale of 0 to 100. These scores are important in ERP to measure anxiety before and during exposures, helping to determine when the anxiety has decreased enough (by at least 50%) to move forward in the therapy process.

How do you determine which exposures to start with in ERP?

Exposures are ranked from least distressing to most distressing, and therapy typically starts with the least anxiety-provoking ones. This allows the individual to gradually build tolerance to the anxiety and work their way up to more challenging triggers.

Why is consistency important in ERP therapy?

Consistency is crucial in ERP because it helps solidify the new neural pathways that reduce anxiety over time. Daily practice ensures that the individual learns to tolerate anxiety without engaging in compulsive behaviors, making the therapy more effective in the long run.

What role does cognitive therapy play in enhancing ERP?

Cognitive therapy can be used alongside ERP to challenge irrational thoughts and biases, such as interpretation bias, where OCD sufferers tend to perceive non-threatening situations as dangerous. Combining the two therapies can help address both the behaviors and the underlying cognitive distortions.

What are safety behaviors and why should they be avoided in ERP?

Safety behaviors are actions people take to feel safer during an exposure, such as touching objects with a finger instead of directly or using gloves. These behaviors can reduce anxiety momentarily but reinforce the OCD cycle, making ERP less effective. It's important to refrain from using them during exposures.

How do you ensure that ERP remains effective over time?

To maintain the effectiveness of ERP, it is important to continue practicing exposures regularly, even those that seem to cause little anxiety. This prevents new fears from developing and reinforces the process of desensitization, making sure that old triggers don't resurface.

How can therapists ensure they are challenging their clients effectively during ERP?

Therapists need to push their clients to engage in exposures that feel uncomfortable and challenge their beliefs about anxiety and safety. Effective ERP requires therapists to consistently negotiate and help clients face difficult situations, even when they are reluctant, to ensure progress in overcoming OCD.