The ABC’s of ERP: Golden Standard for OCD

The ABC’s of ERP: Golden Standard for OCD

Julie Marshall, LCSW

ERP- What is it anyway?

The Gold Standard treatment for OCD is called  Exposure Response and Prevention (ERP). ERP is helpful for other conditions such as specific anxieties/phobias. Stanly Rachman originally developed Exposure and Response Prevention in the 1970s. It falls under the umbrella of Cognitive Behavioral Therapy (CBT) therapeutic treatment techniques. Lots of letters here but bear with me! ERP provides clients with tools to help withstand distressing thoughts. People with obsessions often feel that bad thoughts need to be gone to feel better. 

Many times, attempts to stop obsessive thoughts do not work. And so goes the frustrating cycle of unwanted thoughts-fights to stop the thoughts by using a compulsion- more anxiety (and repeat).  ERP will help approach these thoughts and/or behaviors head-on in a gradual way.


So…how does it work?

Together with a therapist, you will create an “exposure hierarchy” to rate and rank your obsessions/fears/compulsions. You will be given a scale from 0-10 (10 being the most distressing and 0 begin no distress). Next, you will focus on one target at a time. 

A target is a one obsession/compulsion. Many people with OCD have multiple targets.  Below is an example of looking at one target. In this example “Suzy” has recurrent thoughts (obsessions) that she has to check her bedroom door is locked (compulsion) even though Suzy knows it is locked it. Suzy checks her door about 10 times a night before she feels better. 

Target: Locking the door/ checking 

Goal: decrease frequency of engaging in the target

Scale: 0-10 (10 being most distressing)

Hierarchy Example:

Level 1:  Lock the door 3 x max                                            Rating : 6/10    

Level 2:  Allowed to check 2 x                                                Rating : 7/10

Level 3: Allowed to check only 1x                                        Rating : 8/10

Level 4: Not checking at first/ delay for at least 1 hour         Rating : 9/10

Suzy’s therapist works collaboratively to help rank Suzy’s anxiety for the target goal.  Her therapist gives her scenarios that trigger anxiety. As you can see, Suzy has high distress ratings for checking the door. Before beginning exposures, the therapist will help make sure Suzy has coping tools to lower her anxiety.

After that, exposures will occur one at a time. Exposures take place in and outside the therapy room.  This continues with new goals and new targets. 

While exposures are taking place, cognitive strategies will be taught. Exposure cognitive strategies include:

  • thought diffusion
  • visualization 
  • containment
  • cognitive restructuring
  • self-compassion techniques.

Can ERP be done virtually?

Yes! ERP can absolutely happen online. Many forms of therapy have been adapted to virtual modalities. Technical difficulties, missing the face-to-face interaction, and lack of a private space are factors to consider. 

What to do next…

Call us with any ERP questions that come up for you that have not already been answered in this blog. We are happy to fill in the blanks and give more information regarding how Verne treats OCD and uses Exposure Response Prevention modules.

To book ERP therapy, call us at 862-330-1727

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