Mila Loskutova is a registered clinical counselor based out of Vancouver, British Columbia. She specializes in working with trauma and OCD.
Obsessive-Compulsive Disorder (OCD) is a chronic and sometimes debilitating condition affecting approximately 1% of Canadians (CPA, 2021). People with OCD often experience unwanted, upsetting, and ongoing intrusive thoughts called obsessions. To cope with obsessions, they often do repetitive, ritualistic behaviours. These are called compulsions. Compulsions can feel uncontrollable and take up hours of the day. OCD can negatively affect people’s daily functioning, including relationships, work, and schooling.
Exposure and Response Prevention (ERP) is a very effective form of cognitive-Behavioral therapy (CBT) designed to treat OCD. ERP helps individuals confront their fears and reduce the compulsive behaviors that reinforce anxiety.
Understanding ERP
ERP has two key components: Exposure and Response Prevention.
Exposure: Exposure involves gradually exposing the individual to the thoughts, images, objects, and situations that trigger their anxiety or obsessions.
Response prevention: Encourages the person to resist their compulsive behaviors during exposures and at home.
Here is how ERP can help
1. Breaking the cycle of OCD
OCD is often maintained by a cycle of obsessions (intrusive thoughts) and compulsions (repetitive behaviors performed to reduce anxiety). ERP targets this cycle by:
Increasing anxiety tolerance: By confronting feared situations, individuals learn that anxiety decreases over time, even without compulsive behaviors. Repeated exposure helps build tolerance to anxiety and makes it more manageable in the long term. Scientists call this process habituation.
Inhibitory learning: Exposures teach us that the worst-case scenario will not happen, regardless of whether compulsions are completed. ERP helps individuals realize that they can tolerate anxiety without relying on compulsions.
2. Changing thought patterns
ERP helps individuals challenge and change their thought patterns. By facing their fears and not giving in to compulsions, they can see that their feared outcomes are less likely than they thought. They can also cope with the outcomes if they do occur.
3. Improving daily functioning
ERP can lead to significant improvements in daily functioning by:
Reducing time spent on rituals: As individuals learn to resist compulsions, they spend less time performing rituals and more time on meaningful activities.
Decreasing avoidance: Avoidance is a common compulsion because OCD often causes people to avoid their fears. But, it often means no longer being able to take part in fun and fulfilling activities. Through ERP, people learn to confront their fears and participate in things they used to avoid and take control of their lives.
Improving life: Reducing obsessions and compulsions boosts well-being and relationships. They spend less time worrying and more time doing what truly matters to them.
4. Building self-efficacy
ERP empowers individuals by helping them take control of their anxiety and OCD. As they successfully navigate exposures and reduce compulsions, their confidence in managing their symptoms grows.
Practical steps in ERP
Assessment: A therapist works with the individual to identify specific obsessions and compulsions, as well as the situations that trigger them.
Hierarchy development: Together, they create a hierarchy of fears, ranking situations from least to most anxiety-provoking. Exposures are often ranked on a 1-10 scale of intensity.
Gradual exposure: Starting with less challenging exposures, the individual confronts these situations while refraining from compulsive behaviors.
Response prevention: The therapist supports the individual in resisting the urge to perform compulsions. Together, they gradually work up to more challenging exposures.
Finding a therapist
If you’re considering ERP, it's important to work with a therapist trained in this specific type of therapy. A qualified therapist can customize the treatment to your needs. They will also guide you through the process, ensuring it is safe and effective.
Conclusion
ERP is a powerful tool for treating OCD and anxiety. It offers a structured way to confront fears and reduce compulsive behaviors. Using ERP can break the cycle of anxiety and help individuals regain control over their lives. If you or someone you know is struggling with OCD, ERP with a trained therapist can be a vital step toward recovery.
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Mila Loskutova, Registered Clinical Counsellor
Mila Loskutova is a registered clinical counselor based out of Vancouver, British Columbia. She specializes in areas such as trauma, anxiety, depression, and OCD. As a queer person, she is particularly passionate about supporting the 2SLGBTQIA+ community, helping folks of all backgrounds, orientations and genders not only survive but thrive in the world.
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