Clinically proven to be the most effective treatment for OCD
All sessions are conducted virtually through a HIPAA-compliant professional version of Zoom
Maybe this is your first time seeking treatment for OCD, or maybe you have tried other therapies before. It’s not uncommon to spend many years attempting to treat OCD only to find out you’re not getting any better! Traditional “talk therapy” that you may have seen on TV or used in the past to overcome stress or depression is not effective in treating OCD and can actually make OCD worse! It’s important when seeking treatment for OCD that you find a specialist who has received training in diagnosing and treating OCD using Exposure and Response Prevention (ERP).
Visit my OCD page for more information on Obsessive Compulsive Disorder
OCD requires a specialized form of treatment called Exposure and Response Prevention (ERP). ERP is a specific form of Cognitive Behavioral Therapy clinically researched and tested for treating OCD. There are decades of research documenting the effectiveness of ERP, and it is widely recognized as the gold standard in OCD treatment.
If you’re ready, I encourage you to schedule a free 30-minute consultation. I will answer your specific questions and provide an overview of OCD and ERP Treatment.
So what is Exposure and Response Prevention (ERP)?
In a nutshell, ERP, or Exposure and Response Prevention therapy is the process of purposefully and systematically exposing a person to the source of their fears while teaching them the skills needed to refrain from their compulsive behaviors. By repeatedly facing something you are afraid of, your brain is able to habituate and recognize the fear as irrational. Your brain creates new neural pathways and cognitions throughout the process. Over time, your obsessions, compulsions, and distress all diminish. This is done under the guidance and supervision of a specially trained therapist. Although, it is always the goal that the patient will learn to become their own OCD therapist in the end.
ERP is different from traditional therapy in that it focuses less on talking about issues and more on addressing them through action. This is important because anyone with OCD has likely spent countless hours to no avail attempting to talk or reason with the OCD. OCD doesn’t respond to logic; it only responds to action.
ERP is a short-term therapy, typically lasting between 12 and 20 sessions. Research shows that on average, an individual with OCD/Anxiety will experience greater than a 35% reduction in symptoms after only 12 sessions! This is in line with what my own experience has been. There are cases that move slower and there are cases that move faster, however, on average, this is about right. Once a person begins their recovery journey and completes ERP, they are often able to take what they have learned and continue to reduce symptoms month after month on their own. My goal is always to turn each client into their own OCD therapist.
You can think about OCD this way. Pretend you’re in a library and the fire alarm goes off, what do you do? You probably get up and head outside to safety. The alarm signals to your brain there is danger and your nervous system then responds appropriately; prompting you to run for safety. Each time you run for safety your brain believes it has saved you from danger; thus reinforcing you to flee at every alarm. But what if it was a false alarm? What if it was a prank? That’s exactly what OCD does. OCD hijacks your alarm system and begins to send off these false alarms. Naturally, you listen to your brain and seek safety in some way. With ERP you will learn to stick around in the library despite the alarm going off. You will give your brain the opportunity to learn it was only a false alarm. Once the brain learns this is a malfunction, you will stop focusing your attention on the alarms and you will no longer feel the intense urge to flee every time it sounds.
For more detailed info please visit the IOCDF:
International OCD Foundation – Exposure Response Prevention Therapy
How can ERP help with my OCD?
- ERP will greatly reduce if not eliminate your obsessions.
- ERP will reduce if not eliminate your urge to engage in compulsions, rituals, and/or avoidance.
- ERP changes thinking patterns (cognitions) that have maintained your cycle of OCD.
- ERP creates new neural pathways in your brain and reduces your overall anxiety.
- ERP teaches you to manage your distress without engaging in time-consuming compulsions or avoidance.
- Through ERP you will learn that feared outcomes associated with your obsessions do not come true.
- Situations that were once paralyzing become manageable.
So what do ERP therapy sessions look like?
ERP sessions are very structured. The first several sessions are used for evaluation and psycho-education. Once an accurate diagnosis has been made and you have a firm understanding of OCD and ERP Therapy, you will move into the treatment phase.
During the treatment phase, we will work together to create a list of potential exposures (to your specific obsessions/fears) in an order from least distressing to most distressing. This is called a fear hierarchy. The exposures can be in vivo, which means in real life, such as touching items that you feel are contaminated, holding a certain object, or maybe even watching a movie with a specific theme. Or the exposures can be imaginary, in which we create detailed scripts of triggering thoughts and scenarios. I will assist you in confronting the exposures from least distressing to most distressing while allowing your brain to habituate (desensitize) to the anxiety naturally. During each exposure, your brain creates new neural pathways and cognitions which move you closer and closer towards recovery. You and I will process the exposures detailing what your experience was like and what you learned. I will assist you in abstaining from compulsions during the exposures and assist you in creating a plan to reduce compulsions outside of the office.
Typical Treatment Plan for OCD using ERP
Session 1: Diagnostic Assessment (confirming OCD and/or other anxiety disorder)
Session 2: Psychoeducation Session (education on your specific symptoms and ERP therapy)
Session 3: Hierarchy Creation (we work together to build your individual hierarchy of exposures)
Session 4-12: Exposure and Response Prevention (session is spent practicing exposures during session)
Session 13: Relapse Prevention and long-term maintenance (skills for ongoing maintenance of symptoms and relapse prevention)
In ERP, you remain in control of your treatment. You determine the speed of your own recovery. I provide the road map and serve as your guide in overcoming OCD and reclaiming your life. We move at a speed that is comfortable for you. In addition to treating your OCD, you will also learn to overcome future fears, make meaningful purposeful choices in your life and improve your self-confidence.
Example #1
James has Contamination OCD and is afraid of coming into contact with germs. He experiences intrusive thoughts about becoming contaminated with germs and contracting some kind of illness. He obsesses about germs and sees threats in everyday objects and activities. In order to cope with his overwhelming fears, James compulsively washes his hands, engages in several behavioral rituals, and avoids skin contact with most everything outside his home.
In ERP, James and his therapist complete a thorough evaluation. James gains a great deal of knowledge regarding his OCD and how ERP works to change the brain. The two then work together to create a hierarchy of James’s fears from lowest to highest. The therapist helps James work his way through the hierarchy of exposures. During the treatment phase of ERP, James is tasked with willingly resting his bare hands on a coffee table in the office (which he sees as contaminated). As his anxiety spikes his therapist assists him in not engaging in safety behaviors such as washing his hands or removing his hands from the table. He is asked by his therapist to do similar exposures on his own for homework in-between therapy sessions. During the next ERP session, James is asked to touch several public doorknobs and refrain from washing his hands. He continues to move up his exposure hierarchy over the next several sessions. This process continues each session, and although his anxiety spikes each time, it diminishes quicker and quicker with each exposure.
James is learning to assign new meaning to his intrusive thoughts and to relate to them in a different way. His brain is creating new neural pathways and cognitions throughout the ERP process. The therapist assists him in confronting his fears, learning to cope with anxiety, and process what he learns along the way. Over time, his severe anxiety begins to diminish as his brain learns he is not in danger of contamination through normal everyday activities. His obsessions diminish and he no longer feels the compulsion to cleanse himself of germs or avoid touching everyday items. James regains valuable time that he used to spend obsessing and compulsing. He is now able to take that time and focus on the things he finds most important, like his family and his career.
Example #2
Dawn has Harm OCD. She experiences intrusive unwanted thoughts and images of violence. She fears she could impulsively harm herself or others. Obviously she is very distressed about the meaning of these thoughts and images. She compulsively researches different types of mental illnesses, spends hours on Google, ruminates, and repeatedly seeks reassurance from her boyfriend that she is not dangerous. Due to these fears, Dawn avoids sharp objects, violent movies, and several other potential triggers.
After a full evaluation with her therapist and the creation of a fear hierarchy, she is asked to confront the lowest exposure on her hierarchy which is to read news stories of individuals who have harmed themselves or others. She is purposefully confronting her obsessions rather than attempting to avoid them. She is encouraged to abstain from her compulsion to seek reassurance or engage in safety behaviors during and after the exposures. Dawn is asked by her therapist to do similar exposures on her own for homework in-between therapy sessions. During the next several ERP sessions, Dawn continues to move up her exposure hierarchy. She is eventually asked to hold a sharp pair of scissors while sitting with her therapist. This process continues each session, and although Dawn’s anxiety spikes each time, it diminishes quicker and quicker with each exposure. She is learning to assign new meaning to her intrusive thoughts and relate to them in a different way. Her brain is creating new neural pathways and cognitions throughout the ERP process. The therapist assists her in confronting her fears, learning to cope with anxiety, and process what she learns along the way. After completing several months of ERP, Dawn no longer obsesses about her mental health or her potential for violence, in fact, the obsessions have gone away. She spends more time doing the things she enjoys and focusing on her children and school.
Is there homework involved in ERP?
Yes, homework is a crucial part of ERP and has a direct link to your success. I will ask that you complete exposures each day in-between therapy sessions. Homework exposures will be variations of exposures completed during our sessions.
Doesn’t this all seem backwards? Isn’t this going to make me feel worse?
Yes, this absolutely seems backwards! However, it’s proven to work really well and has helped thousands recover from OCD! And yes, sometimes you will feel a bit worse when first starting ERP, however, the benefits outweigh the short term increase in distress. You have to ask yourself “What are the consequences if I don’t seek professional help?” Typically if left untreated OCD gets worse, demanding more and more of a person’s time.
How long does therapy last?
It depends largely on the severity of symptoms, your willingness to complete the homework, and your level of motivation. Some clients are able to complete therapy in 12 sessions, while others may need 24 sessions. I will work with you to form an individualized treatment plan detailing your estimated time in treatment.
This sounds tough!
Well, it certainly isn’t easy! However, OCD is exhausting, painful, and very time-consuming. I will work with you to fight your OCD and reclaim your life, so you can be the person you want to be and do the things you want to do.