Chicago Mind and Body

About ERP for OCD and Anxiety

Exposure and response prevention is a subtype of Cognitive Behavioral therapy (CBT). It helps individuals with OCD and other types of anxiety to gradually face avoided situations and fears while learning to respond to the signals that evoke such fears. Read more below about how ERP can treat OCD and anxiety disorders. 


What is OCD?

Obsessive – Compulsive Disorder is a condition that involves unwanted intrusive thoughts, images or urges that an individual finds upsetting. It is common to feel anxious, fearful, or disgusted by these obsessions and as a result, individuals with OCD feel driven to reduce the feelings of distress they experience. Sometimes people begin avoiding people, places, or situations that they expect to bring about more upsetting thoughts, or they may try to stop themselves from having more unwanted thoughts. Other times, people may try to erase or “undo” the thought by completing a behavior that allows them to feel at ease. Sometimes people may feel compelled to check, seek reassurance, or find out if the unwanted thoughts are true or may come true by analyzing and ruminating. These attempts at reducing the distress from an unwanted thought are considered compulsions.

OCD is sometimes nicknamed the “doubting disorder” because many people with OCD worry about all the “what if’s” they can imagine and spend a lot of time trying to prevent their fears from coming true. While many people experience doubt, OCD is a serious condition that impacts many areas of one’s life. Some people with OCD can spend several hours a day feeling stuck in a loop of unwanted thoughts and compulsions, which can impact their ability to participate fully in their daily lives. OCD can interfere with work, school, relationships, hobbies, and overall well-being.


What is a Phobia?

Phobias are persistent and intense fears of objects or situations that cause significant distress. The fear is often an overestimate of the likelihood of an unwanted outcome. Some may avoid the object or situation or may endure it with a high amount of anxiety. Phobias can interfere with functioning in many areas of life, including traveling, getting appropriate healthcare, or attendance at school, work, hobbies and relationships.


What is Panic Disorder?

Panic Disorder involves frequent, unexpected panic attacks, characterized by a sudden wave of fear or sense of losing control, even when there is no clear danger. Panic attacks often include a combination of physical discomfort and worrying thoughts that are upsetting to the individual. Some common sensations include changes in breathing and heart rate, trembling and shaking, dizziness, muscle and body tension, racing thoughts, and fears of having a heart attack, losing control or being unable to escape.  


How does ERP help?

ERP is a type of therapy designed to help people interact with a feared situation while reducing avoidance or the need to complete a compulsion. In the first few ERP sessions, the therapist will explain how avoidance and compulsions reinforce OCD and worsen anxiety. A goal of ERP is to learn that anxiety and fear are not dangerous, although these feelings are often uncomfortable. Learning about the way the brain associates something as fearful, dangerous, or safe can help people relate to and understand their own inner experiences. The therapist will assess for symptoms and ask about any upsetting experiences that may have initiated anxiety symptoms.


Response prevention is discussed at length to help the client understand different ways to interact with and relate to the feelings of fear one experiences. Several sessions may be dedicated to discussing response prevention to help the client learn strategies and skills. In the first few sessions, variables that influence the client’s symptoms will also be identified to help develop a hierarchy. A hierarchy is often organized into a list that details various situations that are likely to produce anxiety. The client predicts how distressing each situation may feel if they were to face these fears. They then consider response prevention methods to use instead of avoiding or completing compulsions. When ready, the therapist will begin guiding the client through the hierarchy by planning exposures. The exposures are exercises designed to intentionally face feared stimuli while relating to and interacting with feelings of anxiety in a different way. Over time, individuals are better able to cope with feelings of fear and anxiety. They feel more willing to return to parts of their lives that they have missed out on and while distress may still happen in life, it begins to be more manageable.


When is relaxation helpful?

Typically, relaxation is suggested as a daily habit to help cope with stress and manage life's struggles. Building relaxation into a daily routine is encouraged. However, using relaxation during exposures is more often discouraged because it can maintain the fears one is working to improve. This becomes distraction. Distracting one away from uncomfortable feelings can suggest that the feelings of anxiety are "bad" and cannot be tolerated. Instead, mindfully noticing symptoms without judgement, and choosing to re-engage in the here and now is a common method practiced during exposures that stems from mindfulness. 


How does OCD impact athletes?

OCD can have an impact on any aspect of life. Athletes may experience anxiety related to performance, pressure, motivation and focus, and more. Sarah's piece on OCD impacting athletes can be viewed here: How OCD Interferes with Athletic Performance.