Why Past ERP Therapy May Not Have Worked for Your OCD
Compulsive Disorder Treatment
Obsessive-Compulsive Disorder (OCD) is a kind of anxiety disorder. A person with OCD experiences intrusive thoughts and compulsions to complete tasks. Sometimes these tasks are driven by a fear of germs, like constant hand-washing. Other times the compulsions are more like a tic, such as counting while walking or counting the number of times you lock a door.
One of the more common therapies for OCD in recent years is called Exposure and Response Prevention, or ERP. If you’ve ever gone to therapy for your OCD and come away feeling unmoved, you’re not alone. There are several reasons that this form of therapy might not have worked for you.
Before you dive in, remember that our professionals are always here to help
What Is Exposure and Response Prevention (ERP)?
Exposure and Response Prevention (ERP) is a structured form of cognitive-behavioral therapy specifically designed to help people with Obsessive-Compulsive Disorder (OCD). The primary goal of ERP is to break the cycle of obsession and compulsion by gradually exposing individuals to the thoughts, images, objects, or situations that trigger their OCD in a controlled environment. Rather than allowing them to perform their usual compulsive behaviors in response to these triggers, the individual is encouraged to resist the compulsion.
The "exposure" part refers to deliberately confronting feared stimuli—whether it be obsessive thoughts, specific situations, or anxiety-provoking actions. The "response prevention" involves refraining from engaging in the compulsions that typically follow the trigger. Over time, this process helps to reduce the anxiety associated with the obsession, retraining the brain to recognize that not performing the compulsion does not result in the feared consequence.
This method is based on the principle of habituation, meaning that repeated exposure to anxiety-inducing stimuli without the usual compulsion will eventually diminish the fear response. ERP therapy is often tailored to each individual’s OCD symptoms and is a highly effective treatment when done properly under the guidance of a trained therapist.
Why Past Therapy for Your OCD May Not Have Worked
If you’ve undergone ERP therapy in the past, you probably heard the general idea behind how it’s supposed to work. Your brain gives off a warning and you respond to that signal with a compulsion. The treatment supposes that by triggering a person with OCD, then forcing them to resist the compulsion, the trigger can be disconnected from the compulsion.
This rationale isn’t always successful though. Here are some situations where this approach fails:
• Exposing someone with OCD to their triggers habitually can do more harm than good.
• If the person’s compulsions change theme (i.e. from hand washing to checking the locks on doors) the habituation is less useful.
• Consistently exposing someone to their triggers to desensitize is often an unrealistic ideal.
• ERP enforces the idea that anxiety is undesirable and abnormal.
Treatment-Resistant OCD
Another possibility is that your OCD might be treatment-resistant. Treatment-resistant OCD means standard treatments aren’t addressing compulsions or intrusive thoughts. So, if you think you might have treatment-resistant OCD, think about these alternatives.
• Exploring Medication with Your Therapist: There are several FDA-approved medications on the market. Depending on several factors like genetics, body chemistry, other medications you’re taking, missed doses, and drug and alcohol use, these prescriptions may or may not work. You might need to be open to experimenting with your medication types and dosages to find what can work for you.
• Augmentation Treatment Strategies: Augmentation therapy treats OCD symptoms separately. This strategy can improve the relief of symptoms. Using a combination of medications, augmentation might use antidepressants or other treatments to help someone who still doesn’t experience remission with one medication.
• Why Psychotherapy Might Be Failing: Psychological treatments have come a long way, especially to treat OCD. However, we’ve already seen that some of these treatments often still lead to relapses. This could be for multiple reasons, including not being ready for therapy, the wrong type of therapy, lack of connection with your therapist, and a lack of social support.
Getting the Help You Need
You are not alone in your battle with obsessive-compulsive disorder. There are treatment options out there for you, and with some patience and self-compassion, you can find what works for you. Here are some ideas for how to find the help you need:
• Support Groups: Sometimes knowing you’re not the only one going through this is all it takes to feel better. Support groups are a great way to find support outside of your close friends and family. They’re also a fantastic place to take friends or family members who you want to support you but perhaps don’t fully understand your condition.
• Talk with A Therapist: The support of a specially trained therapist can be a monumental tool for gaining control of your OCD symptoms. If you’re seeing a therapist currently and feel you’re not meshing with them, try not to feel guilty. Therapists are here to help you, and if you’re not connecting with one therapist, it’s okay to seek help from someone else.
Ready to tackle OCD treatment? Reach out today!
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