Monday, July 13, 2009

Exposure and Response Prevention

Studies have shown that the best treatment for OCD is Exposure and Response Prevention (ERP). ERP is pretty much just what it sounds like. A person with OCD exposes him or herself to something that they fear, without performing the usual compulsion afterward. For example, for me this might include riding the bus home from work without changing my clothes when I get home, and without washing my hands as soon as I walk in the door.

For a checking compulsion, it might include leaving the house without double- (or triple- or more) checking that the door is locked.

For a perfectionist OCD-er, it might mean purposely disorganizing a dresser drawer.

For someone with what is called "Pure OCD" (usually defined as having disturbing thoughts without physical compulsions), this usually would involve letting those thoughts come without trying to push them away, or without asking someone else for reassurance that you would never actually act on the thought (it appears to me that the most common forms of "Pure-O" are the fear of being homosexual and the fear of harming or killing someone close to you.)

ERP can be really difficult. Even if the danger isn't real, the fear is. But it's by far the most effective treatment. ERP works in two ways. One, because your body can't maintain an extremely high level of anxiety for a really long time (this is known as habituation), the fear you feel while not performing a ritual will always come down in time. And over the long term, as you expose yourself to feared activity and nothing terrible happens, your brain actually learns that the activity isn't so scary after all. Pretty awesome, really.

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