Exposure with Response Prevention (Cognitive Behaviour Therapy) Benefits Research shows that the treatment known as "exposure with response prevention" (or "exposure with ritual prevention") is the most effective psychological approach for treating OCD. Studies show that about 80% of people who complete an intensive treatment program are significantly improved by the experience. Furthermore, people who have been through this treatment often have relief from their OCD problems for a long period of time, even after treatment has ended. This is one major advantage over medication treatments which may work only as long as the medication is taken. Note that this treatment is sometimes referred to as "cognitive behaviour therapy" (or CBT), although CBT is really a general term and applies to some other treatments as well. What it is What is exposure with response prevention (abbreviated EXP/RP)? * Well, to put it simply, exposure means doing the actions, or thinking the thoughts, that create discomfort or fear; * response prevention means making a deliberate effort not to do the rituals (compulsions) that reduce this discomfort. So, for example: A person who worries about germs or contamination would be asked to touch objects that would make them worry about being contaminated, while at the same time resisting the urge to wash or clean. A person who constantly checks that their electrical appliances are unplugged might be asked to leave their home without checking and then to imagine that their house burned down. A person who had to dress in a certain fashion to avoid bad luck might be asked to dress in a another way that would, in their mind, bring about disaster. Why would one want to do these things? For two reasons. When we expose ourselves for long periods of time to objects, thoughts, or situations, that make us anxious, our anxiety will eventually reduce. This is because of a process called habituation, the same process that makes a cold swimming pool feel warmer after we've been in it for awhile. In the same way, touching a contaminated object may bring on a lot of anxiety, but this anxiety will eventually go away on its own, even if we do not wash. Furthermore, the more often we expose ourselves to the things we fear, the more the fear will decrease. When we take the risk of facing our fears, and not using rituals to get rid of them, we learn that our fear was groundless. In other words, we learn that certain objects are NOT dangerous, that the house will NOT burn down, and that we do NOT need to dress in a certain way. Please note: EXP/RP exercises are usually done in a gradual fashion, starting with objects or situations that create a moderate level of fear before moving on to more challenging exposures. There is also evidence that many people with OCD have some general beliefs that contribute to their problems. Persons with OCD often: believe that they should be able to control their thoughts, feel highly responsible for events that they might be able to control, and have perfectionistic beliefs Therapies have been developed that focus on changing these thoughts and beliefs, and these therapies appear to work quite well. However, research has yet to show that this form of therapy is any more effective than exposure with response prevention. In fact, therapies that focus on thoughts and beliefs may be most effective when they involve some exposure as well. These is no doubt that exposure with response prevention is an effective form of therapy for most people with OCD, if they are able to do it. The challenge of this therapy is that giving up old OCD habits can, in the short run, create a lot of fear and doubt. These feelings are unpleasant and can discourage some people from following through on exposure with response prevention exercises. Medication treatments can sometimes help reduce the intensity of obsessive worries for such persons, making them more comfortable to pursue this form of therapy. Although having a trained therapist to assist with exposure with response prevention is often helpful, some people wish to try EXP/RP on their own. Self-help books such as Edna Foa's "Stop Obsessing" have good guidelines for doing EXP/RP, both in a gradual way, and more intensively. For some people, this may be enough to greatly improve the problem. For others, especially if the obsessions and compulsions are more severe, it would be wise to seek treatment with an experienced professional. Information about professional contacts can be found on this website. Laine Torgrud, Ph.D. Clinical Psychologist