The Paradox of Evidence Based Care for Anxiety Disorders

ERP at its core

by Sue Moreland, MSW, LICSW  and Bluestone Psychological Services

People with obsessive-compulsive disorder (OCD) seek care because it significantly impacts their lives. They feel unable to control their compulsions, such as checking/rechecking, cleaning, or counting. This creates a vicious cycle because the anxiety keeps coming back, even when they do their compulsions repeatedly.

ERP helps those with OCD break the cycle.

Research shows that effective treatment involves learning skills to tolerating anxiety and discomfort, which paradoxically reduces the intensity of anxiety over time. Evidence-based Exposure Response Prevention (ERP) therapy is built on this premise.

In ERP therapy, patients will collaborate with a therapist to first understand your OCD. You may be embarrassed about rituals or intrusive thoughts, but they are not unusual among fellow sufferers. A therapist will help you develop a willingness and stamina to tolerate the anxiety which takes the wind out of its sails, rendering compulsions unnecessary to manage the anxiety.

Three Ideas for OCD to Try Right Now

1. Separate – OCD gives you the false message that it is coming from your own ideas. Far from the truth, it is actually a misfire in your brain. Start by separating yourself from the message. “I am me. And that thought is my OCD.”
2. Let It Pass – less response is best. Allow time to pass and often the false OCD message and desire to compulse will lessen.
3. You Do You – OCD can be exhausting. Take time for yourself. Do the things you like. See the people you like. Move your body.

ERP can be challenging, like any personal change project. It takes time and a willingness to do difficult things. However, for those who stick with it, there is a snowball effect, and it gets easier over time. One of the biggest payoffs is the time saved when you are no longer doing compulsions for hours each day, only to have temporary relief.

ERP is difficult to achieve independently and is not recommended. A therapist trained in ERP therapy will help you create a plan and navigate challenges that arise. If ERP is the right therapy for you, it often only takes 2-3 months to make considerable progress. Medications are not necessarily a part of ERP but can help, especially as treatment begins.

Psychiatric Medication for Collaborative Treatment of OCD

Research shows that SSRIs are the best option. We have a trained team of psych med providers who can collaborate with you and your goals to reduce your obsessions and compulsions.

There is considerable evidence that ERP is the treatment of choice for those who suffer from OCD. Learning methods to manage stress, such as mindfulness and exercise, can help as well but usually do not address the root of the problem. If you are interested in ERP care, it’s best to talk with a trained therapist who can help you understand how it works.

We don’t really know what causes OCD for sure. There is some research which suggests it may be trauma related. Other ties this to the intersection between heredity and viral illness, particularly strep throat in childhood.

 

Add’l content provided by David A. Morris, LCSW