How Exposure and Response Prevention (ERP) Therapy Addresses OCD in Young Adults
Reading Time: 7 minutesYoung adults with obsessive-compulsive disorder (OCD) struggle with a range of symptoms including distressing and intrusive thoughts and repetitive behaviors. One of the most effective approaches for treating OCD is Exposure and Response Prevention (ERP) therapy. ERP therapy works by interrupting the OCD cycle of obsessions and compulsions. Young adults learn to tolerate discomfort without resorting to compulsive behavior.
In this article, we take a closer look at how ERP therapy works to relieve symptoms of OCD. We’ll also look at how Newport Institute’s OCD treatment integrates ERP therapy with other therapeutic modalities to create sustainable healing for young adults.
Key Takeaways
- Exposure and Response Prevention (ERP) therapy works by helping young adults to tolerate distress rather than turning to compulsive behaviors.
- ERP therapy is gold standard of care for OCD, leading to significant improvements for about 80 percent of patients.
- The elements of ERP therapy for OCD include psychoeducation, exposure to triggers, and response prevention techniques.
- This type of therapy can be integrated with other modalities to address young adult mental health issues that occur alongside OCD.
What Is Exposure and Response Prevention Therapy?
ERP therapy is a type of Cognitive Behavioral Therapy. The goal of ERP therapy is to give people with OCD greater insight into their behaviors associated with the disorder. In addition, ERP helps patients learn to stop using compulsive behaviors to cope with their obsessions. Research on ERP has shown it is extremely effective for OCD. In fact, it is now the gold standard of care for obsessive-compulsive disorder. Research shows that 80 percent of patients who participate in ERP therapy for OCD experience relief from symptoms.
The use of ERP therapy for OCD started in the 1970s. It was formulated by Stanley Robinson, who drew from previous research in this area, including studies on classical conditioning.
The basis of ERP therapy comes from behavioral scientist Joseph Wolpe. Wolpe’s method of systematic desensitization exposed patients to anxiety-provoking situations. Then they used relaxation skills to reduce distress and sensitivity to triggers.
The OCD Cycle of Obsessions and Compulsions
Cycles of obsessions and compulsions are at the heart of OCD. In other words, people with OCD first experience a trigger, such as being with a particular person or in a particular place, or having an obsessive thought.
Common OCD obsessions include:
- Germs
- Fear of getting hurt or someone they love getting hurt
- Taboo thoughts about sex or violence
- Dread of hurting someone by accident, known as harm OCD
- Anxiety about one’s sexual orientation
To reduce the distress related to this obsession, people with OCD use a compulsive behavior, like counting, washing their hands repeatedly, or checking things (such as the oven or light being turned off).
These compulsions may provide temporary relief from anxiety. But they ultimately keep the cycle of obsessions and compulsions going.
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How ERP Therapy Treats OCD in Young Adults
Exposure and Response Prevention therapy works to interrupt this OCD cycle. In ERP therapy, young adults with OCD are exposed to triggering situations. Then they practice responding to them with new strategies that replace their repetitive, compulsive actions.
ERP therapy doesn’t try to remove triggers for patients’ obsessions. Instead, the exposure process helps young adults learn to stop avoiding potentially disturbing situations or thoughts. Hence, young adults with OCD gain skills for coping with distress and discomfort, without resorting to compulsive behaviors.
Over time, as young adults practice ERP, their obsessive thoughts begin to have less power over them. That’s because ERP gives them the tools to cope with the obsessions. As a result, the intrusive thoughts no longer seem so scary and overwhelming. And in addition, their obsessions gradually begin to decrease in both frequency and intensity. Here’s how the cycle works:
An Example of ERP Therapy for OCD
An example of how ERP therapy works involves fear of germs and contamination—a common OCD obsession—and repeated handwashing, the compulsive behavior typically triggered by this fear. An ERP therapist would have the patient touch a doorknob, dishwashing sponge, bathroom sink, or other object that they view as a contaminant. Then the therapist might ask the patient to touch their face to make the situation slightly more triggering.
Next, the therapist guides the patient to use response prevention techniques to resist washing their hands repeatedly. Instead of defaulting to this compulsive ritual, they learn to tolerate the anxiety of having potentially exposed themselves to germs. And with repeated practice, they learn that they can resist compulsions and nothing terrible will happen.
Components of ERP Therapy for OCD
Here are the various steps of ERP therapy for young adults.
Step 1: Psychoeducation on How ERP Works
In the psychoeducation component of ERP, young adults with OCD learn more about the disorder and how their obsessions and compulsions work.
In addition, the therapist will also share information about how ERP works. This includes the goals of ERP therapy and the different components of the process.
Step 2: Creating an Exposure Hierarchy
To begin ERP therapy, patients work with their therapist to make a list of their triggers, using a system called the Subjective Units of Distress Scale (SUDS). They rate the severity of each obsession in terms of how much distress it causes them. Early in therapy, the patient and therapist will focus on a trigger that is less intense for the patient. As ERP continues, they will work with more distressing triggers.
Step 3: Exposure
During the exposure phase of ERP therapy, the patient is exposed to a trigger that creates obsessive thoughts, distress, and discomfort for them. Types of exposure include:
- In vivo exposure: directly facing an actual feared object or situation
- Imaginal exposure: vividly imagining the anxiety trigger, such as a past traumatic experience
- Interoceptive exposure: inducing physical symptoms that create distress, such as spinning around to induce the dizziness that a patient may feel during a panic attack
- Virtual reality exposure: facing OCD anxieties using simulations of the feared experience, such a flying or driving on a highway
Step 4: Response Prevention
After the exposure step is response prevention. In other words, the patient and therapist work on reducing the compulsive behavior that they usually turn to after a trigger.
The therapist gives clear instructions on how to tolerate distress and avoid or reduce compulsive rituals. Response prevention strategies include:
- Learning to tolerate anxiety
- Delaying OCD rituals
- Modifying the rituals
- Avoiding rituals completely
Step 5: Exposure Homework
Therapists can provide ERP therapy in either individual or group sessions. Patients start by using response prevention techniques in therapy sessions. Next, they begin practicing them outside of sessions. They do exposure homework, which involves exposing themselves to triggers and then resisting the urge to engage in compulsive rituals.
Step 6: Relapse Prevention Planning
An essential part of the ERP therapy process is relapse prevention planning. The patient and therapist discuss ways to keep OCD symptoms from returning. Moreover, they make a clear plan for addressing relapses.
Why Does ERP Therapy Work?
Researchers have various theories about why ERP works for OCD in young adults, as well as other age groups, including adolescents. Exposure and response prevention techniques appear to work on a neurobiological level as well as a cognitive level, directly impacting the brain. Furthermore, Exposure and Response Prevention therapy works through what’s known as habituation. Habituation refers to the gradual decrease in fear and anxiety as the patient has repeated exposures.
Another mechanism in ERP therapy is inhibitory learning. This is the process through which new experiences inhibit fear-based beliefs. That is, ERP patients find out that not completing compulsive behaviors doesn’t result in terrible things happening. As a result, they are less fearful, and it becomes gradually easier for them to resist compulsions.
Over time, young adults learn to accept and live with some level of uncertainty, rather than constantly trying to avoid any anxiety or unknown. Through ERP therapy, young adults with OCD gain the skills they need to confront their fears and move into a thriving, empowered life.
Know the Facts
In one study, 8 out of 10 patients experienced symptom relief as a result of ERP therapy.
Signs That a Young Adult Would Benefit from OCD Treatment
If you think you or a loved one might have OCD, the first step is a full OCD assessment with a mental health professional. A psychiatrist or other mental health clinician can assess whether an individual is struggling with OCD or another type of anxiety, using criteria listed in the Diagnostic and Statistical Manual of Mental Disorders (DSM-5). OCD is also associated with anxiety issues such as severe generalized anxiety and social anxiety, panic disorders, body dysmorphia, agoraphobia, skin-picking, and trichotillomania (hair-pulling).
The following signs indicate that a young adult requires an OCD assessment:
- Trouble sleeping due to obsessive imaginings and intrusive thoughts
- Taking an excessive amount of time to complete homework, due to starting over repeatedly or rechecking all the answers
- Needing to check lights, doors, and windows before leaving the house
- Repeated handwashing, sometimes to the point that their skin becomes raw and bleeds
- Substance use—using drugs or alcohol as a way to cope with the distress caused by OCD symptoms
- Tic disorder, such as repeatedly blinking, shrugging, or throat-clearing
How Do I Find an ERP Therapist Near Me?
Should your child receive an OCD diagnosis, the doctor or clinician may be able to recommend a therapist who specializes in treating OCD using ERP. In addition, the International OCD Foundation maintains a database of OCD specialists throughout the country. Exposure and Response Prevention therapists who work with young adults should be highly trained and experienced in using this modality.
Newport Institute offers young adult mental health assessments at no charge, and also provides specialized programming for OCD that includes 4.5 hours of ERP therapy daily. Contact us today to schedule an assessment, in person or virtually, and learn more about our approach to OCD treatment.
Exposure and Response Prevention as Part of an Integrated OCD Treatment Model
ERP therapy is one of the most effective approaches for treating obsessive-compulsive disorder. However, young adults with OCD are more likely to find long-term, sustainable recovery when ERP therapy is part of a treatment plan that addresses root causes and associated mental health issues—not just OCD symptoms.
That’s why Newport Institute’s OCD programming for young adults addresses underlying causes and co-occurring issues, such as trauma, depression, and generalized anxiety disorder. In addition to treating OCD, our program addresses common issues that occur alongside the disorder, such as severe social anxiety, body dysmorphia, agoraphobia, trichotillomania, and panic disorders.
Find Out More About Newport’s Specialized Young Adult OCD Programming
Our OCD treatment include a wide variety of modalities, provided by a multidisciplinary treatment team. Each young adult’s treatment plan for OCD includes 4.5 hours daily of ERP therapy, delivered in individual sessions, group sessions, and exposure homework.
In addition to ERP, our OCD treatment for young adults incorporates psychiatric care and medication management, family therapy, experiential activities like art and music therapy and outdoor adventures. We also provide a robust life skills component to prepare emerging adults for success in their education and career paths.
Contact us today to learn more about our specialized young adult OCD treatment and schedule an assessment for you or a loved one.
Frequently Asked Questions
What is ERP for OCD?
What is an example of ERP therapy for young adults?
Is ERP better than CBT for OCD?
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