Treatment for OCD can be delivered through outpatient therapy, via an intensive outpatient therapy program (IOP), or at a residential treatment center. Some people can also benefit from self-help in the form of workbooks or online resources. Exposure and response prevention, often called ERP, is the gold standard treatment for OCD and will be a vital component of treatment. Below are several treatment options that we offer at our outpatient OCD program.
Cognitive Behavioral Therapy with Exposure and Response Prevention (CBT with ERP)
Exposure and response prevention (ERP) is a specific form of cognitive behavioral therapy (CBT) for OCD. ERP involves facing your fear (exposure) without engaging in a ritual, compulsion, or avoidance (response prevention). If possible, it is best to do this therapy with the guidance of an OCD specialist. ERP is regarded as the gold standard treatment for OCD.
Exposure and Prevention Treatment Steps
Step1: Understand your OCD and OCD symptoms.
Step 2: Identify target fears to work on.
Step 3: Develop an OCD hierarchy for your fears. Rank exposure to your feared trigger (without doing rituals/avoiding) on a scale from 1-10 in terms of the amount of anxiety the situation would produce for you. For example, perhaps touching a door handle and not washing your hands afterward would be a 6/10. The lower portion of your hierarchy will list the anxiety-provoking exposures, with exposures becoming more and more anxiety provoking towards the top of the hierarchy.
Step 4: Begin exposures with ritual prevention. Repeated exposures with ritual prevention will allow you to habituate (get used) to a fear. Engaging in avoidance or rituals makes your fears stronger, which is why treatment involves discontinuing rituals and avoidance.
Even when you reach the top of your hierarchy it is important to continuously engage in relapse prevention. Relapse prevention involves adopting a position where you learn to confront your fears directly when triggered, whatever the content. Whether you have completed your OCD treatment with a treatment provider or engaged in ERP for your fears on your own, it is of utmost importance to continue to engage in ERP in order to maintain your progress. Planned (i.e., setting time aside to do this) and unplanned exposures provide opportunities to practice the OCD treatment tools you have learned and engage in ERP in order to continue to decrease your OCD symptoms and face fears as they arise. There are many tools such as websites and self-help workbooks that provide ERP accountability.
Medication is another treatment option for OCD. Ideally, medication is added to CBT with ERP therapy, rather than taken on its own. Medication questions should be directed to a psychiatrist who treats OCD. Visit the International OCD Foundation’s Medication for OCD page for more information regarding medication.
Deep Brain Stimulation (DBS)
Deep brain stimulation (DBS) for OCD is an option for those who do not adequately respond to other standard OCD treatments like CBT with ERP and medications. DBS is a form of neuromodulation that involves placing electrodes on specific areas of the brain. A pulse generator is implanted under the skin, similar to a pacemaker. To learn more about this new treatment, visit the International OCD Foundation’s article on deep brain stimulation by Drs. Darin Dougherty and Benjamin Greenberg.