Question
Why is logic ineffective in treating OCD, and how does Exposure and Response Prevention (ERP) address the cycle of compulsions?
Answer
OCD follows a logical progression as sufferers engage in compulsive behaviors to neutralize or escape the distress caused by their obsessive thoughts. This behavior, although seemingly rational to the person, reinforces the cycle of OCD through negative reinforcement. The temporary relief from distress makes the behavior more likely to recur in the future. Therapists often refer to these actions as avoidance or escape behaviors, and when family members help in reducing the individual's distress, it is called accommodation.
ERP is effective because it breaks this cycle by targeting both obsessions and compulsions. Exposure allows the individual to face the obsessive thoughts without resorting to their usual compulsion, while response prevention prevents the compulsion that would typically follow. This process helps reduce the negative reinforcement loop, diminishing the compulsive behavior over time. Although newer methods like inference-based CBT show promise, ERP remains the gold standard in OCD treatment.
This Ask the Expert is an edited excerpt from the webinar, Exposure with Response Prevention (ERP) for Obsessive Compulsive Disorder (OCD), presented by Mandy Simmons, PsyD
