Exposure and response prevention, or ERP, is the form of cognitive behavioral therapy with the strongest evidence for obsessive-compulsive disorder. OCD is maintained by a loop: an intrusive thought causes anxiety, a compulsion relieves it briefly, and the relief teaches the brain that the compulsion was necessary. ERP breaks the loop. With a therapist, you build a ranked list of feared situations, then deliberately face them, starting with easier items, while refraining from the ritual or mental neutralizing that usually follows. Over repeated practice, anxiety peaks and falls on its own, and the brain learns the feared outcome does not occur or can be tolerated.
Exposures are tailored to your obsessions. Someone with contamination fears might touch a doorknob and delay washing. Someone with harm obsessions might write out the feared thought. Someone with checking compulsions might leave the house without rechecking the stove. Sessions typically run 60 to 90 minutes, once or twice weekly for 12 to 20 weeks, with daily homework. Studies show 50 to 60 percent of people who complete ERP improve substantially, and combining it with an SSRI at OCD-range doses helps many more. ERP is also used for specific phobias, panic disorder, body dysmorphic disorder and hoarding. For people whose OCD has not responded to ERP and medication, Deep TMS with the H7 coil is FDA-cleared and available at our Palm Beach Gardens office. Stedfast Psychiatry refers to ERP-trained therapists and coordinates medication throughout.