CBT with ERP
Cognitive Behavioural Therapy (CBT) including Exposure and Response Prevention (ERP) is considered by the National Institute for Health and Care Excellence (NICE) to be the gold standard approach for treating OCD.
ERP involves the therapist first helping the individual to understand the OCD through psychoeducation, before supporting them to confront the OCD-related thoughts or anxiety (exposure), and to resist following through with compulsions (response prevention). The approach involves gradually and safely exposing individuals to actual or imagined situations, or bodily sensations linked to the anxiety or discomfort. ERP does not throw anyone into the deep end.
The aim of ERP is for the individual to learn that nothing bad will happen as a result of them not performing their compulsions, and for anxiety and discomfort to reduce.
How much are family members involved in CBT with ERP?
Living with OCD can feel overwhelming and distressing, not just for the individual with OCD. Family members can unwittingly be pulled into OCD behaviours, which can end up maintaining and exacerbating symptoms. When I see young people, I also involve family members, usually parents/carers, where possible. I provide psychoeducation to family members about OCD and help them to recognise patterns of OCD-related behaviours that have developed over time within their system. I provide ongoing guidance to family members through the ERP process to enable them to support their young person with ERP tasks between therapy sessions.
Is CBT with ERP typically used as a standalone treatment?
CBT with ERP is often used as a standalone treatment for OCD. In some cases medication might be helpful in order to reduce distress to enable the individual to engage in the therapy. Additional therapeutic approaches may be used by the therapist to enhance effectiveness of CBT with ERP. For example, Eye Movement Desensitisation & Reprocessing (EMDR) therapy can be effective at reducing emotional distress to a more tolerable level. If a traumatic or distressing experience has contributed to the OCD developing, EMDR can also help to reprocessing this.
Can CBT with ERP be delivered online?
ERP can be delivered online or in person. However, it is generally recommended that younger children are seen in person.
An individual might feel more comfortable meeting from the comfort of their home, particularly if the OCD has to got to a point where it is difficult or distressing to leave the house or go to new places. However, in these cases, later in their therapy journey it may be helpful to meet for sessions in person as part of the process of challenging the OCD.
Where can I learn more about CBT with ERP?
You can find out more about CBT with ERP on the OCD UK website:
https://www.ocduk.org/overcoming-ocd/accessing-ocd-treatment/exposure-response-prevention/
OCD Action provides detail on what to expect in therapy:
https://ocdaction.org.uk/resources/good-therapy/
I offer compassionate, tailored support to children, adolescents, and young adults who are struggling with the challenges of OCD. Contact me today to explore how I or one of my team could help.