The preferred treatment for Obsessive Compulsive Disorder (OCD) is Cognitive Behavioral Therapy (CBT), with or without the used of medications. One type of CBT that is used widely in the treatment of OCD is Exposure and Response Prevention (ERP).
OCD is typified by obsessions (intrusive thoughts/images/impulses/urges that cause distress) and compulsions (rituals, acts, behaviors, mental rituals that are performed to alleviate the distress). Obsessions cannot be directly conquered. What can be dealt with and changed is the way an OCD sufferer reacts to obsessions — the compulsions.
ERP is essentially about exposing an OCD sufferer to obsessions and not responding through performing compulsions. In other words, ERP is about not performing compulsions.
ERP is done in a structured way, usually through the help and guidance of a trained therapist who is familiar in the use of CBT and ERP.
Basically what happens in ERP is the sufferer thinks about a particular obsession or puts himself into a situation that will trigger an obsession (the exposure) and then resists performing compulsions (response prevention).
Initially the sufferer will be exposed to increased anxiety. Normally the sufferer would perform compulsions to alleviate the anxiety but in ERP compulsions are not performed. What has been found is that through repeated exposures, anxiety levels begin to go down on their own, without the benefit of performing compulsions.
In ERP, a sufferer’s behavior is changed by not performing compulsions, which is the usual way of reacting to an obsession.
Typically a trained therapist will discuss at length how OCD manifests within a sufferer. A game plan is then developed with the sufferer and the plan is put into action. The sufferer exposes himself to an obsession and practices not responding through compulsions. The therapist keeps track of progress and offers suggestions for improvement.
ERP can be done in a graduated format. For instance a problem can be divided up into manageable pieces and each piece is put through the therapy, one at a time, usually from least anxiety provoking to most anxiety provoking. This way the sufferer practices with the least threatening piece first, learns how to overcome that piece and then moves on to the next piece on the list.
Normally a sufferer will work on one aspect of their OCD at a time and repeatedly expose himself to that aspect, practicing not performing compulsions, until there is no rise in anxiety experienced. At that point the sufferer has overcome that aspect and can then move onto the next aspect to be worked on.