#53- Treating OCD: Does ERP Really Work?

There’s a treatment called Exposure and Response Prevention (ERP). Therapists who work with Obsessive-Compulsive Disorder (OCD) know all about it. It’s a specialized form of CBT that is used to treat anxiety and OCD issues. Unfortunately, it has become a ‘cornerstone’ of OCD treatment. On the surface, the approach makes so much sense that nobody even bothers to question it. The logic is simple. The idea is to expose clients to anxiety-provoking thoughts or situations, while encouraging the person to refrain from their habitual compulsive or avoidant behaviors (e.g., handwashing, checking, excessive cleaning, etc). The hope is that the client will learn that his fears are baseless, and that by tolerating distress and uncertainty, he will get passed being stuck in repetitive behaviors and compulsive rituals to relieve anxiety. Sounds good right? So what’s the problem?! The problem is that the method is designed to treat only the superficial behavior. With OCD, the compulsive behavior is what we see; however, this only the tip of the iceberg. Underneath, there is a ‘massive iceberg’ below the (water’s) surface which is a debilitating sense of aloneness and isolation. It is the unconscious experience of aloneness, and difficulty in connecting with others, that drives the surface behavior and compulsions. Ultimately, if this core issue of abandonment is not addressed, the therapist is ‘spinning his wheels’ since the underlying issue remains unresolved. The result is that the client ultimately falls back into his old patterns. This podcast will address what needs to happen for lasting change to take place.