Exposure and Ritual Prevention (ERP) is an effective treatment for many individuals with obsessive-compulsive disorder (OCD).
Those engaged in ERP confront their anxiety triggers while refraining from performing their usual anxiety relieving rituals. Over time, this process helps reduce or extinguish OCD symptoms. ERP is typically provided in tandem with cognitive-behavioral therapy.
ERP and Habituation
Successful ERP depends on the natural process of habituation, or getting used to something that is unpleasant. Habituation requires no effort on our part, and can happen without our realizing it. For instance, if we move to a new home located close to a busy airport, we eventually stop hearing the planes flying low over our neighborhood. Though the annoying noise doesn’t disappear we get used to it, so it no longer registers in our awareness.
In ERP, habituation is related to a reduction in anxiety that occurs with the passing of time. Put more simply, as people get used to something over time, their anxiety lessens. This habituation happens two ways in ERP: “within-trial,” and “between-trial.”
Within-trial and Between-Trial Habituation
Within-trial habituation occurs during an exposure exercise, where people confront something that makes them anxious, such as holding a doorknob, while refraining from their usual anxiety relieving ritual, such as washing hands. By holding onto the doorknob for increasing amounts of time without hand washing, the person’s anxiety gradually goes down. He or she gets used to, or habituates to, holding onto the doorknob.
Generally, the more challenging an exposure exercise is for an individual the longer it takes for within-trial habituation to occur.
Between-trial habituation is the gradual reduction of a person’s anxiety between the exposure exercises. For this to occur the exercises must be repeated often, so that exposure anxiety is increasingly reduced. As the exposure anxiety continues to lessen, so does the anxiety experienced between exposure exercises.
As Often As It Takes
The key, then, to successful ERP is doing exposure exercises long enough to accomplish in-trial habituation, and to repeat the trials frequently - and enough times - to get between-trial habituation as well.
Source: Beyond OCD
Photo credit: Hernan Pinera
