What is the role of exposure and response (or ritual) prevention (ERP) in the treatment of obsessive-compulsive disorder (OCD)?

Updated: May 17, 2018
  • Author: William M Greenberg, MD; Chief Editor: David Bienenfeld, MD  more...
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Simpson et al reported on a multimodal residential treatment program that integrated ERP treatment for OCD with ERP treatment that targeted eating pathology. Patients also received a supervised eating plan, medication management, and social support. The results were significant decreases in OCD severity, eating disorder severity, and depression in the 56 patients with both disorders. Greater improvement was seen in patients with bulimia nervosa than in those with anorexia nervosa. [34]

ERP is now usually administered as part of a broader program of CBT specifically designed for OCD. Other elements of CBT that are used include identifying and challenging the cognitive distortions of OCD symptoms (eg, intolerance of uncertainty, black-and-white thinking, focusing on unlikely extreme possibilities instead of viewing the future in a balanced manner, ascribing overimportance to thoughts, excessive concern about the importance of one's thoughts, inflated sense of responsibility). After making the patient aware of his or her irrational thoughts, the therapist works to have the patient counter them with more rational thoughts and do cost/benefit analyses regarding performing his or her rituals.

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