Josh Hillebrand LCSW

One of my specialties is treating Obsessive Compulsive Disorder (OCD) with a type of therapy called Exposure and Response Prevention (ERP). This is one of the most researched treatments for OCD. To understand how it works, you also have to know a bit about how OCD works.

OCD is characterized by obsessions and compulsions. Obsessions are unwanted intrusive thoughts and compulsions are any action or behavior that attempts to provide relief from the obsessions. But, as people begin using compulsions, they often have to do more and more to cope with the same obsessions. I’ve worked with many people who started treatment when it felt like they were spending most of their waking hours engaged in compulsions. This left them feeling burnt out, stressed, depleted and like they didn’t have any time or energy for all the good stuff in life.

The unwanted intrusive worries that characterize obsessions can usually be categorized into different themes. Here are some examples of different OCD themes:

• Contamination OCD: you might have intense worries about germs and use compulsions like excessive hand-washing, doing the laundry several times a day, going through a bottle of hand sanitizer in a few days or less
• Harm OCD: worries about impulsively hurting someone else or hurting oneself, blurting something inappropriate out loud, etc. Compulsions might include avoiding sharp objects, biting the tongue, staying away from subway platform edges and keeping your hands in your pocket.
• Pedophilia OCD: intrusive thoughts that you might be a pedophile even though you really aren’t. You might have compulsions that tell you to avoid going anywhere near kids or tricks to get the thoughts to go away (which usually only works temporarily)
• Religious/Morality OCD: worries about being immoral, doing something profane or sacriligious, having “bad thoughts” about religious figures. Compulsions might include avoiding religious practices and activities, or over-engaging in religious practices such as praying for forgiveness or mercy because of the “bad thoughts” multiple hours a day.
• There are many more themes too!

ERP works by helping clients approach and expose themselves to the distressing stimuli (i.e., we’re going to stand on the edge of the subway platform, we’re going to touch the inside of the public trash can). It also helps clients learn skills to decrease compulsions (this is the Response Prevention aspect of ERP). This can be one of the most challenging types of therapies for anyone to do and requires a skilled therapist trained in ERP to support clients as they seek change. While these exposures can be intense in the short term, they provide longer term freedom and flexibility from a life controlled by rigid OCD rules and compulsions.