Exposure and Response Prevention
Exposure and Response Prevention, or ERP for short, is the first-line treatment for OCD. This evidence-based treatment is a type of behavioral therapy, in which an individual gradually faces their fears while resisting compulsions. When engaging in gradual exposure in tandem with reduction/elimination of compulsions, an individual can learn that they can handle their anxiety, that what they anticipated would happen is not as likely or as damaging as they had predicted, and that they do not need compulsions for anxiety to eventually go away on its own.
ERP is collaborative, meaning that clients work with their therapists to approach their fears in a gradual manner. At the same time, however, ERP therapists provide encouragement and guidance to motivate their clients to face their fears even when they might feel anxious.
In addition to ERP, I incorporate Acceptance and Commitment Therapy, or ACT for short, into my work with clients. There is growing evidence that ACT can be helpful in the treatment of OCD. I especially use it to support my clients’ in their efforts to engage in treatment and resist rituals.
ERP is also an effective treatment for other anxiety disorders, like Phobias (including Emetophobia), Panic Disorder, Social Anxiety, Separation Anxiety, and Agoraphobia.
Habit Reversal Training
Habit Reversal Training (HRT) is a multi-component behavioral treatment used to treat Body-Focused Repetitive Behaviors and Tic Disorders. It is comprised of four main parts– awareness training, competing response training, stimulus control, and social support. A typical length of treatment is 8 to 16 weeks. Awareness training involves recognizing and identifying signs that the habitual behavior is about to happen as well as identifying situations where these behaviors are more likely to occur. Competing Response training involves development of a counter-action that prevents the behavior from occurring. Stimulus control refers to external tools that can be used to prevent the behavior. Social support involves family, loved ones, and other individuals like teachers and peers, to help reinforce resisting the behavior.
Inference-based Cognitive-Behavior Therapy (I-CBT) is an evidence-based treatment based on the central idea that obsessions are inferences or doubts about what “could be”, or “might be” which arise in response to an obsessional narrative. In I-CBT, obsessional doubts differ fundamentally from reasonable doubts and real uncertainty in that they originate from a distorted obsessional narrative in the imagination as opposed to objective “common sense” reality. In I-CBT, the thought process overly relies on imagination and a distrust of the senses, and because the obsessions originate outside of the realm of objective reality, they can never be truly resolved by compulsions.
Similarly to ERP and ACT, I-CBT is collaborative and encourages clients to resist compulsions/engage in response prevention and live towards their values.
Schema Therapy derives from cognitive-behavioral therapy, attachment-based therapy, developmental psychology, and neurobiology. It posits that difficulties in adult life stem from unmet childhood needs. Because of this, the goal of treatment is to more fully develop the Healthy Adult, care and address the unmet needs, become more aware and replace the maladaptive coping methods, and provide space for the happy Inner Child.
While I am not yet an accredited Schema Therapy provider, I draw heavily upon Schema Therapy principles in my work with clients struggling with the effects of intergenerational trauma and family dynamics.
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