Compulsions are the behavioral part of obsessive-compulsive disorder (OCD) that keeps the obsessive thoughts coming back louder and more upsetting than before. They begin as ways to get temporary relief from distressing, unwanted thoughts. However, the relief is short-lived. When you do compulsive behaviors in response to intrusive thoughts, it can trick your brain into having them more often. Exposure and response prevention (ERP) is an effective treatment for OCD because it helps you build up a resistance to your obsessions in small, manageable doses. You begin with your least upsetting triggers and face them in a controlled manner. Resisting your urges — the response prevention element — is what makes it effective.

Coming up with exposure ideas that are challenging but not overwhelming takes some creativity. In this blog post, we’ll describe seven techniques you can use for response prevention during OCD treatment.

7 strategies used in exposure and response prevention for OCD

There are a couple of theories about how and why ERP works. One is the concept of habituation. This means that your fear and anxiety decrease as you’re exposed to a distressing stimulus several times. The other is inhibitory learning. This means that you build new memories with each experience. As you have more positive experiences, these memories override your fear-based memories and you feel less anxious.

For a method to be most effective, you need to avoid replacing one compulsion with another. Trying to reason with intrusive thoughts can quickly become a game of creating new thought-based compulsions. You also need to avoid strategies that distract you from your stress or what’s happening in the present moment. 

Try using the following strategies during exposure and response prevention for OCD:

• Delay techniques — Waiting to engage in compulsions helps build up your tolerance for discomfort and uncertainty. As your brain gets used to waiting longer and longer, your urges become less urgent. You start to learn that the feared outcome isn’t necessarily linked with the compulsive behavior. 
• Mindfulness-based approaches — It takes a deep reserve of calm and inner strength to build up distress tolerance skills. Grounding, deep breathing and other mindfulness techniques can help you stay in the present moment when your mind wants to spin out of control. Practicing mindfulness outside of ERP can help make these techniques more effective.
• Cognitive restructuring — With this approach, you should be careful not to fall into the trap of trying to prove or disprove irrational thoughts. Choosing more balanced, alternative thoughts to focus on isn’t always helpful since people with OCD usually know their thoughts are irrational. Cognitive restructuring for OCD works best when dealing with the nature of thoughts themselves. When intrusive thoughts or urges come up, you might tell yourself, “I have a lot of other thoughts. My discomfort doesn’t make these thoughts more important or more true.” 
• Defusion strategies — Thought defusion techniques help you distance yourself from your thoughts so they’re less urgent, distressing or important. You might create some distance by saying, “I’m having a thought …” or imagine your thoughts as leaves floating on a river. 
• Acceptance strategies — Accepting your intrusive thoughts as part of your OCD can help make them seem less distressing. It can also help you stop judging yourself or thinking you’re a bad person for having these thoughts. In practice, you would just remind yourself that these thoughts are a part of a mental health condition and they don’t have any reflection on who you are. Obsessions and compulsions are usually ego-dystonic in nature, which means they go against the grain of your personality.
• Commitment strategies — Sometimes intrusive thoughts are an opportunity to take a committed action that’s more aligned with your values. Recognizing this choice and coming up with values-aligned actions can help prepare you to make different choices when urges come up. This approach is taken from acceptance and commitment therapy (ACT), but it can be applied to ERP. ACT focuses on accepting things you cannot change, such as intrusive thoughts, and doing what you can to stay present and control your responses. If your OCD tells you you shouldn’t make dinner because you might hurt yourself or someone else with a kitchen knife, the committed action would be to make dinner because you want to care for your needs.
• Self-as-context —This technique is another strategy taken from ACT. It helps you separate yourself from your thoughts by focusing on what you can control. You might picture yourself as a bus driver, and your intrusive thoughts and urges are all passengers on the bus. Instead of listening to them, you would try to stay focused on where you want to go. 

Receive ERP as part of a personalized treatment plan at Lightfully

Response prevention isn’t about white-knuckling through anxiety. It’s about learning that you can tolerate uncertainty and discomfort without engaging in compulsions, ultimately leading to true freedom. ERP works best as part of a comprehensive treatment program that includes medication and other types of therapy. Many of the techniques in this post are taken from acceptance and commitment therapy (ACT). Dialectical behavioral therapy (DBT) also includes helpful distress tolerance and emotion regulation skills.

Resisting your compulsions is only one part of the bigger picture of your mental health journey. At Lightfully, we provide trauma-informed, whole-person-centered mental health treatment. Our Precision Care Model (PCM) combines evidence-based techniques like ERP, ACT and DBT. Each person receives a personalized treatment plan that addresses four core life processes: thoughts, feelings, behaviors and relationships.

Are you looking for a treatment provider who’s experienced with ERP? Let’s talk about it. Reach out to our Admissions Concierge Team today.