As I have mentioned in many of my articles, exposure and response prevention (ERP) therapy is the front line treatment for obsessive-compulsive disorder as recommended by the American Psychological Association. Though it can be intensely anxiety provoking and difficult to do, this evidence-based therapy produces results that are often dramatic. I wholeheartedly believe ERP therapy saved my son Dan’s life when he was tormented by severe OCD.
In a thought-provoking post entitled “No one should do exposure and response prevention,” Dr. Jonathan Grayson argues that nobody should engage in ERP therapy just because the experts say it is the right thing to do. Rather, for it to work, the person with OCD needs to truly believe that this therapy is the best way to proceed. In short, the desire to participate in ERP therapy needs to come from within. While those with OCD can be encouraged to embrace this therapy, they can’t be forced.
Though this advice can apply to other therapies for different disorders, it can get quite complicated in reference to OCD. Even though people with obsessive-compulsive disorder typically know their obsessions and compulsions are illogical (just read any first-person blog by someone with OCD and you are bound to see a phrase such as, “I know this sounds crazy but….”) most find it incredibly difficult to give up the “safety” of their rituals (a requirement of ERP therapy). This is true even when they realize their sense of security is false. It just doesn’t matter – it is a risk that many with OCD are either unwilling or unable to take. Conversely, because those who struggle with OCD are often steered by what they perceive is right, they might agree to attempt ERP therapy because it is the “right thing to do,” not because they truly are committed to it and believe it will help them. They go into ERP for the wrong reasons and are unlikely to be successful.
When my son Dan spent nine weeks at an intensive residential treatment program for OCD, he learned a lot about how OCD operates — it is tricky and deceitful, and hones in on what matters most to the people it latches onto. It tries to convince those with OCD that it is protecting them, when in reality it is destroying their lives. Once Dan understood this, he quickly came to the conclusion that ERP therapy was what he needed — it was his ticket to freedom. As I said above, those with OCD know they are acting irrationally. But because they are rational people and can potentially understand their disorder better than anyone, there is hope. There is good reason to believe many who struggle with OCD will embrace ERP therapy once they actually understand their disorder and how ERP therapy can help.
It is far from easy to muster the courage to fight OCD, but it is possible. Children, teenagers, and adults can all benefit from ERP therapy. Empowered with knowledge, strength and desire, those with this potentially devastating disorder can move forward and take responsibility for their own recovery. And while the battle might be long and torturous, the choice to keep fighting — for all the right reasons — is what really matters.