I recently received an email from a woman in her thirties who has had obsessive-compulsive disorder since she was a child. She came across one of my articles and was interested in learning more about exposure and response prevention (ERP) therapy, as she had never heard of it. She had been to all kinds of health care providers over the years, yet she had never heard of ERP.
Unfortunately, emails such as hers are not uncommon, but they sure are frustrating. She’s had OCD for twenty plus years and never heard of ERP? This realization jolts me out of my little corner of the world (or blogosphere) where everyone knows about ERP therapy because we talk about it over and over again. Is progress actually being made? Are we really getting the word out? Sometimes I just don’t think so.
It’s bad enough that so many people with OCD are not familiar with the proper treatment, but what is even more upsetting to me is when I see articles on OCD, or information on the Internet, and there is no mention whatsoever of ERP. I recently read an article discussing the use of high-intensity focused ultrasound for patients with OCD who do not respond to medication. The study mentioned in the article was conducted by Jin Woo Chang, M.D., Ph.D., with results published in the Journal of Molecular Psychiatry. Dr. Chang says:
“There is a need for non-invasive treatment options for patients with OCD that cannot be managed through medication.”
Hmm. He is talking about non-invasive treatment options. And there is no mention of ERP?
Someone searching for treatments for OCD who stumbles on this article might easily assume medication, surgery, and possibly this new ultrasound procedure are their only options. The truth is that the Cognitive Behavioral Therapy known as exposure and response prevention (ERP) therapy is the first line psychological treatment for OCD as recommended by the American Psychological Association. Why is that not included?
To make matters even worse, there are many health-care providers, including therapists, who are either not aware of ERP or choose not to learn about it or use it. To me, this is reprehensible. It’s similar to having a certain type of cancer that is known to respond well to a specific, evidence-based treatment, but your oncologist says to you, “I think we will try some other type of therapy instead.” Who among us would think this is a good idea?
I recently spoke at a conference where this topic came up. There was a pediatrician in the audience who also happened to be a mom whose daughter had OCD. She said that she had never heard of ERP therapy until she searched for the proper treatment for her daughter. So when parents had previously asked for her help, she suggested they see a therapist. That’s exactly what my son Dan’s long-time pediatrician said to us, and off our son went to the local therapist for four months of the wrong kind of therapy that only exacerbated his OCD.
And he is certainly not alone. Many people with OCD finally muster the courage to reach out for support, only to receive the wrong treatment. How devastating for those who are seeking help! They might believe their OCD is not treatable, or even worse, totally lose hope.
So what’s the answer? I wish I knew. I do know we need to keep talking — to each other, to all of our health-care providers and indeed, to anyone who will listen. The message is clear: If you have OCD, you need exposure and response prevention (ERP) therapy.
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