OCD and ERP Treatment PDF

OCD and ERP (Exposure and Response Prevention) Before the 1960s, OCD was considered unresponsive to psychotherapy (psychoanalytic and supportive approaches). The introduction of ERP in the 1960s significantly improved the prognosis for OCD. Numerous studies worldwide establishe...

OCD and ERP (Exposure and Response Prevention) Before the 1960s, OCD was considered unresponsive to psychotherapy (psychoanalytic and supportive approaches). The introduction of ERP in the 1960s significantly improved the prognosis for OCD. Numerous studies worldwide established ERP as a highly efficacious therapy for OCD. Abramowitz Meta-Analysis (1975–1995): ○ Reviewed 24 studies with over 800 patients. ○ Large pre-post treatment effect sizes (ES): 1.16 (self-reported outcomes). 1.31 (interviewer-assessed outcomes). ○ Improvements were maintained at follow-up. Specific Effects of ERP: ○ ERP’s effectiveness surpasses nonspecific therapy factors like time, attention, or therapeutic relationships. ○ Compared to relaxation controls in RCTs, ERP showed a large effect size (ES = 1.18). Van Balkom Meta-Analysis (86 studies): ○ Standalone exposure techniques had significant effects: 1.46 (self-reported symptoms). 1.47 (assessor-rated symptoms). ○ Results strongly support the effectiveness of ERP alone or with cognitive techniques. Mechanism of Exposure Therapy in OCD OCD involves a unique relationship between obsessional fears and compulsive behaviors: ○ Obsessional fears: Triggered by situations or thoughts that are not objectively dangerous. ○ Compulsions: Rituals that temporarily reduce anxiety but maintain it through negative reinforcement. ERP teaches patients that: ○ Obsessive fears are excessive. ○ Compulsive behaviors are unnecessary for safety. ○ Anxiety and obsessional thoughts are safe and tolerable. ERP weakens the association between: ○ Obsessional stimuli → anxiety. ○ Compulsive rituals → relief. Challenges for Other OCRDs 1. Body Dysmorphic Disorder (BDD): ○ BDD shares similarities with OCD: Persistent, anxiety-provoking thoughts about appearance (obsession-like). Ritualized behaviors (e.g., checking mirrors, avoidance). ○ Exposure therapy helps patients confront fears (e.g., going out without makeup) and resist compulsive behaviors (e.g., mirror-checking). 2. Trichotillomania (TTM) and Skin Picking: ○ Distinct from OCD: No obsessional fears. Behaviors are positively reinforced (pleasurable or satisfying), not fear-driven. ○ ERP is not effective; instead, treatment includes: Habit reversal (competing response strategies). Avoiding high-risk cues that trigger behaviors. 3. Hoarding Disorder: ○ Hoarding behaviors are ego-syntonic (not resisted), unlike OCD’s compulsions. ○ Poor insight and emotional attachment to possessions interfere with ERP. ○ Effective treatments include: Motivational interviewing to address ambivalence. Developing organization, decision-making, and problem-solving skills. Conclusion ERP is highly effective for OCD and partially applicable to BDD. ERP does not apply to disorders like TTM, skin picking, or hoarding due to different psychological mechanisms. Misclassifying these disorders under OCRDs can lead to the misuse of ERP and inappropriate treatments. These bullet points highlight the critical details and distinctions for your study. Let me know if you need further clarification! 4o You said: i just want bullet points please ChatGPT said: ChatGPT Before the 1960s, OCD was considered unresponsive to psychotherapy (e.g., psychoanalytic and supportive approaches). The introduction of ERP (Exposure and Response Prevention) in the 1960s significantly improved outcomes for OCD. Abramowitz Meta-Analysis (1975–1995, 24 studies, 800+ patients): ○ Large effect sizes (ES): 1.16 (self-reported outcomes). 1.31 (interviewer-assessed outcomes). ○ Improvements persisted at follow-up. ERP outperforms nonspecific therapy effects like time, attention, or therapeutic relationships. Abramowitz RCT Meta-Analysis: ○ ERP vs. relaxation control → large effect size (ES = 1.18) in favor of ERP. Van Balkom Meta-Analysis (86 studies): ○ Standalone exposure techniques showed large effects: 1.46 (self-reported symptoms). 1.47 (assessor-rated symptoms). OCD involves a specific relationship between obsessional fear and compulsive behavior: ○ Compulsions temporarily reduce anxiety but maintain it through negative reinforcement. ERP weakens associations between: ○ Obsessional stimuli → anxiety. ○ Compulsive rituals → relief. ERP teaches that obsessive fears are excessive, compulsive behaviors are unnecessary, and anxiety is tolerable. Other OCRDs: ERP’s efficacy does not apply to all disorders in the OCRD category: ○ Body Dysmorphic Disorder (BDD): Shares similarities with OCD; ERP is effective for confronting appearance fears and reducing rituals. ○ Trichotillomania (TTM) and Skin Picking: Not fear-based; behaviors are positively reinforced (pleasurable). ERP is ineffective; treatments like habit reversal and cue avoidance are used. ○ Hoarding Disorder: Behaviors are ego-syntonic (not resisted) with poor insight and emotional attachment. Effective treatment includes motivational interviewing and skill development (organization, decision-making). Misclassifying TTM, skin picking, and hoarding under OCRDs risks the misuse of ERP and inappropriate treatments.