Finding the right approach: Talk Therapy vs. ERP

by Yvonne Baker, Psychology Intern

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Obsessive Compulsive Disorder (OCD) is a mental health disorder characterized by recurrent/persistent thoughts and/or repetitive disruptive behaviors that can be treated with therapy and/or medications. On the therapeutic side of treatment, often used are Exposure & Response Prevention Therapy (ERP), a type of Cognitive Behavioral Therapy (CBT). ERP therapy is the “gold standard” in treatment OCD, consisting of slowly exposing the person to their fear within a controlled environment (Hezel, 2019). It is important for people who are looking into Exposure and Response Prevention Therapy to know it is not the same thing as flooding, a phenomenon where fear is interacted with in an uncontrolled approach and which negatively impacts the individual. ERP is tailored to each individual’s OCD, is set at the client’s pace, and its treatment is known for having a strong positive effect on its symptoms (Pinciotti, 2023). ERP can be done via telehealth or in person, using imaginal exposures, or through virtual reality (VR) technologies. Efficacy of ERP using VR is still as beneficial as telehealth or in person options. (Javaherienani 2022).

Cognitive Behavioral Therapy (CBT) without ERP, or “talk therapy,” is another common approach for those living with OCD. CBT without ERP is not the evidence-based standard for OCD treatment, however, it is a good starting place for individuals with OCD (McDonald et al. 2023). Talk therapys is a general practice that takes problems occurring in one’s life and helps them cope by breaking it down into smaller parts with a more positive outlook.  These techniques are also utilized in CBT with ERP and can therefore offer some value to individuals who feel unprepared approaching their fears using Exposure Therapy. There are many therapeutic practices available to clients seeking therapy services.  It is important to look into these styles to see what may best fit an individual on their mental health journey.

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References

Hezel DM, Simpson HB. Exposure and response prevention for obsessive-compulsive disorder: A review and new directions. Indian J Psychiatry. 2019 Jan;61(Suppl 1):S85-S92. https://doi.org/10.4103/psychiatry.IndianJPsychiatry_516_18

Javaherirenani, R., Mortazavi, S. S., Shalbafan, M., Ashouri, A., & Farani, A. R. (2022). Virtual reality exposure and response prevention in the treatment of obsessive-compulsive disorder in patients with contamination subtype in comparison with in vivo exposure therapy: A randomized clinical controlled trial. BMC Psychiatry, 22. https://doi.org/10.1186/s12888-022-04402-3

 

McDonald, S., Melkonian, M., Karin, E., Dear, B. F., Titov, N., & Wootton, B. M. (2023). Predictors of response to cognitive behavioural therapy (CBT) for individuals with obsessive-compulsive disorder (OCD): a systematic review. Behavioural and Cognitive Psychotherapy, 51(4), 302–319. https://doi.org/10.1017/S1352465823000103

 

Pinciotti, C. M. (2023). Adapting and integrating exposure therapies for obsessive–compulsive disorder and posttraumatic stress disorder: Translating research into clinical implementation. Clinical Psychology: Science and Practice, 30(2), 190–203. https://doi.org/10.1037/cps0000143