Exposure Action Plan for Patients with Obsessive Compulsive Disorder

By Laura Koehler, Psy.D. | Licensed Clinical Psychologist

Obsessive Compulsive Disorder (OCD) is characterized by a pattern of constant unwanted fears or thoughts that lead to repetitive behaviors or thoughts intended to neutralize or counteract the obsessive thoughts. These obsessions and compulsions are often consuming and prevent those who deal with them from living a full and meaningful life. While there are many treatment options for OCD, the International OCD Foundation states that the most effective treatments are a type of Cognitive Behavior Therapy (CBT) called Exposure and Response Prevention (ERP), and/or a class of medications called serotonin reuptake inhibitors, or SSRIs.

Exposure therapy comes in many forms. According to the American Psychological Association (APA), exposure therapy has proven to be a helpful treatment option for many mental health issues. This treatment option can be tailored to the specific patient’s needs and, over time, helps reduce fear and avoidance. When paired with acceptance and commitment therapy—a behavioral therapy focused on fostering a patient’s ability to respond flexibly to all experiences—ERP can be a powerful tool in treating OCD and other anxiety disorders. Endeavor Health Behavioral Health has taken this information into account and created an Exposure Action Plan designed specifically for patients suffering from OCD. The tenets of the program include:

Value-Based Exposure Therapy

As the preferred method of Endeavor Health Behavioral Health, this therapy highlights three primary elements during treatment: directly facing fears in real life, focusing on how the patient relates to their OCD, and finally placing an emphasis on living a meaningful life. This is completed by the patient first remaining in contact with the object of their obsessions and/or anxiety and then taking action toward what is important to them outside of those obsessions and the compulsions they use to neutralize them.

Commitment is Imperative

During ERP, it is important for patients to engage long enough to learn they can be fully present with uncomfortable internal experiences without engaging in avoidant behaviors. It can be challenging to begin the ERP process, but when followed correctly, it is possible to “retrain the brain” to no longer see the object of obsessions as a threat and, in turn, prevent the indulgence of compulsive behavior.

Exposure Therapy is a Process

There are many ways in which ERP can be a helpful treatment option for OCD. One is habituation, where anxiety declines over time during and between repeated exposures. Another is self-efficacy, where exposures provide evidence that patients are capable of confronting feared situations and can manage feelings of anxiety. Finally, extinction and emotional processing may help. Exposures to feared thoughts or situations weaken previously learned associations between feared situations and bad outcomes, eventually leading to the extinction of the anxiety surrounding them. Exposures also teach patients to attach new, more realistic beliefs about the feared situation and become more comfortable with the experience of fear, which is an example of emotional processing.