How Exposure and Reponse Prevention Targets the Learning Processes Behind OCD

        Obsessive-Compulsive Disorder (OCD) is a mental health condition characterized by persistent, intrusive thoughts called obsessions and repetitive behaviors called compulsions. Individuals with OCD often feel driven to perform these repetitive behaviors to reduce the overall anxiety that is caused by their obsessions, even when they know the behaviors don’t make logical sense (Powell et al., 2017, p. 343). From a behavioral learning perspective, these compulsions are maintained through a negative reinforcement cycle, ultimately because performing them leads to the temporary relief of distress, anxiety, or discomfort. One of the most effective and empirically supported treatments for OCD is Exposure and Response Prevention therapy (ERP). ERP works by gradually and safely exposing individuals to the source of their anxiety without allowing them to engage in the compulsive behavior. Over time, this can help individuals to reduce both the anxiety that arises due to the compulsion(s), as well as the subsequent urge to perform the compulsion. It is important to highlight that while ERP may be considered a very standard treatment in the realm of the mental health field, this type of treatment won’t be universally applicable to everyone who has OCD. Some individuals may benefit from a different therapeutic approach, such as Acceptance and Commitment Therapy, where there is a focus on mindfulness, acceptance of distressing thoughts, as well as an overall commitment to values-based actions without relying on compulsions. Acknowledging the differences when it comes to treatment for OCD is essential because it creates a personalized and truly client-centered approach that is focused on what works best for the individual and their needs. 

        Building on the behavioral principles introduced above, ERP is effective because it disrupts the maladaptive learning processes that uphold OCD. According to Mowrer’s two-process theory, obsessions produce anxiety through classical conditioning, while compulsions are negatively reinforced through operant conditioning because they reduce that anxiety, or at least they do temporarily. ERP ultimately challenges this cycle by repeatedly, and safely, exposing individuals to feared stimuli without allowing the compulsive ritual that would normally follow. Over time, this leads to habituation, or a natural decrease in regard to the produced anxiety, only with repeated exposure. This also promotes extinction learning, as the brain begins to unlearn and further “extinguish” the association between the obsessive thought(s) and the need for compulsive action. As this association fades, individuals can build their distress tolerance and gain a greater sense of control over their thoughts and actions, ultimately with the hope of reducing their reliance on ritualistic behaviors to manage their fear or discomfort. 

        ERP has consistently been shown to be highly effective for treating OCD when it comes down to the empirical research. In a 2021 review and meta-analysis, Ferrando and Selai examined 24 randomized controlled trials involving over 1,134 individuals and found that ERP was significantly more effective than both placebo treatments and alternative forms of types of therapy for reducing OCD symptoms. Furthermore, to ensure the results reflected ERP alone, the researchers applied strict criteria to separate it from other cognitive-behavioral approaches. Ferrando and Selai also utilized the Yale-Brown Obsessive Compulsive Scale, which is a widely recognized tool for measuring OCD symptoms. Ultimately, they uncovered consistent improvements from before to after treatment. These findings support ERP as one of the leading evidence-based treatments for OCD, while also emphasizing the overall importance of personalized and tailored levels of mental health care. 

References

Ferrando, C., Selai, C. (2021). A systematic review and meta-analysis on the effectiveness of exposure and response prevention therapy in the treatment of Obsessive-Compulsive Disorder. Journal of Obsessive-Compulsive and Related Disorders, (31). https://doi.org/10.1016/j.jocrd.2021.100684

Powell, A. R., Honey, L. P., Symbaluk, G. D. (2017). Introduction to Learning and Behavior, Fifth Edition. Cengage Learning.