Exposure Response Prevention (ERP)
The most effective treatment for OCD is a form of behavior therapy called Exposure Response Prevention, or ERP for short. ERP involves exposing yourself to your scary obsessional thoughts while refraining from engaging in rituals (i.e., compulsions) that would bring relief. Choosing to provoke, experience, and accept this anxiety without ritualizing can be very difficult, especially in the beginning phase of therapy. However, with repeated practice, you get used to tolerating the fear and discomfort that your obsessions provoke, and your obsessions actually begin to cause less and less anxiety. The process of getting used to something so that it is no longer upsetting or emotionally significant is called “habituation.” Thus, ERP for OCD works because it reduces your fear of the obsessional thoughts (habituation) and teaches you to accept the anxiety without ritualizing if it does spike up from time to time in the future (increased anxiety tolerance). Anxiety tolerance is a crucial, often underemphasized skill learned in ERP because it allows you to confidently and swiftly handle OCD when it flares up in the future (and, due to its neurological basis, OCD usually does create future challenges).
Many physicians and psychiatrists prescribe medication as a first line treatment for OCD. Although medication often reduces or eliminates symptoms of OCD, there is virtually a 100% relapse rate if you choose to discontinue the medication. That is, medication might treat your OCD symptoms, but you will have to be on medication indefinitely. The medication-only treatment approach is reasonable if the medication works well, has limited side effects, and makes sense for you financially. However, this is often not the case.
Combined Treatment: ERP + Medication
Experts more often recommend medication in combination with ERP. In this case, medication lowers your anxiety enough so that you can engage in ERP and learn anxiety management techniques. A common analogy for this use of medication in OCD treatment is using water wings when learning to swim. Like water wings, medication enables you to remain afloat and learn a new skill. While medication may be a necessary part of your treatment if your OCD is severe and debilitating, I recommend that you include ERP as well, since ERP is associated with more long-term treatment benefits and often increases your self-esteem, your sense of self-efficacy, and your ability to manage anxiety and other negative feelings in aspects of your life beyond OCD. As a psychologist, I provide ERP therapy, but I am happy to refer you to a psychiatrist for medication if you believe that combined ERP + medication treatment is something that is right for you.