An Alternative to Exposure and Response Prevention for OCD
Numerous studies have now shown that Exposure and Response (or Ritual) Prevention (ERP) remains our most effective treatment for obsessive-compulsive disorder (OCD). In ERP, clients deliberately confront feared stimuli while learning to refrain from engaging in compulsions.
Even with the effectiveness of ERP, the search continues for how to get even better results, as not everyone benefits from ERP and some clients are resistant to it. Recent research on Acceptance and Commitment Therapy (ACT) suggests that other approaches—such as learning to observe obsessions without engaging or “buying into” the content of the obsessions—can supplement ERP. One of the core ideas of ACT is helping clients to mindfully observe obsessions with greater distance.
I recently came across a new paper that focuses on these newer approaches to OCD and thought it might be helpful for clinicians working with OCD. The authors provide a nice summary of recent research on the use of ACT, Dialectical Behavior Therapy, mindfulness-based approaches, and Metacognitive Therapy in the treatment of OCD. They also provide some background on the roots of ERP in behaviorism and (later) cognitive therapy. The authors summarize what makes these approaches unique in the treatment of OCD:
In general we agree that most approaches to OCD address the function of inner experiences to some degree; in addition arguing that what makes the approaches covered here unique is the greater or complete shift toward addressing the function of inner experiences and a substantial reduction in categorizations of types or styles of inner experiences. (p. 34)
I would like to emphasize that none of these newer strategies are incompatible with ERP. I often find they are a useful complement to exposure work in my clinical work. My sense is that these strategies can help us expand our range of effective treatment interventions for OCD to help prepare clients for exposure work or as an alternative for those who are not willing to engage in ERP.
If you’d like to read the paper, you can currently download a pdf for free here. For a list of other blog posts I’ve written about exposure, click on this link.