Wednesday, October 18, 2006

OCD: An Explanation of Exposure & Response Prevention Part 2

Ok, so unfortunately, I never got around to writing the second example for this that I promised in the previous post but now I have some free time so I'm going to write it now.

Example 2:

In the first example I went for a very common type of OCD, I thought for this example I would look at one which is less common and show that the treatment is essentially the same with just a few refinements.

So the example I have decided to cover is perhaps one of the most disturbing and certainly a difficult one for non-OCD sufferers to understand. The example is a person who fears he has or will do something really terrible, in this case murder someone.

This may seem an extreme example but I have chosen it because it shows the opposite side to the illness, one where the compulsions and obsessions are harder to spot and many of the compulsions are done internally and how we may combat this.

Step 1:

As before we begin by making a hierarchy, I'm going to try and do this one in a little more detail as I believe its harder to put together than in the original example.

So we have highlighted that our Obsession is that we might be a murderer, it is now important to notice our compulsions that go along with this, both external (things we actually do) and internal (things we think).

Note the following list is not exhaustive but should provide a basis to work from.


1) Avoiding certain objects that could be used, i.e. knives.

2) Avoiding being alone with people.

3) Avoiding things containing violence such as music, movies, games, the News.


1) Repeatedly telling yourself your a 'good person'

2) Giving yourself reasons endlessly as to why you wouldn't do that

3) Comparing yourself to killers of the past, noticing similarities, desperately trying to find differences.

So we have now highlighted some external and internal compulsions, many sufferers are good at spotting their external compulsions but struggle to spot internal compulsions, successful treatment requires stopping both external and internal compulsions.

With these compulsions we can now as before create a hierarchy:

The Hierarchy:

We will now set our hierarchy as before and work down the list in order of difficulty (the order and contents obviously vary for each person)

1) Listening to music that talks about a killer - Difficulty 15

2) Watching a fairly violent movie - Difficulty 25

3) Watcing the News - Difficulty 30

4) Watching a very violent/senseless violence movie - Difficulty 50

5) Deliberately looking for similarities between yourself and a killer without looking for differences. - Difficulty 60

5) Showing yourself that your not actually that good a person - Difficulty 75

6) Give some reasons why you might actually kill someone one day - Difficulty 90

7) Being alone with someone and watching a violent movie - Difficulty 95

8) Having a knife next to your bed at night while your partner is asleep next to you - Difficulty 100

Now we have our hierarchy we simply proceed as before by doing each of the following until the anxiety/ Difficulty drops to 0 and then moving on to the next and then adding things as necessary in the list until we have combatted the whole list.

Note: As before this is a long process and very difficult, it is often two step forwards one step back, it is not an easy or a quick fix. Seeing a professional is ALWAYS the best idea.

For much more detailed articles see

Wednesday, October 04, 2006

OCD: An Explanation Of Exposure & Response Prevention (ERP)

Well its been a while since my last post but finally i've gotten round to writing a new post.

I thought i'd continue on OCD with an explanation of the most commonly used treatment, which is a psychological treatment called Exposure & Response Prevention (ERP)

What Is ERP?

ERP consists of two main parts, the first is exposure and the second is response prevention, the first part exposure works on the Obsessions part of OCD and the response prevention works on the Compulsions part of OCD.

In simple terms, ERP involves exposing yourself to your (ocd) fears and not performing your compulsion (i.e. preventing a response)


I figured the easiest way to explain how I would go about ERP is by means of some examples. I have decided to discuss two different forms of OCD here (one today, one tomorrow), one of which is common and another which is less common, hopefully with these it'll be possible to see how to put together a strategy for other forms of OCD yourself.

Example 1 (Cleanliness):

Perhaps the most common form of OCD is cleanliness, or the need to repeatedly wash. In my example we are going to consider a made up person who fears making herself an others ill by not being clean enough and either getting a disease or causing a disease to others.

Step 1: Make a hierarchy:

Since this is difficult to do, it is important first to make a heirarchy with things you find difficult, rating how hard each thing to do would be on a scale of 1-100.

So we get something like this:

Not washing hands after touching a table: Difficulty 20
Not washing hands after shaking hands with someone: Diffculty 40
Not washing hands before eating: Difficulty: 80
Not washing hands after going to the toilet: 100

Ideally the list should be longer than the above and the gaps much smaller, this however is just an example so it should do.

Implementing the Hierarchy:

Now the aim is to start at the lowest difficulty and move on to the most difficult, before moving on to the next one the difficulty rating should drop to 0.

So we would begin by touching a table and not washing our hands for as long as we could, i.e. refusing no matter how difficult it became to wash our hands, over time the fear lowers (this is a long process, it doesn't happen overnight!) and the need to wash hands because a table has been touched diminishes, when this is the case we move on to the next step, i.e. the one with the next lowest difficulty and repeat the process on that until we get to the top of the list. If a new fear comes we add that to the list in the appropriate place and work on it when we get to it.

That is it, sounds easy I know and infact the process is simple, sticking to it and not giving in to your desire to wash your hands is the key.

Things you can do to help not give up:

1) Set realistic targets, don't start with something really hard, start with something easier and work up to harder stuff.

2) Use medication, if necessary medication can take the edge off and make keeping to the ERP easier.

3) Have an accountability partner, preferably a psychologist who can help in putting together a hierarchy, working through problems etc but even a friend can be a huge help.

4) Take it slow, remember this is a long process not a quick fix.

5) If you give up, try again!