1. Imaginal exposure: vividly imagining feared situations and negative outcomes to safely elicit and learn to regulated the unwanted emotions.

2. In-vivo exposure: directly confronting feared situations in real life without engaging in compulsions, such as allowing intrusive thoughts without controlling them. In-vivo exposures also include living life fully instead of anxiety controlling behaviors and avoidances.

3. Interoceptive exposure: inducing feared physical sensations (heart rate increase, dizziness) to increase the ability to tolerate physiological changes associated with discomfort.

4. Response prevention: A collaborative plan to reduce, delay, or remove the compulsions following the exposure. This is a necessary part of any structured exposure.

5. Process new learning: Exposure response prevention emphasizes new learning after engaging in exposures. The goal of exposures is to inhibit previous anxious learning by creating new and safer associations with the triggers and emotions. Inhibited learning theory creates important insights that challenge one’s previous overestimation of danger and underestimation of ability to cope. It helps individuals live life fully while allowing unwanted emotions. It is considered an improved therapy that will more likely sustain progress, while previous OCD treatment (habituation theory) focused on engaging in exposures only to decrease the discomfort.

What is an example of OCD: OCD has an abundance of themes or types of irrational fears that can present. Common irrational fears or OCD themes include: contamination, harming self or others, order and symmetry, just right feeling, intrusive thoughts, relationships, and religion.

What is an example of ERP therapy: Exposures are collaboratively structured between the client and therapist. ERP often starts with manageable fears and builds towards harder ones. During exposures, the individual reduces or removes compulsions. Across all types of OCD, the goal of ERP is to learn to live with unwanted emotions while engaging in a meaningful life.

A person with contamination OCD, may touch contaminants in the environment that are avoided (in-vivo exposure). It is especially helpful to target contaminants in areas that are important to attend but are being avoided. The handwashing or reassurance seeking (with self or others) is removed. The individual allows the anxiety and the uncertainty related to the outcomes of touching contaminants. The person learns over time that the emotions are tolerable, the feared outcomes are less likely or more manageable than predicted.

Can you do ERP on your own: There are many CBT and ERP resources for mild symptoms. Self-help can be helpful for some. If symptoms are more moderate to severe and interfering in quality of life, it is recommended to seek professional help by a clinician with training and experience in exposure and response prevention therapy. It can be especially helpful if the clinician has experience in additional research based treatments, including DBT, ACT, mindfulness, and self-compassion.

Adjunct treatments for OCD:

1. Acceptance and Commitment therapy (ACT): Teaches how to change relationships with obsessive thoughts rather than stopping them and focuses on increasing a values-based lifestyle. Exposures are structured around returning to meaningful activities.
2. Dialectical Behavior Therapy (DBT): All concepts of ACT are included in DBT. DBT is a more comprehensive treatment that includes emotion regulation, interpersonal, distress tolerance and mindfulness skills. The skills coaching is useful when there are barriers to completing exposures effectively.
3. Self-compassion therapy: a necessary part of OCD recovery that reduces unjustified shame related to OCD symptoms.