8 - Exposure and response prevention treatment for obsessive-compulsive disorder  pp. 102-121

Exposure and response prevention treatment for obsessive-compulsive disorder

By Fugen Neziroglu, Beth Forhman and Sony Khemlani-Patel

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Introduction

Behavior therapy, specifically exposure and response prevention (ERP), has been utilized to treat obsessive-compulsive disorder (OCD) from the late 1960s to the present, with promising results. This chapter will cover the theoretical model of ERP, its application to comorbid conditions, and adjunct therapies, such as cognitive therapy (CT) and acceptance and commitment therapy (ACT).

Theoretical basis of exposure and response prevention therapy

The roots of ERP are in learning theory and it is considered to be a form of counter-conditioning and extinction. In 1958, Wolpe utilized systematic desensitization to cause the waning of anxiety reactions by coupling relaxation with anxiety-exacerbating situations. Mowrer (1947) described a two-factor theory of fear and avoidance behavior in anxiety disorders, suggesting that fear develops based upon classical conditioning and is sustained through operant conditioning. Dollard and Miller (1950) applied this theory to the development of OCD. Through classical conditioning, a neutral stimulus that is paired with an unconditional stimulus acquires the same properties as the unconditional stimulus and thus elicits anxiety. New responses need to be learnt to decrease the anxiety in the presence of the conditioned (neutral) stimulus. These learned responses are designated as “avoidance or escape responses” (Dollard and Miller 1950) as they remove anxiety and, therefore, are negatively reinforcing.

The procedures of ERP were originally derived from animal experiments. Fixated or stereotyped behaviors in animals, which are analogous to human compulsive behaviors, are difficult to remove.

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