Cognitive behavioural therapy which involves exposure and response prevention (CBT-ERP) and obsessive compulsive disorder (OCD)

Strong evidence – there is lots of high-quality evidence that some young people find this treatment option helpful.

Cognitive behavioural therapy (CBT) is a type of therapy where your therapist helps you to learn about how your feelings, thoughts, and behaviours affect each other and keep you stuck in unnecessary, upsetting, or harmful cycles. Your professional will also help you to find ways to change this.

CBT is used as a treatment for a range of problems, and a specific form of CBT is developed for each type of problem. When treating OCD, the therapy must include exposure and response prevention (ERP), which works directly on the OCD cycle. It’s parts include:

  • Exposure, where you do something that will bring on the anxiety.
  • Response prevention, where you are supported to make the active choice to stay anxious instead of doing a compulsion to reduce it. By doing this your anxiety will gradually reduce, which breaks the link between your intrusive thought and anxiety. This helps you to ignore the thoughts, and stops you from feeling the need to perform the compulsion.

ERP is based on the idea that the intrusive thoughts make you feel anxious, and so you use compulsions to get relief from the anxiety. This relief then supports your brain’s belief that your intrusive thoughts must be right, and something bad will happen if you don’t carry out the compulsion. This sets off a vicious cycle where you keep having the intrusive thoughts, and then need to carry out the compulsions.

You might start off with small things that only bring on a bearable amount of anxiety, and then build up from there. Or, you might only hold back compulsions for a few minutes at the beginning, and wait longer and longer each time.

Graded exposure

Eventually, ERP exercises will involve doing things that would have seemed quite scary at the start. This is called graded exposure. Your therapist will work out with you where to start, what kind of things to tackle, and help you to feel ready to tackle them. Your therapist will practice the exposure task with you in your sessions, and they will usually ask you to practice the tasks in between sessions on your own (often called ‘homework’).

Treatment length

CBT-ERP for OCD typically involves between 12 and 20 sessions. These should last about 45 minutes to 1 hour and should generally be at least once a week.

CBT-ERP usually works better if your parents or carers are involved.

Multi-disciplinary review

If CBT-ERP has not helped after 3 months it is important to check what might be getting in the way of recovery, for example:

  • are you following the treatment plan?
  • is there another problem, such as depression?
  • are there problems in your social or family life which are making things worse?

This is sometimes called a full multi-disciplinary review, which means your professionals meet with you and your parents or carers to talk through these questions. After this, you might be offered treatment with medication.

Treatments outlined on these webpages may not be available in every local area. It’s important that you discuss with your GP or mental health professional the treatment options available to you. You can also search for services near you on our Youth Wellbeing Directory and find out more about referral processes here.

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