Types of Treatment

Exposure and Response Prevention (ERP) is at the heart of the treatment for OCD and anxiety disorders. The goal of ERP is to systematically learn to experience what triggers your anxiety and practice more flexible responses in the presence of your anxiety. More flexible responses to your anxiety triggers allows you to engage in meaningful behaviors. To achieve this, we work together to purposefully and gradually confront your fears so that you learn to accept the discomfort. ERP creates an opportunity for you to relate to your fears differently and changes how you respond to your anxiety.

There are a variety of ERP procedures:

• In Vivo (in life) Exposure
• Interoceptive Exposure
• Imaginal Exposure
• Thought Based Exposure
• Doubt Induction
• Response Prevention

In vivo (in life) Exposure – involves confronting situations in your life that evoke anxiety. This generally involves creating a list that targets situations that you avoid because you are afraid or uncomfortable. Next, we will create a plan for you to face your fears by engaging in meaningful activities while you are anxious. Practicing exposure therapy allows you to learn from your experience how to engage in activities more flexibly even while you are anxious.

Interoceptive Exposure – Interoception is the awareness of physiologic bodily sensations. People with anxiety often have physiological sensations associated with the fight or flight response (rapid heart rate, increased respiration, breathlessness, tightness in the chest, sweating) when there is no sign of danger. These bodily sensations often trigger anxiety and are misinterpreted as dangerous in some way. As a result, this discomfort can create barriers for living the life you want. Interoceptive exposure involves purposely creating bodily sensations associated with anxiety. This type of exposure helps you practice observing the sensations for what they are without misinterpreting them as dangerous.

Imaginal Exposure – Some fears that create anxiety are related to disturbing mental intrusions. These intrusions can be thoughts, images or urges that are unacceptable.  An anxious brain is a creative storyteller. Attempting to push these intrusive images and thoughts away actually intensifies them. Imaginal exposure involves a variety of techniques to purposely evoke anxiety by creating scripts or audio recordings of the fearful story your anxiety has created. We may create scripts about your fears that lead you to avoidant behavior and/or compulsions. Additionally, we may create scripts related to what you fear will happen if you don’t engage in avoidant behavior and/or compulsions. With practice, you can learn to experience these mental intrusions differently.

Thought Focused Exposure – Intrusive thoughts can be powerful. Repeating avoided thoughts, words or phrases on purpose several times and in different ways provides you with a chance to practice observing thoughts and experiencing them differently.

Doubt Induction – Intolerance of uncertainty is anxiety provoking for most people who have OCD or an anxiety disorder. Creating a script that contains language that helps create more doubt will provide you with practice on experiencing doubt in a more flexible way. Fear of uncertainty leads to overanalyzing thoughts in a way that contributes to even more uncertainty. Doubt induction helps you learn to live with uncertainty.

Response Prevention – Response prevention is a component of ERP that helps people develop a plan on how they will refrain from unhealthy behaviors that are designed to reduce anxiety and provide a false sense of safety. These behaviors are specific to the individual and can be related to compulsions or avoidance.  We often need to develop a response prevention plan that will help you stop engaging in behaviors that keep anxiety alive.

Acceptance and Commitment Therapy (ACT) emphasizes creating psychological flexibility. Individuals with anxiety and OCD avoid situations, thoughts, objects, people, or animals that trigger anxiety. Avoidant behavior narrows choices and coping ability and provides some immediate relief that is short lived. Because there is temporary relief, people are tricked into believing that avoidance is a solution. ACT emphasizes living a valued life even while you are experiencing anxiety. ACT actually is an exposure-based therapy. The practice of acceptance and commitment therapy involves learning to live in the present moment, observe internal experiences without judgment, and commit to behaviors that are consistent with your values.

The ACT model emphasizes mindfulness and acceptance practices. Mindfulness is present moment awareness of internal feelings, thoughts, bodily sensations and external observations. Mindfulness strategies help us develop a nonjudgmental attitude about our experience and help us notice our experience. Rather than trying to make uncomfortable internal experiences go away, those who practice mindfulness strategies work to increase their capacity to bear it. With mindfulness, people are able to change their relationship with uncomfortable internal experiences. There are a variety of ways to practice mindfulness; some are very informal, such as being aware of sensations while taking a walk or doing a chore, while others are more traditional mindfulness meditation practices.

Mindfulness and acceptance practices are used during exposure therapy to stay in contact with feelings, thoughts, and bodily sensations in the present moment. This is practiced with an attitude of curiosity so you can observe what your experience is when you are engaged in anxiety provoking tasks.

HRT is a structured behaviorally based therapy that focuses on awareness training. Clients learn alternative responses to pulling hair or picking skin. We also identify lifestyle behaviors that may increase the likelihood of successfully eliminating pulling and picking behavior.

CBIT is a structured behaviorally based therapy used primarily for tics. The therapy focuses on training to increase the awareness of tics, while teaching you competing behaviors when you feel the urge to tic. We also work on lifestyle changes that may be helpful in reducing tics.