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Exposure & Response Prevention

Completion of a course of behavior therapy appears to work as well as medication for the treatment of OCD. Research is finding that, over time, behavior therapy can change a person's brain chemistry. Patients tend to stay in remission long-term, requiring only occasional refresher sessions.

Behavior therapy requires motivation and cooperation on the patient's part. When used together, medication and behavior therapies complement each other. Medication alters the level of serotonin relatively quickly, while behavior therapy helps modify behavior by teaching the patient how to resist compulsions and obsessions. Exposure and response prevention are the principal behavioral techniques for treating OCD.

The purpose of exposure is to decrease the anxiety and discomfort associated with obsessions through habituation, getting used to the feared thought or object This may be done by desensitization with brief imaginal exposure or prolonged exposure to the real-life ritual-evoking stimuli. For example, the person may be exposed to garbage or other contaminated objects and instructed not to relieve their own anxiety by washing their hands. As the person realizes that the feared consequences will not occur, the anxiety decreases. This is called habituation.

The purpose of response prevention is to decrease the frequency of rituals. Patients are faced with feared stimuli without practicing rituals, such as hand washing or excessive checking. At first, the patient may be allowed to delay performing a ritual, working gradually towards resisting the compulsion.

Relaxation is usually not used during exposure and response prevention exercises because it interferes with progress. It is important not to let coping tactics lead to avoidance. However, some patients do find applied relaxation techniques to be helpful.

In some cases, patients experience OCD symptoms only in particular situations. Exposure and response prevention may need to be carried out in special settings. Home visits or field trips may be required by the therapist. For best results, the patient must be motivated and faithful in fulfilling homework assignments, and the patient's family needs to be cooperative.

Behavior therapy for hoarding involves encouraging the patient to gradually discard items. Desensitization to the worrisome thoughts is required first. The therapist will help the patient determine the order in which things can be thrown out. Hoarders need guidelines for what to save and discard. The therapist may need to visit the patient's home to get a clear picture of the problem.