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Exposure and response prevention

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Exposure and response prevention (ERP) is a treatment method available from behavioral psychologists and cognitive-behavioral therapists for a variety of anxiety disorders, especially obsessive–compulsive disorder and phobias. It is an example of an exposure therapy and was first developed by UK psychologist Victor Meyer.[1]

The method is predicated on the idea that a therapeutic effect is achieved as subjects confront their fears and discontinue their escape response.[2][3] The behavioral process is called Pavlovian extinction or respondent extinction.[4] An example of how this process works: Imagine a person who repeatedly checks light switches to ensure they're in the off position, even when entering a clearly unlit room. The person would be exposed to their feared stimulus (leaving lights switched on), and would refuse to respond with any safety behaviors. It differs from exposure therapy for phobia in that the resolution to refrain from the escape response is to be maintained at all times and not just during specific practice sessions. Thus, not only does the subject experience habituation to the feared stimulus, they also practice a fear-incompatible behavioral response to the stimulus. While this type of therapy typically causes some short-term anxiety, this facilitates long-term reduction in obsessive and compulsive symptoms.[5]

More recent work by Craske and colleagues[6] suggests that habituation is not a necessary condition for successful long-term outcome with exposure therapy. This work has been extended to ERP for OCD.[7] Rather, the inhibitory learning approach posits that exposure to anxiety itself is an important factor in long-term extinction of fear.

Recent results indicate that ERP can be carried out effectively with minimal face-to-face contact between the therapist and the subject.[8]

The results of a 2008 study indicate that simultaneous administration of d-cycloserine substantially improves effectiveness of exposure and response prevention.[9] Other studies, however, suggest that d-cycloserine does not impact the outcome of ERP. Another study conducted in 2014 at the Medical University of South Carolina also suggests that ERP effectiveness may be enhanced by administering transcranial magnetic stimulation to the pre-supplementary motor area before ERP sessions.[10] Combination therapies that can compensate for the downfalls of ERP are being explored and seem to be extremely promising.

Organizations

Exposure and response prevention is a behavior therapy technique. Many organizations exist for behavior therapists around the world. The World Association for Behavior Analysis offers a certification in behavior therapy.[1] Their exam tests knowledge of this technique.

The Association for Behavioral and Cognitive Therapies (ABCT)[11] is the world's largest organization dedicated to disseminating behavioral therapies.

Additionally, the International Obsessive Compulsive Disorder Foundation [2] provides training and recognition for training in Exposure and Response Prevention for Obsessive Compulsive Disorder.

See also

References

  1. ^ Meyer, V. (1966). Modification of expectations in cases with obsessional rituals. Behaviour Research and Therapy, 4, 273-280.
  2. ^ Huppert & Roth: (2003) Treating Obsessive-Compulsive Disorder with Exposure and Response Prevention. The Behavior Analyst Today, 4 (1), 66 - 70 BAO
  3. ^ Abramowitz, Jonathan S.; Deacon, Brett J.; Whiteside, Stephen P. H. (2011-03-14). Exposure Therapy for Anxiety: Principles and Practice. Guilford Press. ISBN 9781609180171.
  4. ^ Michael P. Twohig, Maureen L. Whittal, Jared M. Cox & Raymond Gunter (2010)An initial investigation into the processes of change in ACT, CT, and ERP for OCD. International Journal of Behavioral Consultation and Therapy, 6(1), 67- 81 BAO
  5. ^ Audio-taped exposure therapy in a case of obsessional neurosis By Thyer, Bruce A. 9-1985
  6. ^ Craske, Michelle G.; Kircanski, Katharina; Zelikowsky, Moriel; Mystkowski, Jayson; Chowdhury, Najwa; Baker, Aaron (2008-01-01). "Optimizing inhibitory learning during exposure therapy". Behaviour Research and Therapy. 46 (1): 5–27. doi:10.1016/j.brat.2007.10.003.
  7. ^ Abramowitz, Jonathan S.; Arch, Joanna J. (2014-02-01). "Strategies for Improving Long-Term Outcomes in Cognitive Behavioral Therapy for Obsessive-Compulsive Disorder: Insights From Learning Theory". Cognitive and Behavioral Practice. 21 (1): 20–31. doi:10.1016/j.cbpra.2013.06.004.
  8. ^ Lovell K, Cox D, Haddock G, Jones C, Raines D, Garvey R, Roberts C, Hadley S. (2006) Telephone administered cognitive behaviour therapy for treatment of obsessive compulsive disorder: randomised controlled non-inferiority trial. BMJ. Oct 28;333(7574):883
  9. ^ Wilhelm, Sabine; Ulrike Buhlmann; David F Tolin; Suzanne A Meunier; Godfrey D Pearlson; Hannah E Reese; Paul Cannistraro; Michael A Jenike; Scott L Rauch (March 2008). "Augmentation of behavior therapy with D-cycloserine for obsessive-compulsive disorder". The American Journal of Psychiatry. 165 (3): 335–41. doi:10.1176/appi.ajp.2007.07050776. PMID 18245177.
  10. ^ Adams TG, Badran BW, George MS. Integration of cortical brain stimulation and exposure and response prevention for obsessive-compulsive disorder (OCD). Brain Stimul. 2014;7(5):764-5.
  11. ^ "ABCT | Home Page". www.abct.org. Retrieved 2015-11-10.

Further reading

  • Stop Obsessing, by Foa, Edna
  • Marks I (1981) Cure and Care of Neuroses John Wiley & Sons Inc, ISBN 0-471-08808-0
  • Marks I. (1997) Behaviour therapy for obsessive-compulsive disorder: a decade of progress. Can J Psychiatry. Dec;42(10):1021-7.
  • Lovell K, Cox D, Haddock G, Jones C, Raines D, Garvey R, Roberts C, Hadley S. (2006) Telephone administered cognitive behaviour therapy for treatment of obsessive compulsive disorder: randomised controlled non-inferiority trial. BMJ. Oct 28;333(7574):883
  • Abramowitz, J et al., (2011) Exposure therapy for anxiety: Principles and practice [1]
  1. ^ Abramowitz, Jonathan S.; Deacon, Brett J.; Whiteside, Stephen P. H. (2011-03-14). Exposure Therapy for Anxiety: Principles and Practice. Guilford Press. ISBN 9781609180171.
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