ERP
Core Mechanism
Prolonged exposure to obsessional triggers without compulsive response produces habituation and inhibitory learning
Ontology
Obsessions are maintained by compulsive neutralization; avoidance prevents disconfirmation
Therapeutic Voice
"I know touching the doorknob without washing feels unbearable right now. Can you stay with that feeling and let it be?"
View of the Person
An organism whose avoidance maintains fear; exposure permits new learning that inhibits old associations
Evidence
NICE: recommended for OCD. APA Div 12: Strong Research Support
30+ RCTs
Cochrane review; multiple meta-analyses
Gold standard for OCD. Very strong evidence base.
Conditions
Epistemology
Blind Spots
Highly effective for OCD but narrow in scope; exposure without relational attunement can feel mechanical
Contraindications
Active suicidality, active psychosis, severe depression that prevents engagement in exposure tasks, untreated PTSD where OCD exposures overlap with trauma content, clients who have not given informed consent to tolerate distress
Training
Graduate CBT training + specialized ERP for OCD training. IOCDF resources
BTTI through IOCDF
BTTI: 3 days + supervised ERP cases
$1K-3K
Philosophical Roots
Mowrer (two-factor theory); Pavlov (classical conditioning); Rachman (habituation); Craske (inhibitory learning); empiricism broadly
Related Modalities
Clinical Vignettes
See how ERP formulates these cases:
Test Yourself
Why is response prevention essential for OCD?
Show answer
Must refrain from compulsions, letting anxiety decrease naturally.