Exposure and Response Prevention ERP for POCD

I have been writing a series of articles on therapy for POCD, and today I want to look at Exposure and Response Prevention (ERP) and how it helps with Paedophilia-themed OCD (POCD). I think of all the sub-types that exist within obsessive-compulsive disorder, that people with POCD may be the most reluctant to get help as they are so deeply ashamed of their thought processes, but it is still OCD, and treatments do help, especially ERP.

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Why ERP is Helpful for POCD

ERP is considered the gold standard for treating OCD, including POCD because it directly targets the underlying mechanisms of the disorder. If you have not yet attended therapy, this might be the first time you start to see all those thoughts and images as a disorder, and having the ability to do so, is a huge step on your way to recovery as you are now open to the idea that the thoughts are a symptom of something else, namely OCD. When you start ERP you confront your intrusive thoughts and fears in a controlled, gradual manner, reducing the power these thoughts have over your life. By systematically exposing individuals to their fears and preventing the usual compulsive responses, ERP can significantly reduce anxiety and improve overall functioning​(NOCD)​​ (IOCDF)​​ .

Research indicates that ERP is effective because it helps retrain the brain to view anxiety-provoking stimuli more realistically, breaking the cycle of fear and avoidance that perpetuates OCD symptoms. Studies have shown that ERP can lead to significant reductions in OCD symptoms, with many individuals experiencing lasting improvements.

Now that you know that it is an effective and researched model of therapy, how do you get started? I will briefly outline below what happens when you meet with either myself (psychologist) or other licensed mental health professional as having an understanding of the process can take away some of the fear of therapy.

What happens in therapy?

First, your therapist will undertake the initial assessment and provide psychoeducational.

This helps me (or another psychologist to understand what has been happening for you and get an idea of what your specific thoughts are and what you do to help feel a bit better when you get the thoughts. Psychoeducation is really useful at this opening stage as your thoughts that you find so repulsive will be explained in terms of obsessions, and the things you do, such as avoiding contact with children, will be explained as compulsions. For many, this is the first time they can clearly see their symptoms in terms of OCD, which can bring incredible relief and give you hope for further sessions.

An exposure hierarchy is then created. Identify specific thoughts, images, or situations that trigger anxiety related to POCD. This step is crucial for understanding the scope and specifics of the patient’s fears, providing a clear map of what needs to be addressed in therapy  (NOCD)​. Triggers are ranked from the least anxiety-provoking to the most, and this is from the exposure plan, where you start working on an attainable step before moving to the one next on your hierarchy.

Exposure. With guidance from me or another therapist, you start with, for example, an image of school gates with children coming out. You work with things resisting the urge to ritualise until you can habituate and move to the next item. In ERP we build for success, starting small before moving on to next always given you as much as possible chance for success.

image os woman talking to man with word ERP for POCD and moodsmi h logo

When you are able to do this without resorting to rituals or avoidance, this is the response part of ERP where you manage your anxious thoughts and feelings without using compulsions. This step breaks the cycle of compulsions, teaching patients that anxiety will decrease naturally without these behaviours​ (IOCDF)

​​Cognitive restructuring is used to help you challenge unhelpful irrational beliefs and paedophile and harm, once you are able to get more realistic appraisals of your thought, it takes the emotional sting out of the thoughts and gives you perspective.

You will also be taught relaxation and mindfulness to help you calm anxious feelings and also to keep you focused on the here and now as opposed to running riot with your thought processes.

Effectiveness of ERP for POCD

Research consistently supports the effectiveness of ERP in treating POCD. Studies have shown that about two-thirds of individuals respond well to ERP, experiencing significant reductions in OCD symptoms and improvements in quality of life. ERP is most effective when combined with other treatments like cognitive restructuring and, in some cases, medication such as selective serotonin reuptake inhibitors (SSRIs). This comprehensive approach helps manage symptoms more effectively and supports long-term recovery​ (IOCDF)

If you are not yet ready for therapy, there exist support groups and reputable information from organizations such as OCD Action, OCD-UK

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