Navigating the Challenges of Exposure and Response Prevention Therapy: Tips to Avoid Common Pitfalls

The therapist plays a crucial role in guiding the client in Exposure and Response Prevention Therapy (EX/RP), which can negatively impact treatment. The goal of EX/RP is to help the client see that engaging with feared threats without compulsions or avoidance can be tolerable and that the feared outcome does not come to pass. Creating the exposure hierarchy with the client allows transparent communication. The therapist encourages the client to agree to what exposures will be rehearsed (in-vivo, imaginal, or interoceptive) and guides the creation of exposures to address core fears and obsessions.

Common Pitfalls

1. Not encouraging clients to confront their core obsessions or engage with high-distress exposures.

2. Choosing the wrong form of exposure (In vivo vs. Imaginal) to address the nature of the obsession(s) and compulsion(s) in the most distressing way.

3. Encouraging distraction (Avoidance) during exposure

4. Focusing on periphery worries instead of core worries

5. Ineffectively handling mental compulsions, such as mistaking mental compulsions as obsessions,

6. Not addressing ritual accommodation from loved ones and other environmental reinforcements of avoidance and compulsions.

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Source:

Gillihan, S. J., Williams, M. T., Malcoun, E., Yadin, E., & Foa, E. B. (2012). Common Pitfalls in Exposure and Response Prevention (EX/RP) for OCD. Journal of obsessive-compulsive and related disorders, 1(4), 251–257. https://doi.org/10.1016/j.jocrd.2012.05.002