What is the treatment approach used for OCD and other severe anxiety disorders?

For OCD, the main emphasis is a technique called Exposure and Ritual Prevention (ERP). ERP has been found to be the “treatment of choice” for OCD. Exposure refers to the gradual and repetitive exposure of an individual to their feared situations (e.g., someone with contamination obsessions touching a doorknob), or ideas (e.g., someone with contamination obsessions thinking about AIDS).

Exposure work targets the obsessions, and seeks to prolong the obsessional thought, image, or impulse long enough for the process of habituation to occur. Habituation is the natural, normal process of anxiety levels reducing with nothing more than the passage of time. Research has shown that 97% of people experience the process of habituation. Ritual Prevention is the blocking of the ritual or compulsion that would normally be performed upon exposure (e.g., hand washing, checking).

In addition to ERP, cognitive restructuring strategies are also taught. Cognitive restructuring or ‘thought challenging” is the identification and correction of “errors” in thought that create anxiety. Two errors in thought most focused on are “probability overestimation errors” and “catastrophizing errors.”

A probability overestimation error is when someone overestimates the likelihood of a bad event happening (e.g., the house will burn down if I don’t check the stove). A catastrophizing error is when someone blows out of proportion, magnifies, or catastrophizes how bad fairly likely events really are (e.g., dropping something on the floor for someone with contamination obsessions).