What is the term EXPOSURE in CBT?
Exposure is typically the opposite of avoidance. Exposure is when you face the distressing obsessive thought deliberately and avoid the compulsion. This can be done in vivo or imaginal. For example., if you are highly distressed about touching door knobs (due to concerns of contamination), deliberately increase the exposure to door knobs by touching the door knob step by step.
What is RESPONSE PREVENTION in CBT?
RESPONSE PREVENTION is the step after EXPOSURE. It requires the prevention of responses such as compulsion or avoidance. For example., if the compulsion was to wash hands immediately after touching the door knob or avoid touching the doorknob by using a tissue, and deliberately not performing the compulsion and avoidance is known as response prevention. The more you are about to do the Exposure and Response Prevention to an obsessive thought, the better you will overcome this in the long run. This is the crux of the CBT of OCD.
First, it was thought that ERP works only by the principle of habituation. Now we know that another learning mechanism, Inhibitory Learning, is also involved in overcoming distress.
What is HABITUATION?
Habituation is a term used in psychiatry. It is a form of learning in which an organism’s sensitivity to a stimulus decreases after repeated exposure. Habituation is adapting to our environment by learning to minimise our response to what is not essential and focus on what is important. For example., many people, when they relocate to Chennai from a quieter village or abroad, find the traffic too loud. It does not bother them anymore in about six months as they get used to it. This is the principle of habituation.
In habituation, when a stimulus is repeatedly presented, the organism loses the response to the stimulus by decreasing neurotransmitter response. For example., if you keep touching the door knob every single day and stay without washing your hands, initially, the distress may be a lot. The recommendation would be to accept and remain in the state of distress and NOT relax into it but “accept” and “get used” to the distress; in about a month, you will realise that your distress to touching door knobs has reduced a great deal.
What is INHIBITORY LEARNING?
During ERP, obsessional fears are not “unlearned.”.” Instead, new information is “learned”. This new learning is strong enough to inhibit the original fear or block it out. The new information that teaches the brain that it is safe is strong enough to overcome the old information. For example., take the door knob for instance. The original fear might be that you will become sick with an infection if you do not wash your hands immediately. However, by staying without washing your hands and getting used to the distress, your brain learns that it is safe to touch the doorknob and not wash your hands, as there is no evidence of infection following this. ERP is an effective treatment for OCD. These blogs aim to give you as much information as possible to aid your journey with treatment.
