Common pitfalls in exposure and response prevention (EX/RP) for OCD
Open accessAbstract
Obsessive-compulsive disorder (OCD) is a highly debilitating disorder. Fortunately there are treatments that help the majority of OCD sufferers. The behavioral treatment with the most empirical support for its efficacy is exposure and response prevention (EX/RP). Over the years in our supervision meetings and in our clinical practice we have noted a number of relatively common therapist pitfalls that decrease the effectiveness of EX/RP. These pitfalls include not encouraging patients to approach the most distressing situations, doing imaginal exposure when in vivo is called for (and vice versa), encouraging distraction during exposure, providing reassurance, failing to address the core fear, ineffective handling of mental compulsions, and difficulty working with close others in the patient's life. In the current article we describe these common pitfalls and how to avoid them.
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Participants in the CBT + ERP arm may have engaged in competing responses, such as distraction.
“Similarly, partici pants in the CBT + ERP arm may have engaged in competing responses, such as distraction”
From Habit as a therapeutic component in psychological treatment for obsessive-compulsive disorder: A randomised controlled feasibility study. (2026) · cites this paper as [73]
Section 4, “Encouraging Distraction During Exposure” (page unavailable), says patients may distract themselves during EX/RP, intentionally or not. It does not address participants in the particular CBT + ERP arm or establish that they engaged in distraction. (LLM, conf=0.83)
Experimental — accuracy not yet measuredHelping clients avoid difficult exposures can be harmful and can increase the likelihood of relapse.
“In fact, helping clients avoid difficult exposures can be harmful and increase the likelihood of relapse (Gillihan, Williams, Malcoun, Yadin, & Foa, 2012).”
From Enhancing Inhibitory Learning: The Utility of Variability in Exposure (2019) · cites this paper as Gillihan, Williams, Malcoun, Yadin, & Foa, 2012
Clinicians are susceptible to making errors in how they deliver ERP, which inhibits its effectiveness.
“clinicians are susceptible to making errors in how they deliver the treatment to patients, which likewise inhibits its effectiveness.[29]”
From Exposure and response prevention for obsessive-compulsive disorder: A review and new directions (2019) · cites this paper as [29]
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“[28] Similarly, clinicians are susceptible to making errors in how they deliver the treatment to patients, which likewise inhibits its effectiveness.[29] Given the strong association of adherence to treatment outcome, future interventions that increase patient and therapist fidelity to ERP would be worthwhile.”
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- Authors
- Gillihan, S. J., Williams, M. T., Malcoun, E., Yadin, E., & Foa, E. B.
- Affiliations
- University of Pennsylvania (US)
- University of Louisville (US)
- Corresponding author
- Gillihan, Seth J.
- Venue
- Journal of Obsessive-Compulsive and Related Disorders
- Publisher
- Elsevier BV
- Published
- 2012-10
- Volume
- 1
- Issue
- 4
- Pages
- 251-257
- ISSN
- 2211-3649 (ISSN-L)
- PMC
- PMC3423997
- OpenAlex
- W2106318534
- Cited by
- 114
- References
- 39
- Citations by year
- 2026: 17 · 2025: 12 · 2024: 13 · 2023: 6 · 2022: 10 · 2021: 9 · 2020: 11 · 2019: 6 · 2018: 6 · 2017: 6 · 2016: 4 · 2015: 7 · 2014: 1 · 2013: 6
- FWCI
- 5.09
- Type
- journal article
- Language
- en
- Open access
- green
- www.ncbi.nlm.nih.gov
- Locations
- Journal of Obsessive-Compulsive and Related Disorders (publishedVersion)
- PubMed (publishedVersion)
- Europe PMC (PubMed Central) (acceptedVersion)
- PubMed Central (acceptedVersion)
- Funders
- National Institute of Mental Health (R01MH045404)
- Topics
- Social Sciences › Psychology › Clinical Psychology › Obsessive-Compulsive Spectrum Disorders
- Social Sciences › Psychology › Experimental and Cognitive Psychology › Anxiety, Depression, Psychometrics, Treatment, Cognitive Processes
- Social Sciences › Psychology › Clinical Psychology › Psychoanalysis and Psychopathology Research
- Keywords
- exposure and response prevention, obsessive-compulsive disorder, imaginal exposure, in vivo exposure, reassurance, treatment supervision, behavior therapy
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