1. Jasmine Mary John IPSW

2. ERP Also referred as- ‘ Exposure and Ritual Prevention’  It is a treatment method available from behavioural and cognitive behavioural techniques for a variety of anxiety disorders, especially Obsessive Compulsive Disorder

3.  It is functioning on the idea that a therapeutic effect is achieved as subjects confront their fears and discontinue their escape responses  Self directed methods  Therapist directed methods

4. Obsessive Compulsive Disorder… The essential features OCD are recurrent obsessions or compulsions that are severe enough to be time consuming or cause marked distress or significant impairment

5. Exposure relies on two important and related learning processes: 1. Habituation 2. Extinction

6. Habituation The natural tendency of our nervous system to ‘numb- out’ from repeated, prolonged contact with a novel stimulus. It has also been referred to as ‘the remedy of nervous system boredom’. Eg.a sudden feeling of chillness as we touch cold water. If stayed for long, the chilling sensation diminishes. Mechanism is that our nervous system ‘numb-out’ to clillness sensation and we become habituated to cold water

7. Extinction All behaviour is governed by its consequences- reinforcers. Extinction is what happens when a reinforcer no longer brings about feelings of pleasure or no longer reduces tension or discomfort

8. Response/Ritual prevention The supervised self-controlled blocking of the compulsive rituals that lessen or block anxiety or discomfort. Simply means  preventing oneself from performing ones usual ritual  Deliberate exposure  Preventing patient from performing  decrease in distress

9. ERP is based in the principle well established in scientific research that fear is overcome by daring to face the very objects or situations that cause anxiety, dread and avoidance -ie, presenting person with a harmless but fear evoking stimuli untill the stimuli no longer elicit fear

10.  In OCD’s, compulsive rituals reinforce obsessions and worries by reducing, at least temporarily, the tension, worry and anxiety of obsessive thoughts and feelings. In ERP, blocking rituals with response/ritual prevention reduces obsessive worries by means of extinction. By blocking behaviours that reinforce worries and keep them going, obsessional worries eventually diminish

11.  here, not only does the subject experience habituation to the feared stimulus, they also practice a fear- incompatible behavioral response to the stimulus. While this type of therapy typically causes some short- term anxiety, this facilitates long-term reduction in obsessive and compulsive symptoms

12. Steps 1. Explaining the rationale behind and educating the patient and family members on the ground rules of therapy 2. Preparing Anxiety/Exposure list SUDS Scale-Subjective Units of Distress Scale (Edward Wolpe,1970) *100 point scale

13. 3. Prepare mini-list; select specific areas 4. Start with items that provoke at least a moderate amount of anxiety 5.Allow patient’s discomfort to rise; stay with it and do not avoid it

14. Aim 1. Reducing intensity of symptoms 2. Enriching personal-social-occupational functioning

15. “TO WANT TO FORGET SOMETHING IS TO THINK OF IT” French proverb