This chapter will introduce the concept of graded exposure and self-imposed response prevention (ERP). It will describe the vicious cycle of compulsions and reassurance-seeking behaviours and the way they are rewarded by a reduction in discomfort. However, although these behaviours reduce discomfort, it is reduced only slightly, and the effect is often short-lived. Overall, therefore, the compulsions and reassurance-seeking serve to prolong and worsen the obsessive-compulsive symptoms. Later in this book, we will be discussing the practice of ERP in greater detail.

Avoidance of discomfort-inducing situations is also frequently found in OCD. This avoidance can lead to further worsening of the condition and an abnormal lifestyle which might, at its most extreme, threaten general health.

The treatment using ERP will be explained in full. Personal stories explaining the principles of ERP treatment will be given. We will also examine the success and likely outcomes of treatment with ERP.

The reasons why an ERP programme may not work in any specific case will be examined, and tips for moving forward in subsequent ERP programmes are presented.

Finally, the role of other therapies, including cognitive strategies as well as counselling, psychotherapy, and family therapy, will be mentioned.