Exposure and Response Prevention in OCD: A Framework to Capitalize Change

Exposure and response prevention (ERP) constitutes the first-line treatment for obsessive-compulsive disorder (OCD). Despite robust empirical evidence supporting its efficacy, ERP has challenges, including high attrition rates and difficulty sustaining engagement. Research suggests that focusing on clients' strengths while addressing their difficulties can enhance therapy effectiveness. The present article details the case of a young adult with OCD characterized by sexual obsessions and mental compulsions, who initially underwent 12 sessions of cognitive-behavioral therapy (CBT) with limited progress. A subsequent transition to ERP throughout nine sessions resulted in positive treatment outcomes. The article illustrates how ERP may be coupled with a framework that capitalizes change using Innovative Moments (IMs)-changes in clients' discourse that reflect progress in therapy as manifested by new and adaptive ways of acting, feeling, or thinking. Therapists can be attentive, detect, and explore these moments to expand and promote further change. By attuning to and reinforcing IMs during ERP, the therapist assisted the client in disengaging from compulsions, increasing exposure tolerance, and consolidating therapeutic gains. This case underscores a practical strategy for clinicians: therapists can leverage naturally occurring change markers to enhance motivation and deepen learning in ERP rather than solely correcting dysfunctional patterns. The recognition and expansion of IMs have the potential to assist clients in maintaining engagement, tolerating distress, and cultivating more flexible responses to intrusive thoughts, which are all pivotal factors in the effective treatment of OCD.