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Don’t Stop…ERP Now!

By February 18, 2021April 6th, 2021Alberto Collazzoni, Ph.D., Blogs

The COVID-19 pandemic began 1 year ago, and our lives drastically changed from that time. Our hobbies, work style, and relationships have been affected by the virus. This challenging time asked us to adjust to a new reality, and it has not been easy for anyone. It has been the same for the psychotherapy work with OCD, particularly, the contamination subtype.

As reported in an important article, patients and therapists have been equally affected by the virus. Patients with OCD contamination have reacted in two ways: 1) the pandemic increased their obsessions and their compulsions or 2) they adjusted easily to the new reality since everybody acts like them now, and they felt their obsessions and compulsions have been justified by the pandemic (Fineberg et al., 2020). The patients felt that their OCD which they previously viewed as more egodystonic at times now feels more egosyntonic than in the past.

How have practices changed for therapists who use ERP? According to the same article, ERP therapists should continue doing exposures, while respecting the Center for Disease Control (CDC) or Organizacion Mundial de la Salud (OMS) rules regarding the risk for virus infection. They also added that ERP should be suspended in some cases if the exposures don’t respect the CDC or OMS rules (Fineberg et al., 2020). As a therapist who LOVES exposures, I partially agreed with the colleagues. When we use ERP, we must remember the main rule for ERP, (e.g., therapists need to evaluate and quantify the safety and the tolerability of ERP for OCD), which means that exposures must be conducted considering the patients’ safety and must be conducted gradually to respect the patients’ tolerance (Schneider et al., 2020). Therefore, we never conduct an exposure that can put our patients in jeopardy.

So how can we adapt our practice during the pandemic, to incorporate contamination exposures for our patients? The answer is helping patients break the OCD “chain,” respecting the CDC or OMS rules, and helping our patients understand what is appropriate or not appropriate in terms of safety during the pandemic. For example, we know that CDC rules suggest wearing a mask outside, washing our hands with soap and for at least 20 seconds, and respecting 6 feet of social distancing when we are outside. If our patients wear their mask inside their house, or they wash their hands 30 times per day for longer than 1 minute each, we must ask them, as an exposure, to respect CDC rules and not their OCD.  The practice of ERP while respecting the CDC rules during the pandemic does not mean suspending the exposures. Instead, it means to ask our patients and ourselves to be flexible and adjust to a new reality (that is, in my opinion, one of the most important achievements for patients practicing exposures).

The goal of ERP is to help patients to accept the uncertainty related to their fears. We cannot tell our patients to suspend all exposures because it could be dangerous. If we tell them, they will not be willing to do exposures in the future because they will be afraid, and they will be justified by what we told them. We practically reassured them about that their avoidances are helpful! Instead, we should provide more psychoeducation about OCD and ERP during the pandemic, as the first step, before exposures, and help them to familiarize themselves with the new reality and the CDC rules.


– Fineberg, N. A., Van Ameringen, M., Drummond, L., Hollander, E., Stein, D. J., Geller, D., … & Dell’Osso, B. (2020). How to manage obsessive-compulsive disorder (OCD) under COVID-19: A clinician’s guide from the International College of Obsessive-Compulsive Spectrum Disorders (ICOCS) and the Obsessive-Compulsive Research Network (OCRN) of the European College of Neuropsychopharmacology. Comprehensive Psychiatry.

– Schneider, S. C., Knott, L., Cepeda, S. L., Hana, L. M., McIngvale, E., Goodman, W. K., & Storch, E. A. (2020). Serious negative consequences of exposure and response prevention for obsessive‐compulsive disorder: A survey of therapist attitudes and experiences. Depression and anxiety37(5), 418-428.