Engagement, participation and humor key components for successful ERP therapy

DENVER — Exposure and response therapy improves with increased engagement, participation and humor, according to a panel of experts at the Anxiety and Depression Association of America annual conference.

The panel was made up of experts from the NW Anxiety Institute based in Portland, Oregon.

 

“ERP is super effective. For 80% of the people who engage in a full course of ERP, we see really meaningful outcomes,” Kevin Menasco, MSW, said during the presentation. “OCD in kids usually goes untreated or undertreated for about 2.5 years, and for adults, it’s 14 to 17 years. So people go quite a long time without gaining access to meaningful care.”

 

Assessment of a patient’s progress needs to be nuanced and must be ongoing throughout treatment to ensure full participation, according to Hayley Dauterman, PhD.

 

In addition, Dauterman noted, a significant amount of time is spent dealing with psychoeducation, focusing on negative reinforcement and avoidance, and how those two factors will maintain the cycle of anxiety over time.

 

“With the 80% effectiveness rate for people who do complete their sessions, that’s the most effective treatment we have for mental health disorders,” Dauterman said. “So, I tout that from the rooftops.”

 

Allison Bonifay, MA, LPC said pacing of therapy is important, as well as participation with a patient, even for those exercises that are nasty or uncomfortable. A “scaffolding” approach of success with smaller issues leading to bigger ones may assist those with anxiety or obsessive-compulsive disorder to become better prepared for exposures.

 

“Humor requires flexibility and creativity, and it is a component in getting someone to think differently,” Myles Rizvi, PsyD, said. “I think humor, when used judiciously and respectfully, and with consent in mind, can be so powerful for developing that rapport and relationship.”

 

Rizvi said humor is a valued tool to augment and optimize therapy once trust is established, and to ease any fears about the therapy itself, which is often uncomfortable on purpose.

 

Philosophically, Rizvi said that humor in the therapeutic session can break down barriers, likening the use of laughter to alleviate anxiety to political cartoons.

“We know the high cost of care, especially for a specialty clinic, is a huge barrier for clients, and the difficulty in finding meaningful care is often a huge barrier to effective treatment,” Menasco said.