Is exposure or response prevention more important for OCD recovery? This article suggests that RESPONSE PREVENTION is what makes the difference between illness and wellness. - 40 adults (on ssris) with OCD participated in a research study about how ERP works. Previous research showed that compliance with ERP daily homework assignments predicted symptom reduction regardless of symptom type or initial symptom severity. - The next important question to answer was "what part of the homework mattered most?". So researchers had participants provide feedback each week about how many daily assigned exposures were they completed (exposures) and about what percentage of urges to do compulsions the participants acted on (response prevention). - When they analyzed the data, a clear pattern emerged. As you can see in the chart, participants who reported resisting 90% of rituals by week 6 had an 80% chance of reaching wellness. 75% success with response prevention by week 6 correlated with a 60% chance of minimal symptoms at the end of the study. Participants who managed less than 75% Response Prevention or less than 50% response prevention had much lower odds of positive outcomes. - To contrast, the percentage of exposures the participants attempted was unrelated to their final outcomes. - Now, a SUPER important thing to remember when interpreting this data is that participants could be in different categories week to week. This graph isn't showing how four different groups of people fared over the course of the study. It shows how response prevention success at each timepoint related to final outcome. Just because someone started out preventing less than 50% of compulsions does not mean that they couldn't move to preventing 90% of compulsions later on and have very good odds of recovering. - The overall conclusion that Response Prevention is more important than number of exposures didn't come as a big surprise to me. I've said for a while that the point of exposures is to create opportunities for response prevention and that response prevention is where the brain rewiring happens. - What did surprise me was the level of response prevention needed for success. Resisting 50% of compulsions was not anywhere near good enough to have decent odds of recovering. Even 75% was iffy. More than 75% gave decent odds, but it wasn't til more than 90% of compulsions resisted that recover was a solid bet. - If I'm honest with myself, I resist maybe 75% of urges to do compulsions. Lately, I've been really down on myself about how I'm not seeing the progress I hope for. This study suggests that my experience of continued symptoms is expected given the level of response prevention I'm at. And that sucks. It feels yucky. Yet, it gives me information about where to focus my energy to see better results. I've got to amp up my response prevention game to the next level. And while daunting, that's something I can do. After all, when I first started trying to get well, I resisted maybe 10% of urges to do compulsions. I've improved response prevention before, and I can do it again. - Thoughts? Questions? Leave them in the comments so we can explore the together!