Exposure and Response Prevention (ERP) is first-line psychological treatment for OCD. What is the critical 'response prevention' component, and which learning theory mechanism explains its long-term efficacy?
- A Response prevention reinforces avoidance behaviours that compete with compulsions; operant conditioning
- B Blocking compulsions prevents positive reinforcement, extinguishing obsessions through punishment
- C Preventing the patient from performing compulsions during exposure allows anxiety to peak and then habituate; classical extinction of conditioned fear ✓
- D Response prevention triggers thought suppression rebound, which desensitises the patient to intrusive thoughts
Explanation
In ERP, response prevention means withholding the compulsive ritual during and after exposure to the feared stimulus or obsessional cue. The therapeutic mechanism involves classical extinction: repeated exposure without the compulsion (the safety behaviour) prevents the predicted feared outcome, disrupting the conditioned fear association. Modern inhibitory learning models (Craske) further suggest that ERP creates a new inhibitory memory that competes with the original fear memory. Compulsions are maintained by negative reinforcement (anxiety reduction); blocking them extinguishes this reinforcement cycle and allows natural anxiety habituation.
Reference: Kaplan & Sadock's Synopsis of Psychiatry, 11th ed.
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