Behavioural accounts led to the development of exposure and response prevention (ERP) as a psychological treatment for OCD (Meyer, 1966; Rachman et al., 1971). This involves encouraging the individual to expose themselves to the thoughts, situations or activities that induce anxiety for a prolonged period of time, without carrying out the compulsion or other responses that normally terminate the exposure. As a result, they learn to tolerate the anxiety or discomfort, over time the anxiety decreases and through repetition it eventually habituates. In addition, they may discover that the feared consequence does not occur.
Early studies in adults demonstrated that ERP was a successful treatment (Meyer et al., 1974; Rachman and Hodgson, 1980); around 60 to 70 per cent of individuals with compulsions who completed treatment made significant improvements (Abramowitz, 1996). However, behavioural treatments have been difficult to apply to young people who ruminate or do not have compulsions and treatment refusal and drop-outs have been common. There has been one randomised controlled trial of ERP in young people (Bolton and Perrin, 2008), which found that ERP reduced OCD symptoms substantially as compared with a waiting list condition.
