The pandemic has normalized some of the common compulsions of OCD, such as handwashing. Although protection recommendations (i.e. handwashing) are meant to be carried out only to a reasonable degree, it can reinforce the irrational beliefs of patients with OCD and poor insight. Therefore, ERP can be affected as the incentive for people with OCD to choose to not perform a compulsion is weakened.

Normalization of Compulsions VS ERP

ERP requires people to choose to not perform their compulsions in the face of their obsessions as much a possible. In the case of hand washing and other protective compulsions, this means that people have to refrain themselves from these actions. However, such refrain may impact their safety as it increases the likelihood of being infected with the virus.

Balancing ERP with Risk of Transmission

- Normalization of Compulsions 
- Balancing of ERP with Risk of Transmission

Smith College

The gold standard treatment for OCD is Exposure and Response Prevention (ERP) from cognitive-behavioral therapy. The Exposure in ERP refers to exposing yourself to the thoughts, images, objects and situations that make you anxious and/or start your obsessions. The Response Prevention part of ERP refers to making a choice not to do a compulsive behavior once the anxiety or obsessions have been “triggered.” It is important to note that people with OCD must make the choice themselves. Otherwise, forceful response prevention can exacerbate their symptoms. However, the effectiveness of ERP is being restricted due to the spread the pandemic

Exposure and Response Prevention (ERP) in the Covid-19 Pandemic

There are concerns that the increased focus and normalization in hygiene and washing may worsen the symptoms of OCD, especially when contamination obsessions and hand washing compulsions are some of the commonest symptoms of OCD. For people who have went and have responded well to therapy, the stress and anxiety related to to the pandemic may also trigger a relapse.

The other side of COVID-19: Impact on obsessive-compulsive disorder (OCD)

Silva RM, Shavitt RG, Costa DL. Obsessive-compulsive disorder during the COVID-19 pandemic. Braz J Psychiatry. 2020;00:000-000. http://dx.doi.org/10.1590/1516-4446-2020-1189

Obsessive-compulsive disorder during the COVID-19 pandemic

Difficulties of Exposure Response Prevention in the Pandemic

Anxiety works as an alarm system to warn people of dangers so that they can protect themselves from danger. However, when OCD takes control, every little event can set the alarm that they are in danger. Compulsive behaviors are the attempts to keep themselves safe when that alarm goes off, but he behaviors fuel the brain’s idea that they must be in danger, thus feeds the part of the brain that gives out these many unwarranted alarm signals. When you don’t do the compulsive behaviors, over time you will actually feel a drop in your anxiety level. This natural drop in anxiety that happens when you stay “exposed” and “prevent” the compulsive “response” is called habituation.

Why Response Prevention?

- Contamination Obsessions
- Perfectionism
- Possibility of Harming Others
- The Need for Certainty and Updates
- Overestimation of Threats

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