Converging evidence from research and practice over the last forty-plus years strongly supports exposure and response prevention (E/RP) as a vital component of this approach.

E/RP is an empirically proven treatment of anxiety disorders, including OCD, where the individual is exposed to the anxiety-producing stimulus and asked to resist compulsive or safety behaviors. Exposure exercises help desensitize people or learn new responses to triggers, such
as intrusive thoughts, as the participant learns that thoughts are just thoughts. Clients are encouraged to practice exposure daily during treatment and continue to practice after treatment to help inoculate against relapse.

Myths and misconceptions in professional literature can create false beliefs as well-meaning proponents of alternative treatments cast E/RP in a negative light, suggesting E/RP is too aversive and distressing. Myths and misconceptions can hinder dissemination and prevent people suffering from OCD from receiving evidence-based medicine. Spencer et al. (2023) address three myths/misconceptions.
1. Uncertainty about the evidence base for CBT for OCD
2. Dropout rates are unacceptably high and carry excessive risk and perceived intolerability
3. Alternative treatments need to be quickly developed due to the significant limitations of E/RP

The authors note examples of literature that, unfortunately, have promoted misconceptions while recognizing that science should maintain a healthy skepticism and intellectual humility to promote "self-correcting clinical science."

Regarding uncertainty about the evidence base for CBT, the authors cite a long line of meta-analyses and systematic reviews of randomized controlled trials showing effect sizes that consistently favor CBT over waitlist controls and active interventions, including serotonin reuptake inhibitors.

What about dropout rates, excessive risk, and perceived intolerability? Recent meta-analyses have compared E/RP to other treatments for OCD. Concerning intolerability, even stand-alone treatment using E/RP showed no significant differences in dropout rates (14.7%) or refusal rates (4.0%). The perception of excessive risk appears rooted in clinicians' fear that patients may decompensate or lose control during exposure. Surveys of 300 clinicians practicing CBT with E/RP reveal that serious negative consequences (e.g., inaccurate patient or family perceptions) were rare (less than 0.01% per patient). There were no adverse events noted with patients acting on intrusive thoughts.

The authors address the third misconception/myth that alternative treatments for OCD need to be quickly developed due to significant limitations of E/RP by presenting ample evidence that E/RP is efficacious and acceptable for adults and children with OCD. They also point out
emerging interventions beyond E/RP, providing preliminary evidence for efficacy. Treatment such as Acceptance and Commitment Therapy. Within ACT, it is clear that exposure principles are likely responsible for much of the efficacy of this treatment.

The authors address the importance of implementation science in overcoming myths and misconceptions. CBT clinicians have intuitively included emotions other than anxiety to promote change, as clients' expectations are violated when they approach previously feared situations or thoughts (not as bad as I thought). Additionally, training for clinicians that includes the revised exposure model, i.e., the inhibitory learning model, can help therapists develop skills and confidence in CBT with E/RP.

*Spencer, S. D., Stiede, J. T., Wiese, A. D., Guzick, A. G., Cervin, M., McKay, D., & Storch, E. A. (2023). Things that make you go Hmm: Myths and misconceptions within cognitive-behavioral treatment of obsessive-compulsive disorder. Journal of Obsessive-Compulsive and Related
Disorders, 37, 100805