A patient with severe contamination obsessive-compulsive dis… | MyMerci
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NCLEX-RN PSI
Question

A patient with severe contamination obsessive-compulsive disorder is starting exposure and response prevention (ERP) therapy. Which patient statement indicates correct understanding of how ERP works?

Explanation
Option 3 is correct. In exposure and response prevention, the client confronts a feared trigger and refrains from the compulsion, allowing anxiety to become tolerable and often decline without washing while new safety learning develops. Option 1 is incorrect because ERP does not depend on replacing every intrusive thought with a rational thought. Option 2 is incorrect because avoiding triggers between sessions reinforces fear and prevents learning from generalizing. Option 4 is incorrect because taking extra antianxiety medication solely to suppress distress can interfere with exposure learning and should not be done without a specific treatment plan.
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In-depth explanation

The therapeutic mechanism of ERP is the anxiety habituation curve: anxiety spikes during exposure, peaks within 30-60 minutes, and falls naturally if the compulsion is not performed. Each repeat exposure produces a faster, lower curve. Anything that short-circuits the curve (PRN benzo, mental rituals, reassurance-seeking) blocks therapy progress.

Clinical scenario

Adult patient with severe contamination OCD performs hand washing 50+ times daily. ERP therapy begins with the therapist instructing the patient to touch a doorknob and then refrain from washing. The nurse reinforces ERP teaching.

Key concepts

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