Exposure and response (or ritual) prevention (ERP) is the treatment for OCD with the strongest research support. As I wrote in a prior post, studies suggest ERP with or without medication is more effective for OCD than medication alone. Despite decades of research on ERP, there are people—including therapists—who question its effectiveness and some who even claim that ERP is harmful.

A recent journal article by a group of OCD experts and researchers walks through some of the common misunderstandings and even deliberate distortions of ERP (Spencer et al., 2023). Since the article is a bit technical, I thought I’d summarize it here.

As consummate scientists, the authors carefully note that they invite valid criticism of ERP. No treatment is perfect, and there is room for improving ERP and tailoring it for the individual. At the same time, as more than four decades of research supports the use of ERP for OCD, it is frustrating when there is still widespread misinformation about it—especially in research publications.

Research methods are constantly evolving. Scientists are continually raising the bar for what is a high-quality study. Consequently, relative weaknesses in older studies contribute to some of these misunderstandings.

I also want to speak about something the authors repeatedly reference in their paper: meta-analysis. Meta-analysis is a method for taking multiple studies with different empirical designs and measures and then statistically calculating the effects to allow for comparisons across studies. This rigorous approach permits researchers to aggregate the results across more than one research study, as several studies demonstrating the effectiveness of a particular treatment provide sturdier evidence than a single study.

There are weaknesses to meta-analyses. For one, they are only as strong as each study the researchers include. Not all research studies are created equal. Some have better designs than others.........

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