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Hi everyone, I'd like to find out about where to access ERP treatment outside of the specialist or tertiary centres like Maudsley, Springfield, Bath, Priory Southgate, Welwyn Garden City, Dundee, Sheffield or Newcastle. (I know that Springfield and Bath do travel throughout England but they have long waiting lists and can't say how long exactly). I'd be pleased to hear from anyone who's had ERP, and to find out how intensive it was (i.e. how many hours a week), how hard you had to fight to get it, where you had it and how long you had to wait. Thanks

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ERP is of no value until we learn how OCD works by mastering the cognitive side first. 

 

An experienced clinical psychologist will treat OCD with cognitive behavioural therapy, which should include ERP when the therapist believes the patient is ready. 

For me, going into an ERP session works best when we are reasonably calm and confident. 

We work out a hierarchy of reaction to triggers, from the least reaction to the most reaction. We start with the least. 

We then expose ourselves to the trigger and note our thinking and behavioural reaction to it - reminding ourselves how the OCD works and that our reaction is due to us connecting with the trigger, giving belief to it. 

We stick with exposure to the trigger for a while, reminding ourselves that, to a non-sufferer, the trigger thoughts /images would be treated as mental chaff and gently but firmly eased away. Then we end the session. 

We repeat this with the trigger at further times until our anxiety reaction to the trigger has eased right down. 

Next time, we tackle the next trigger on our hierarchy - and so on.

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Go to the main OCD-UK website and use the drop down box to "find a therapist" for help in this regard. 

I used private therapists because I initially had private medical insurance to cover the cost then, when the benefit ran out, paid myself. 

If waiting for therapy via NHS its a good idea to learn about the condition and how you might treat it yourself meanwhile - there are some excellent self-help books available from the bookshop on the main OCD-UK website. 

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6 hours ago, seekingERPnorthwest said:

Hi everyone, I'd like to find out about where to access ERP treatment outside of the specialist or tertiary centres like Maudsley, Springfield, Bath, Priory Southgate, Welwyn Garden City, Dundee, Sheffield or Newcastle. (I know that Springfield and Bath do travel throughout England but they have long waiting lists and can't say how long exactly). I'd be pleased to hear from anyone who's had ERP, and to find out how intensive it was (i.e. how many hours a week), how hard you had to fight to get it, where you had it and how long you had to wait. Thanks

Hi,

Just to be clear, the charity do not recommend ERP to the treatment for OCD.  It's an aspect of the treatment, but should only be a small part of a much bigger CBT treatment package. The cognitive aspect is equally important part of treatment. In my opinion ERP alone may help, but is much more likely to be harder and may not address the faulty thinking patterns we sometimes have.

CBT is available through the NHS across the country, and you should be able to access it by speaking to a GP. Generally most patients will only be offered therapy for about a hour a week for 10-20 sessions.   Sometimes local therapists can offer CBT that is more than enough, more than helpful but sometimes we may need the help of an expert and that will often mean referral to the specialist clinics mentioned in your post. 

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Hiya, before I started therapy I had my idea of what erp would be like, based on my fears I thought I'd have to expose myself to sexual content etc until the anxiety goes down, however I haven't done this, instead my therapist has taken the approach of getting me back to living my life regardless of the content of the fear, so basically I've to do all the things I did before I got sick again despite anxiety, such as spending time with friends, going shopping etc, I was worried that without actually facing the content of the fear that it would not work, but it is working as I keep making progress in the areas we are focusing on, now I feel that CBT is the way forward and ERP can be fairly easily done on ur own if u have the tools taught to u via CBT.xx

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Thanks for the replies.  The NICE Guidelines specifiy "CBT with ERP" at all stages from mild through to very severe, which is why I posted to try to find out who has anyone has been offered the ERP component of this anywhere in the country and where, other than in the specialist centres. 

The Guidelines don't say CBT with self-taught / self-administered ERP - I understand them to mean that the healthcare professional should help the patient to do undertake graded exposure - with live / in vivo being preferable to imagined.

In Scotland, AIS states that "the gold standard treatment for OCD is a robust trial (20 sessions) of ERP with a therapist with expertise / experience in OCD", and the Scottish Psychological Matrix highly recommends it.    Paul Salkovskis' centre's welcome / information brochure says that "distinct specialist CBT programmes have now been developed for each of the anxiety disorders" and I took the OCD one to be CBT with ERP. 

http://www.cbtregisteruk.com lets you search by place or language only, not by specialism or type of anxiety they treat  -  you can see the therapists' contact details but it doesn't specify the type of CBT they do, eg. if they do "CBT with ERP".

I'm surprised that OCD UK doesn't recommend ERP...   I've spoken to clinicians from most of the centres in my original post and they all do offer ERP... but according to NICE Guidelines and the Scottish Matrix it should be offered in primary and secondary care as well, so that's why I'm keen to hear from anyone who has succeeded in accessing it as a direct intervention / specific part of therapy provided by the NHS and / or privately and where.  I don't understand why they include it on the NICE Guidelines but make it so hard to find out about it and access it.

 

Spoiler

 

 

Edited by seekingERPnorthwest
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I think we are splitting hairs here. 

For me, ERP needs the sufferer to first understand OCD and how it works - the cognitive side - doing it on its own with no understanding of this is likely to be unsuccessful.

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Does it require the professionals who work with the person with OCD to understand OCD too?  For hoarding, I was told that they could help but it would "involve throwing things away"...  Obviously that's one of the overall aims but I don't think it's the first step?

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Yes if the therapy is to be successful. 

Take a look at the guidance OCD-UK gives,from the how we can help you dropdown on its website, regarding finding and choosing a therapist. 

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45 minute weekly sessions, which for me seems right as the sufferer needs to apply what they learn through homework between sessions, then the therapist can review explain adjust things. 

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There seems to be some confusion here. CBT is Cognitive Behavioural Therapy, which is the combination of Cognitive Therapy and Behavioral Therapy. The Behavioral Therapy is almost assuredly going to include ERP. ERP is a type of Behavioral Therapy.

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Hi

I notice from your location you are in Cumbria, the NHS option there is First step and you can self refer. ERP will quite likely form part of the process if CBT is considered the best course of action for you.

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  • 3 weeks later...

Thanks so much, Avo.  First Step was introduced after I had passed that stage so I did First Step at about the 3rd or 4th step. It consisted of a nice bloke and a Powerpoint.  ERP was not part of First Step when I did it but now it is.  I asked if I could have ERP and Cumbria Partnership said no, because I had not responded to CBT, but that 2/3 of patients do not.  Fortunately I found out about NHS Choice so for my next episode of care I exercised my legal right to go elsewhere.   With a lot of stress and struggle.

Subsequently I found out that Cumbria Partnership has a NICE Guidelines policy.  I did a Freedom of Information request to find out whether or not CBT with ERP has been ratified.  NICE Guidelines have been ratified for First Step but not for adult secondary care.  So you cannot get CBT with ERP in my area.  I have not been able to find a database of which Trusts do offer CBT with ERP.  I have a care co-ordinator at long last in Cumbria.  He says that he can only do "very basic" ERP and recommends I wait to see a specialist instead.  I've been waiting 15 months now...

Polar Bear - I'm afraid the CBT I've had or have been offered has not included ERP, hence my quest to try to find a CBT service which does offer with ERP within a realistic travelling distance of Cumbria.  One of the difficulties is that there is not specialist centre in the whole of the north west of England - there is in Newcastle in the north east (subject to CCG funding) but that would be the best part of a 6 hour return journey for a 1 hour appointment.  Manchester would be the obvious place for them to open a CBT with ERP centre in the north west.  Glasgow is easy to get to if they did it there but no good in countries with devolved healthcare and no reciprocal arrangements... .... ...

I have been on the waiting list for ADRU for 8 months but they have no way of knowing when I would be seen, and their geographical catchment for their hoarding option does not stretch to Cumbria.  So I've applied to Paul Sarkovskis' service in Bath instead, because they will travel throughout the country. But Paul said in the Webinar that theirs is a tiny service and is flooded with applications.

My local MP happens to be Tim Farron, and on the ITV debate last night he told the story of a 19 year old from my town who tried to get help for her eating disorder but was told that it was not serious enough.  The NHS should not wait until people's conditions deteriorate until they are prepared to help them.  It's going to cost them more in the long run, and it's going to affect people with mental health conditions and our famiies, our job prospects etc. etc.  I've heard "cutting waiting lists" mentioned as part of the election banter.  What needs to be done to cut waiting lists for people with OCD and how soon can they do it?!

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