Author ORCID Identifier

Year of Publication


Degree Name

Doctor of Social Work (DSW)


Individuals suffering with Obsessive-Compulsive Disorder (OCD) face many challenges receiving proper diagnostics and evidence-based treatment. Furthermore, Exposure-Response Prevention (ERP), the empirically supported gold standard approach for targeting OCD, presents its own challenges. Examining the influences of ERP treatment reluctance is paramount to bolstering the effectiveness of outcomes and safeguarding participant adherence and ultimate success. This Capstone highlights the overlooking of addressing shame within traditional ERP protocol and posits a practice application model that supports the adjunctive use of self-compassion, a potent antidote for shame, within the use of ERP. As treatment hesitation is an inhibitor to relief for OCD sufferers, it is vital that OCD researchers and treatment providers remain abreast of opportunities to strengthen service delivery.

In service of identifying explanations for ERP hesitancy, a systematic review was employed to galvanize knowledge regarding the validity of ERP’s conceptualization of OCD neurological dysfunction, which largely postulates that the amygdala, a complex structure of cells within the limbic system, malfunctions during OCD symptom provocation. Findings demonstrated that this hypothesis holds credibility; however, a salient theme suggested that connectivity issues between the amygdala and the prefrontal cortex during symptom provocation appear to be a potentially greater source of malfunction.

Continued research identified that shame, particularly related to the “taboo” nature of intrusive thoughts within obsessions, was an obstacle to OCD treatment election. Furthermore, research suggests that the neurological presence of shame appears to mirror the dysfunction observed during OCD symptom provocation. This finding influenced the creation of a conceptual product that posits the importance of addressing shame within ERP treatment to relieve treatment hesitancy.

The final piece encompasses a systematic review, conceptual outline, as well as practice application suggestions to ameliorate barriers and bolster positive outcomes of ERP. As pioneering efforts showcase that self-compassion is an antidote for shame, the conceptual framework within illustrates a harmonious pairing of ERP and self-compassion. Furthermore, a delineated practice application supports how practitioners can take advantage of this emerging information and bridge the gap between research and implementation.