Welcome! Are you someone who has heard of Exposure and Response Prevention (ERP) and wondering what exactly it is? Or, maybe you’re familiar but curious to learn about its ins and outs. If so this is the blog for you!
ERP is considered the top evidence-based treatment for anxiety disorders, including social anxiety, phobias, and obsessive-compulsive disorder (OCD). But what exactly is ERP, and why does it work so well? In this blog, we’ll introduce the principles of ERP, its treatment process, and how it can help you regain control over your life.
So What is Exposure and Response Prevention Therapy?
ERP is a form of cognitive-behavioral therapy (CBT) designed to help individuals challenge their anxious or obsessive/intrusive thoughts and reduce the behaviors that have developed to decrease their anxiety. It’s based on the idea that by avoiding feared situations, thoughts, or emotions and engaging in compulsive behaviors we will only reinforce anxiety over time. ERP works by slowly exposing a person to the sources of their anxiety in a controlled way while helping them avoid their usual responses.
Core Principles of ERP
- Exposure: This involves gradually exposing a person to the thoughts, images, situations, or objects that trigger their distress, anxiety, or fear. The goal is to desensitize a person to these triggers over time.
- Response Prevention: This part focuses on preventing someone from engaging in compulsive behaviors or rituals that they use to reduce anxiety. By resisting these urges, you learn that anxiety can still be reduced without needing to do the rituals developed to make the anxiety go away.
So How Does It Work?
- Assessment and Goal Setting: Treatment starts with an assessment (such as the YBOC) to identify specific fears and behaviors. Together with your provider you set goals and create a hierarchy, starting from the least anxiety-provoking thought or situation to the most distressing.
- Gradual Exposure: You and your provider then begin to work together to expose these feared situations/thoughts, beginning with low-stakes scenarios and gradually progressing to more challenging ones. The goal is to progress through your hierarchy at a manageable pace to build tolerance to the feelings of distress over time. Check out this website for an example of an exposure technique called imaginal exposure.
- Response Prevention: During exposure, you’re practicing how to resist your compulsive behaviors. For example, if you have a compulsion to excessively wash your hands due to a fear of contamination, you would avoid following through with that behavior for as long as possible.
- Building Tolerance: Through repeated exposures and response prevention, you start to learn that anxiety will decrease over time, and gain confidence in your ability to handle anxiety without relying on the compulsions.
- Generalization and Maintenance: As progress in treatment is made, the focus shifts to applying the skills learned to your day to day experiences. This phase involves generalizing the techniques to various aspects of daily life and maintaining the skills learned.
Check out my other blog on OCD subtypes
Why is ERP Effective?
- Reduces Avoidance: By confronting fear based thoughts or situations directly, ERP helps you break the cycle of avoidance and reinforces the idea that facing fears can lead to a decrease in anxiety.
- Promotes Long-Term Change: ERP encourages individuals to experience anxiety and learn that it can resolve without engaging in compulsions, leading to long-lasting changes in how they respond to anxiety.
- Empowers Individuals: Through repeated practice and gradual exposure, you can build resilience and gain confidence in your ability to manage anxiety, empowering them to take control of your life.
Final Thoughts
If you or someone you know is struggling with anxiety or OCD and is considering ERP therapy, it’s important to seek a qualified mental health professional who specializes in this approach. ERP can be challenging, but with the support of a skilled provider, it can lead to significant improvements in managing your anxiety and help you get towards a life no longer weighed down by fear.
About the Author
Eleanor Raker (she/her) MA., LPC is a Licensed Professional Counselor who specializes in Dialectical Behavioral Therapy. Eleanor works with teens (ages 14+) through adults who are seeking better balance in their lives and the tools to get them there. She believes the therapy process is unique to each person and strives to make meaningful connections to each client. Click here to learn more about Eleanor’s experience and therapeutic approach
References
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3059660/
https://ocdla.com/imaginal-exposure-ocd-anxiety-4847