​You may have heard of Cognitive Behavioral Therapy (CBT) before. Exposure and Response Prevention (ERP) is a specialized form of CBT designed primarily for individuals experiencing anxiety disorders such as social anxiety or obsessive compulsive disorder (OCD). As a therapist, I use ERP as a structured approach to help clients with anxiety disorders or OCD to confront their fears while reducing compulsive behaviors in a gradual, supportive, and systematic way.

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How does ERP work?

ERP is composed of two components: (1) exposure and (2) response prevention.

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(1) The exposure component of ERP involves the gradual exposure of clients to situations, thoughts, images, or objects that trigger anxiety or obsessive thoughts. This exposure is typically hierarchical, meaning we start with less anxiety-provoking situations and progressively move toward more challenging scenarios over time.

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(2) The response prevention component of ERP involves helping clients refrain from performing compulsions or avoidance/safety behaviors that they typically use to manage anxiety.

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The goal of combining exposure and response prevention is to help clients learn that their feared outcomes are often unlikely to occur or that they can handle the feared triggers and that their anxiety will diminish over time without engaging in compulsive behaviors (or safety/ avoidance behaviors). By resisting these urges, clients can learn to tolerate discomfort and recognize that their anxiety decreases naturally over time. This process reinforces the understanding that anxiety is manageable and does not necessitate ritualistic responses.

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Why consider ERP?​​​

Purposefully exposing yourself to anxiety-provoking situations and triggers may sound very scary or difficult! That is an understandable response and you may be wondering why to consider this approach. ERP can be challenging but when used to treat an anxiety disorder, the following can happen:

1. You will feel an initial increase in anxiety, uncertainty, and/or obsessive thoughts.
2. These feelings will be distressing but you can learn that they are safe and manageable, despite your distress.
3. When you stop fighting the anxiety and/or obsessive thoughts by engaging in compulsions that keep you stuck, the feelings can eventually subside. The decrease in anxiety when you remain in the exposure while resisting the compulsion or safety behavior(s) is called "habituation."
4. New learning develops! You can learn that your anxieties are less likely to come true than you thought and that you are more capable of handling the feared situations/thoughts/images than you previously thought. This can help you to better manage anxiety triggers day to day.​

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The Brain and ERP

Another way to think about this is that anxiety is your body's alarm system. You could think of this as a smoke detector. When the smoke detector goes off in your home, it happens to get your attention to protect yourself from a fire that could cause you or your loved ones harm. However, when you have an anxiety disorder such as OCD, social anxiety, or panic disorder, your body's alarm system is overly active. Using this metaphor, this means that your smoke detector begins to respond to even small triggers such as you cooking in the kitchen as a catastrophic, terrifying threat (e.g., a dangerous fire).

 

Compulsive behaviors are behaviors and/or thought patterns that you have developed to try to mitigate this anxiety to keep you safe when your body's alarm system goes off. In the case of an anxiety disorder, this could be behaviors such as avoiding anxiety-provoking situations, over-preparation to prevent a feared response, or even mental rituals such as mentally reviewing conversations with a loved one or hypervigilance for signs of social rejection. The problem with these compulsions, or safety behaviors, is that they reinforce your brain's belief that you are in danger, which temporarily decreases anxiety but reinforces the fear. Unfortunately, this may lead to anxiety persisting or even worsening over time.

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ERP can feel uncomfortable in the short-term because you are intentionally facing your fears, but in the long-term, ERP can help to challenge your fears.
 

​Is ERP right for me?

I can make recommendations based on your therapeutic goals and needs, but this is ultimately up to you. However, ERP can be helpful in addressing address a variety of anxiety-related concerns, including:

• OCD (Obsessive compulsive disorder)

• Social anxiety

• Performance anxiety

• Phobias

• Panic attacks

 

Through ERP, clients often experience significant reductions in anxiety and compulsive behaviors, leading to improved overall functioning and quality of life. This therapeutic approach is backed by extensive research, demonstrating its efficacy in treating OCD and other anxiety-related disorders.

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As a therapist, I emphasize the importance of a safe and supportive environment throughout this process, ensuring that clients feel empowered to face their fears while receiving guidance and encouragement to take gradual steps at their own pace. Ultimately, ERP can be used not only addresses the symptoms of anxiety-disorders but to also foster resilience and adaptive coping strategies that extend beyond therapy.