Exposure and response prevention is often referred to as “ERP” or “exposures”. You may have heard from others about doing exposure therapy for common phobias like blood draws, or flying. ERP is based on a behavioral understanding of fear based behavior where if we act in congruence with what our fears want us to do, we learn behaviorally that the fear needs to be kept and obeyed to keep ourselves or others safe/comfortable. Unfortunately when the fear is out of proportion to the actual threat, this type of learning is unhelpful and in fact creates more problems for us. We see this for individuals who have OCD, social anxiety, and phobias.
ERP is the framework for interfering in this unhelpful behavioral learning cycle to learn new ways of behaving with our out of proportion fears that are more in line with our values and desired way of living.
A more brief explanation is: ERP involves individuals gradually exposing to feared situations or stimuli (exposure) while discouraging the use of compulsive or avoidance behaviors (response prevention).
What is Exposure and response prevention (ERP)
How does it work
ERP works on the principle of habituation and inhibitory learning where repeated exposure to feared stimuli leads to a decrease in anxiety over time, as well as new learning of how to live without fears hijacking normal day to day decisions.
Therapists help individuals create a list of feared situations or objects that are focused on what the individual wants to get back in their life and have less anxiety about. The individual can choose how they want to progress through these whether that is from easiest to hardest, or with areas they care the most about.
effectiveness
Exposure and response prevention is highly effective for individuals to regain their freedom and live a life they feel is meaningful. ERP has been studied and finessed for several decades and has a lot of research backing up how effective it is in reducing fear based behavior that pulls people away from their life.
After learning and practicing ERP in therapy, you will be able to utilize this method throughout your life to continue staying connected with your values without your fears stopping you.
who benefits from ERP?
ERP is commonly used for several specific diagnoses. These include OCD, specific phobias, panic disorder, and social anxiety disorder. Also, individuals of all ages benefit from ERP including children, teens, and adults.
how is it different from other therapy
ERP is different from other therapies. It is focused on behavioral changes and emotional processing through facing fears instead of trying to avoid them or solve them. When doing ERP there is typically less focus on past experiences, and more focus on re-engaging with values consistent activities.
finding a therapist
There are several ways to find therapists who are experienced in ERP. I recommend using several different directories. IOCDF provider list, and Psychology Today filtered for your location, ERP as a treatment provided, and whether you are looking for a child, teen, or adult.
A lot of therapists offer free 15 minute consultations before initial appointments. I recommend asking about this when contacting them for help in deciding if it feels like a good match for you.
what to expect
Before starting exposure and response prevention it is important that you and your therapist get really curious about what the fears are, the triggers, and behaviors you feel you have to compulsively do as an attempt to neutralize the threat you feel is there. Mindfulness based skills can be really helpful at this stage to gain perspective of your thoughts and feelings in this cycle.
From this point the exposures are created based on your observations of your fears and on the activities you want to be able to participate in, in your life. Essentially you will do the things your fears are telling you not to (the fears that are out of proportion to the actual threat), combined with doing things that increase meaningfulness in your life, and resist doing the behaviors that the fears are telling you to do. Through this process, your brain will actually create new neural pathways of new ways of navigating fears in daily life that are more congruent with what you want.
When first starting ERP it is common that anxiety will increase because you will be facing your fears instead of trying to avoid them. Your therapist will support you through this phase and as you stick with it, with therapeutic and social support, your anxiety will decrease and you will gain confidence in yourself and abilities.
potential challenges
Typically when first starting ERP individuals have an increase in anxiety since they are facing their fears instead of focusing on avoiding them. This will be navigated with support from your therapist who will coach you in implementing additional emotional skills to increase your ability to tolerate this.
Some may fear losing control or ERP making their symptoms worse. I highly recommend talking these through with your therapist. Research does not support that ERP will make symptoms worse or that people lose control when doing ERP. However, your therapist can help you find exposures that feel like good starting points and are more likely to help you gain confidence in this process.
tips & tricks
Practice self care! Do something for yourself every day that helps you relax, feel fulfilled, or connect.
Brush up on DBT skills like “ride the wave”, and “radical acceptance”
Daily meditation can be beneficial support for ERP
Exercise will help you help your body process the stress of doing ERP.
Celebrate all your efforts even if they feel “small”
Be consistent with ERP. The more you do it the more quickly you will start to see your progress.
additional resources
International OCD Foundation is one of the best resources on how exposure and response prevention is used to help individuals with OCD and related struggles decrease overall anxiety in their lives.
They also have a great book and media list to learn more about ERP and treatment in general.
NOCD is another reliable organization that provides information, and resources for individuals who benefit from ERP. They also have a team of therapists that provide online therapy.
If you think you need more intensive therapy options The OCD and Anxiety Treatment Center is a local clinic that offers an intensive outpatient program for individuals who will benefit from ERP.
CONTACTS
If you are feeling suicidal or having urges to harm your self call or text 988, or call the suicide hotline: (801) 587-3000.
For starting therapy with Amy Lambert, LCSW email amy@myanxietytherapy.com, or call/text (801) 332-9526
For starting therapy with Bailley Ogles, LCSW email bailley@myanxietytherapy.com, or call/text (801) 332-9015