Exposure and Response Prevention (ERP)

What is Exposure and Response Prevention (ERP)?

Exposure and Response Prevention, also known as Exposure Therapy or ERP for short, is a powerful treatment approach used to help individuals struggling with anxiety disorders. This therapy relies on the principle that facing one’s fears repeatedly and learning to tolerate distress will eventually help people overcome their anxiety symptoms and reduce their chances of having future episodes. Although each anxiety disorder has its own nuances and symptoms, nearly all anxiety disorders involve the avoidance of certain situations or objects because of a fear that something bad might happen.

Individuals with Obsessive-Compulsive Disorder (OCD) often avoid touching objects that they fear may be contaminated or have been touched by someone with an infection. Exposure therapy is designed to help people face their fears and learn that the object of their anxiety does not pose a threat, even if it seems dangerous at first.

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How Does Exposure and Response Prevention (ERP) Works?

Exposure involves confronting the things that trigger your obsessions and exposing yourself to situations that make you anxious. It’s important that during this phase of treatment you are exposed to your greatest fear — for example, if you have a fear of contamination with germs, you might be asked to touch a public door handle or even a toilet seat.

Response prevention involves resisting the urge to engage in your compulsion — for example, if you have a fear of contamination with germs and need to wash your hands repeatedly throughout the day, you would refrain from doing so during treatment sessions. It is important that you refrain from your compulsion for the duration of each session.

You may find it helpful to engage in relaxation techniques such as deep breathing, meditation or progressive muscle relaxation during sessions. After each session, you are encouraged to write down what happened, how difficult it was and any strategies that helped. At first, ERP exercises may be very difficult, but it’s important to stick with them and not give up.

Sometimes people find ERP difficult to understand, especially if they have never experienced OCD before. It is important that you ask your therapist or doctor questions about what is happening during sessions and why. If problems arise in sessions, don’t hesitate to let your therapist know.

What are the Common ERP Techniques?

Therapists who use exposure and response prevention employ a number of methods and activities to help clients undergoing treatment. Some of the techniques used in ERP include:

Imaginal exposure

This involves creating mental images & scenarios to help clients face their fears in a controlled manner. For example, if a client has difficulty interacting with strangers, the therapist may ask them to imagine meeting & talking with different people.

In-vivo exposure

This involves engaging in activities that trigger anxiety in the client, such as going to a crowded store or making small talk with strangers. Therapists may start by helping clients cautiously manage & overcome fears, & then build up to more difficult situations over time.

Physical exposure

This involves actually engaging in the activity that triggers anxiety, such as touching something dirty or contaminated, or spending time in a confined space. Therapists may work closely with clients to make sure that physical exposure is done safely and effectively.

Behavioral experiments

Activities designed to help clients learn more about their anxieties, & identify the situations that are most likely to trigger their symptoms. For example, if the client has a fear of contamination, the therapist may ask them to wear dirty clothes or touch bacteria-ridden objects.