What Is Exposure and Response Prevention Therapy?

Exposure and Response Prevention Therapy (ERP) is a form of Cognitive Behavioral Therapy (CBT) developed specifically to address Obsessive Compulsive Disorder (OCD). ERP is an evidenced based practice. Our thoughts, feelings and behaviors are all interconnected. Within the OCD cycle, we think about the thing we’re afraid of, we feel fear which causes us to behave/respond in fearful ways in order to achieve short term relief. OCD relies on the illusion of control and worry.

ERP is broken in two parts. Exposures, which are stimuli or situations that are meant to illicit distress. Exposures can be things that you and I read, write, watch, talk about, imagine, or physically do. The goal of the exposure is to illicit distress and focus on the obsessions/fears that you hold. Exposures target obsessions/thoughts/fears. The second part of ERP is response prevention. Response prevention will target compulsions/behaviors. Response prevention will include resistance of compulsive behaviors and measures to use to help manage distress.

With ERP, we are gradually looking to exposure ourselves to the feared stimuli. To confront what causes you distress and resist the urge to engage in the compulsion to get that short term relief. OCD offers up the short term relief of the compulsions which leads us to long term distress as the OCD cycle is continued to be reinforced. While ERP is feeling short term distress with the exposures, it will eventually lead to long term relief as you break the OCD cycle.

Outcomes of ERP:

  • That anxiety/distress will lessen the longer you stay in the distress.

  • You’ll learn the feared outcomes are more bearable than you expected.

  • You can tolerate distress better than you thought and without compulsions.

  • Distress lessening over time.

  • Learn to accept uncertainty behind the obsessions.

  • Acknowledge unwanted thoughts/images/urges without feeding into them/engaging with them.

  • Challenge the way we think.

  • Learn that fear is uncomfortable but not dangerous.

  • Becoming comfortable with the uncomfortable.

Like all skills, ERP needs to be practiced in and outside of the therapy sessions. The more practice, the more confident you will become in your ability to manage distress without compulsions.

ERP is a collaborative approach that you and I will do together. Exposures are done in a gradual sense that we will develop together early in sessions. We will develop a list of fears/obsessions/exposures in a hierarchical fashion. ERP will teach you how to cope by approaching fears rather than avoiding them. Success with ERP starts with a gradual approach. Starting with facing obsessions/fears that cause the lowest level of distress. By approaching ERP in a gradual manner, we can continue to learn and practice through each exposure the effective response prevention and make progressive progress. We do not want the distress to get too high at the start that we are not able to use effective response prevention. Having a solid foundation of response prevention and plans of exposures will ensure we are following evidence based protocols.

As a licensed mental health therapist trained in ERP, I will assist you through the exposures and how to implement effective response prevention measures. If you feel that OCD has had a negative impact on your life, you might consider counseling and ERP to learn how to handle it more effectively. Please feel free to reach out for a free consultation, where we can discuss impacts of OCD and benefits of counseling/ERP.


Written By Michael Anderson – Link to post