Exposure and Response Prevention (ERP) is one of the most effective treatment options for dealing with specific anxieties. In ERP therapy, a client will face his/her fears step-by-step, developing a hierarchy of anxiety-producing situations or stimuli and then beginning the safe process of exposure to the triggers outlined in that hierarchy. The goals for ERP are both to teach clients how to control their cognitive, behavioral, and physiological responses to these triggers and to help them generalize the skills they learn during an exposure so they can use them on their own, without the therapist.

Regardless of disorder or method of exposure, each course of exposure-based treatment has common elements, including: a complete initial evaluation, education on the specific anxiety disorder, education on the specific course of exposure treatment, determination for readiness for change, baseline assessment of key symptoms, reduction of rituals or safety behaviors, exposure therapy with your clinician and on your own between session, thoughtful emotional processing of each exposure, and finally, relapse prevention.

ERP and OCD

Exposure and Response Prevention is a Cognitive Behavior Therapy intervention recognized as the “gold standard” for treating Obsessive-Compulsive Disorder (OCD), in most cases. The Exposure in ERP refers to exposing oneself to the thoughts, images, objects and situations that make you anxious and/or start your obsessions. The Response Prevention part of ERP refers to making a choice not to do a compulsive behavior once the anxiety or obsessions have been “triggered.”

For Obsessive-Compulsive Disorder, Exposure therapy is coupled with response prevention, also known as ritual prevention, or just RP. RP is a component of treatment that is particularly important for people who have developed ritualized, repetitive behaviors such as compulsions. The compulsive behavior serves to “undo” or neutralize the anxiety that occurs when faced with an anxiety-provoking situation. Since compulsive behaviors serve to reduce or eliminate anxiety they are inherently rewarding. Therefore, they are easily repeated over and over and often become the primary method of coping with obsessions.

RP is built upon our knowledge of learning theories. According to this principle, when a behavior is no longer rewarded (reinforced) it becomes extinct. This means the behavior gradually fades away. For instance, washing hands after contact with a doorknob serves to “undo,” or negate the anxiety that occurs after touching a doorknob. Response prevention eliminates the rewarding effect of hand washing. As such, compulsive hand washing will gradually become extinct as will ritualistic reassurance seeking, counting, checking, ordering and arranging.

ERP is one of the most effective treatment options for dealing with specific anxieties, including:

• Phobias

• Social Anxiety

• OCD