Everything you need to know about Exposure and Response Prevention Therapy. With sources.

What is Exposure and Response Prevention Therapy?

Exposure and Response Prevention therapy, or ERP for short, is a form of cognitive behavioral therapy (CBT). It involves three primary parts:

1. Psychoeducation: You will learn about mental disorders, why we have them, and how treatments work. You will develop a plan for your ERP therapy and learn new skills and strategies to use.
2. Exposure: You will create a hierarchy, which is list of exposures ordered from easiest to hardest. You will start at the easiest exposure, which might be as simple as reading letters and words, and slowly progress along the hierarchy. You are in control of the order and pace of exposure, your therapist will guide you and help you make progress.
3. Response Prevention: Perhaps the most important part, you will avoid engaging in compulsions when facing the discomfort of your exposure hierarchy. This will include stopping safety behaviors. For example, you may be asked not to rub your hands together as a distraction, or you may be asked not to repeat a specific phrase in your head, while practicing exposure. By choosing to sit in discomfort you over time reduce the anxiety response.

Here are two major misconceptions cleared up. First, you will never be asked to do something actually dangerous. ERP is about addressing fear that is out of proportion with the actual danger, so at no point are you expected to enjoy your fear, or do something dangerous - the goal is only to return your fear response to the appropriate level. Second exposure is not the same as exposure therapy. If you've been faced to face your fear but didn't 'get better' that's because simple being exposed is not enough. Exposure is only one part of ERP. It becomes 'therapy' when you add in psychoeducation and response prevention.

Does it work?

Yes. ERP is clinically proven to treat OCD, phobia, and anxiety disorders. Studies show success across adults, children, teenagers, all around the world from mild to severe cases. Virtual ERP is shown to be just as effective as in person therapy.

Will I have to do (thing you don't want to do)?

Many people do not start or consider ERP as a treatment option because, well, it's quite directly the last thing on earth they want to do. Remember, ERP is an incremental process, where you build and move along your own hierarchy. You may never need to complete certain tasks, as ERP skills generalize (meaning practicing ERP for one phobia can even relieve you of another), but more likely you will find the that thing is no longer scary by the time you reach it in the hierarchy.

It sounds scary

ERP is about facing fear is a controlled, and incremental way so that when you face them in life you have already had practice. Ask yourself what is scarier: living your entire life with OCD/Phobia/Anxiety, or practicing exposure and response prevention therapy?

What if I move too fast?

Your therapists will help you adjust your rate of exposure. Growth, and therefore new types of discomfort are a sign of progress in ERP. When you face a new challenge, allow yourself to feel the discomfort as a part of the process.

What if I have a set back?

There is no recovery without setbacks. Like potentially moving too fast, accept this as a part of recovery and work with your therapist to adjust as needed.

I tried it once and it didn't work for me

OCD and phobia have high co-morbidity with depression, which leads to higher drop out rates of therapy. Evidence suggests that multiple attempts are more likely to lead to relief.

Can it work with kids?

ERP is shown to be highly effective for kids and teenagers.

How do I get started?

Find a therapist near you who has experience with ERP.

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Sources

1. Exposure and Response Prevention in the Treatment of Obsessive-Compulsive Disorder: Current Perspectives
2. Exposure and Response Prevention Process Predicts Treatment Outcome in Youth with OCD
3. Online Video Teletherapy Treatment of Obsessive-Compulsive Disorder Using Exposure and Response Prevention: Clinical Outcomes From a Retrospective Longitudinal Observational Study
4. Exposure and response prevention for obsessive-compulsive disorder: A review and new directions