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Exposure and Response Prevention

Reviewed by Psychology Today Staff

Exposure and response prevention (ERP) is a form of cognitive behavioral therapy (CBT) that helps people manage anxiety-provoking thoughts or obsessive thoughts and behavior, by exposing them to stimuli that induce their maladaptive responses.

When It’s Used

ERP is commonly used to alleviate obsessive-compulsive disorder (OCD), a condition in which people repeatedly experience unwanted and distressing thoughts or feelings, often in response to specific stimuli. One person with OCD may touch a doorknob in a public restroom and worry intensely that she has been infected; another may have intrusive, taboo thoughts about violent or sexual acts and fear that he may cause someone harm.

In OCD, these frequent, uninvited thoughts provoke anxiety and lead to compulsive rituals—such as excessively washing one’s hands or ruminating about troubling matters. The compulsive rituals may temporarily reduce anxiety, but in the long term, they promote a cycle of obsession and compulsion that prolongs distress. ERP is a proven approach to breaking the cycle.

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What to Expect

Exposure and response prevention, which may last a dozen sessions or longer, begins with a thorough assessment, during which the therapist will provide education about OCD and identify the patient’s unique triggers and the compulsions they provoke. With the therapist’s guidance, the patient is systematically exposed to objects, situations, mental images, or other stimuli that trigger obsessions or directly to the obsessions themselves.

An important challenge in ERP is the “response prevention” component—learning not to respond to the obsessions with the usual compulsive behaviors. With exposure to increasingly uncomfortable stimuli, patients acquire the ability to tolerate the distress they generate without having to resort to the rituals that only wind up perpetuating obsessive-compulsive patterns.

Sessions typically take place within a therapist’s office but may also incorporate a location that normally triggers symptoms. Eventually, a therapist may direct the client to engage in exposure and response prevention activities on their own. ERP will generally conclude with the therapist and patient making a plan to prevent relapses.

How It Works

Exposure and response prevention is designed to gradually reduce the anxiety that feeds obsessions and compulsions. One way in which this is thought to happen is through a process called habituation, whereby people become less physiologically aroused by triggering stimuli or obsessions after being repeatedly and safely exposed to them.

Further, individuals with OCD learn over time that the stimuli, thoughts, and feelings that prompt compulsions are more bearable than they anticipated. They also realize that being exposed to their fears does not actually lead to the outcomes they dread. They come to recognize that they are capable of coping with the triggers without resorting to compulsive rituals.

What to Look for in a Therapist Who Uses ERP

Look for a licensed mental health professional with specialized training and experience in exposure and response prevention therapy. In addition to credentials, it is important to find a therapist with whom you feel comfortable working.

You might ask a prospective therapist such questions as:

  • How often have you dealt with problems such as mine before?
  • How do you know whether a patient is a good candidate for ERP?
  • How does ERP work?
  • What is a typical plan of treatment, and how long is a typical course of therapy?
  • How do you measure progress?

While ERP is considered a highly effective treatment for OCD, it is not the only option. It is advisable to seek a therapist who is skilled in other therapy techniques as well.

References
Exposure and Response Prevention (ERP). Retrieved from https://iocdf.org/about-ocd/ocd-treatment/erp/.
Treatment: Exposure and Response Prevention for Obsessive-Compulsive Disorder. Retrieved from https://www.div12.org/treatment/exposure-and-response-prevention-for-obsessive-compulsive-disorder/.  
The Inhibitory Learning Approach to Exposure and Response Prevention. (n.d.). Retrieved from https://iocdf.org/expert-opinions/the-inhibitory-learning-approach-to-exposure-and-response-prevention/.