Exposure and Response Prevention (ERP) is a form of psychotherapy intended to help those with obsessive thoughts refrain from responding with compulsions or rituals. ERP, which gradually exposes clients to stimuli that induce their maladaptive responses, belongs to the category of treatment known as cognitive behavioral therapy (CBT).
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. A 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.
What to Expect
In ERP, which may last a dozen sessions or longer, the client—typically guided at first by a therapist—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 to not respond to the obsessions with the usual compulsive behaviors. With exposure to increasingly uncomfortable stimuli, clients 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 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.
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, clients learn over time that the stimuli, thoughts, and feelings that prompt compulsions are more bearable than they anticipated and do not actually lead to feared outcomes. 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.