What is Exposure and Response Prevention (ERP)?
Exposure and Response Prevention (ERP) is a type of Cognitive-behavioral therapy (CBT) considered most effective for treating OCD (with or without medication) based on extensive clinical research over the past 30 years.
Exposure involves gradually confronting feared situations and thoughts repeatedly in order to get used to them. By getting used to intrusive thoughts and the situations or activities that trigger them, people with OCD are much less bothered (or not at all bothered) when these thoughts arise, they experience fewer urges to do compulsions, and over time they experience significantly fewer intrusive thoughts.
Response prevention involves learning to stop compulsions both during exposure and in daily life. When compulsions occur, they reinforce the belief and feeling that intrusive fears are dangerous and likely to occur, thus strengthening the OCD. Therefore, response prevention is an essential part of treatment since it teaches that feared outcomes are unlikely to occur and that anxiety will go down on its own without having to do compulsions.
What makes exposure and response prevention so powerful is that it corrects mistaken beliefs about danger and threat at both the rational level and emotionally, allowing one to experience a significant reduction in anxiety. The result is that someone with OCD learns a set of skills they can apply regularly to live a healthier and fuller life in which intrusive thoughts, avoidance, and compulsions no longer get in the way.
How is Exposure and Response Prevention (ERP) done?
ERP usually involves 2-3 introductory sessions in which the model of treatment is described and the client’s symptoms are reviewed to create a personalized treatment plan that includes a hierarchy of feared thoughts and situations to expose to. Treatment begins with easier exposures and works up to more difficult one’s as the client gains confidence with the strategies; response prevention begins at the same time as exposure and involves using learned strategies to stop compulsions. Two types of exposures are used. In-vivo exposure (in life exposure) is used to get used to situations or activities that trigger fears (e.g., using a public bathroom for fear of contamination or driving a car for fear of harming others). Imaginal exposure involves imagining a feared situation in order to get used to the intrusive fears themselves (e.g., imagining leaving on the gas and burning down one’s house) and to see that such thoughts are not dangerous.
Exposures are first done in-session with the help of the therapist and then it is practiced between sessions as homework. It is this repetition of exposure, while stopping compulsions, that helps clients get used to feared situations and thoughts. A typical course of treatment involves 17 sessions lasting from 90-120 minutes each. Some clients require additional sessions to make optimal gains while others may need fewer. Shorter and less frequent follow-up sessions, in either a group or individual format, can be helpful to maintain treatment gains.