Exposure and Response Prevention (ERP)

What Is ERP Therapy?

As humans, anxiety is our natural alarm for danger. As such, it is a useful and necessary function for our survival. Not only do we need anxiety to perceive threats within our environment but it can also be useful for moving us forward at times.

Unfortunately, for those of us who suffer from Obsessive Compulsive Disorder (OCD), our danger response conflates with non-threatening events, setting off alarm bells in our brain that tell us, “We are in danger, this is life or death.” To mitigate the perceived danger, we engage in compulsive behaviors to ensure our safety. However, the more compulsive behaviors we engage in to ward off danger, the more likely these behaviors will proliferate out of control.

Exposure and Response Prevention therapy (ERP) is a type of Cognitive Behavioral Therapy (CBT) where clients with OCD are progressively exposed to distressing triggers—thoughts, images, places, and feelings—while also being prevented from engaging in compulsions or avoidant behaviors. As an evidence-based intervention, ERP therapy is the most effective treatment for OCD. [1]

As a subsect of Cognitive Behavioral Therapy (CBT), the framework of ERP is built upon the idea that our thoughts, behaviors, and emotions are interrelated and influence each other. ERP therapy is useful in treating OCD because it addresses the thoughts, emotions, and behaviors that can keep people stuck in cycles of intrusive thoughts followed by compulsive behaviors.

How Is ERP Incorporated Into Therapy Sessions?

Oftentimes, someone who struggles with OCD engages in compulsions to gain relief from their anxiety. Exposure and Response Prevention involves them being exposed to their stressful situations and thoughts followed by methods of prevention for the typical response/compulsion. For example, if your OCD is related to contamination, you might be assigned an ERP exposure to touch a trash can and then not wash your hands afterward.

ERP therapy helps your brain correct the danger response so you can perceive threats more accurately. When OCD is part of your life, not washing your hands immediately after touching a trash can will feel like life or death. That is why it is useful to demonstrate to your brain through exposure that your life is not actually in danger and you can tolerate the anxiety of a stressful stimulus.

The goal of ERP counseling is to demonstrate to yourself you can experience stressful situations and tolerate discomfort effectively. Feelings are not dangerous, and they naturally dissipate quickly. When we resist or avoid negative emotions, the discomfort is greater than if we accept the distress we’re experiencing and allow it to fade naturally.

Other Things To Know About ERP Therapy Sessions

Before starting ERP treatment, we will conduct an assessment to confirm the OCD diagnosis. Then, a collaborative approach will be formulated between client and therapist that includes psychoeducation, validation, and ERP therapy scheduled every week, or more frequently if needed. Sessions can be conducted online or in person.

Once OCD treatment is underway, it’s important to avoid inadvertently creating a new, sneakier compulsion in the process. When you suppress the OCD response to a stressful situation, your OCD may want to negotiate new compulsions in its place, such as wiping your hands off on a towel several times rather than washing your hands.

In addition to suppressing the compulsion, you must sit with the resulting anxiety and learn how to tolerate those uncomfortable emotions, resisting the urge to pivot to another relieving behavior. For this reason, other therapies often provide very little relief or will sometimes make OCD symptoms worse by entrenching new compulsive behaviors.

Who Can Benefit From ERP Therapy?

Exposure and Response Prevention (ERP) is the gold-standard for treating Obsessive Compulsive Disorder (OCD) in children, adolescents, and adults. “Research shows ERP and medication are the most effective treatments for OCD, with about 70-85 percent of people benefitting from one or both.” [2]

ERP is most effective when you feel motivated to gain power over your OCD and want to try exposure therapy. Even though the idea of exposure may sound daunting, ERP counseling is not dangerous. Exposure poses no risk to your emotional or physical health. With the help of your therapist, you will create a hierarchy of situations. This hierarchy will start with the situations that are the least uncomfortable for you and progressively increase in difficulty as you proceed through the treatment. Gradually, you will notice changes in the way your brain responds to perceived threats and experience relief from OCD.

Why We Incorporate ERP Therapy Into OCD Treatment

Since opening in 2018, Colorado CBT has specialized in providing evidence-based interventions to our clients. Frustrated by the limited referral options for OCD treatment in our region, we pursued advanced training and supervision in ERP to ensure we could offer this gold standard therapy to our clients with OCD. In addition to offering in-person and online ERP therapy, we also have an in-house psychiatric mental health nurse practitioner who can prescribe medication if necessary.

As the gold standard treatment for OCD, we have witnessed first-hand how effective ERP therapy can be when implemented between a skilled therapist and a motivated client. With ERP treatment, they gain valuable insight that their anxiety cannot actually harm them. As OCD gradually loosens its hold over daily function, clients develop an increased sense of confidence and agency over their lives. The time that was being spent obsessing or engaging in compulsions can now be used for more enjoyable pursuits.

If you are living with OCD and are ready for life to feel better, Colorado CBT has ERP-trained therapists on staff who are ready to join you on your journey.

Learn How ERP Therapy Can Help You

ERP Therapy is an evidence-based approach. If you would like to find out more about Exposure Response Prevention Therapy, please visit our contact page to schedule a consultation.

[1] https://www.treatmyocd.com/blog/does-erp-therapy-work-for-everyone
[2] https://iocdf.org/about-ocd/treatment/