Exposure and Response Prevention (ERP)

Exposure and Response Prevention (ERP) is the gold standard treatment (with some researching demonstrating it is 60-80% effective) for Obsessive Compulsive Disorder (OCD) in children, adolescents, and adults. To read about OCD, click here. Exposure and Response Prevention is a Cognitive Behavioral Therapy (CBT), meaning the framework of ERP is built upon the idea that our thoughts, behaviors, and emotions are interrelated, or influenced by one another. The way we think influences the way we feel, and the way we feel influences our behaviors, and vice versa. Exposure and Response Prevention is useful in treating OCD because it addresses the thoughts, emotions, and behaviors that can keep people stuck in OCD cycles. 

Exposure and Response Prevention involves exposure to the stressful situations and thoughts that plague those who experience OCD. Often an individual who struggles with OCD engages in compulsions to gain relief from their anxiety. The response prevention portion of ERP refers to preventing the typical compulsion, or response, to the stressful stimulus. For example, someone who lives with contamination OCD might have an ERP exposure of touching a trash can and then not washing their hands. There is the exposure to the trigger and the prevention of the typical response.

It’s important to avoid inadvertently creating a new, sneakier compulsion in this process. When you are suppressing the OCD response to a stressful situation, your OCD may begin negotiating new compulsions such as wiping your hands off on a towel several times rather than washing your hands. It is important that while suppressing the compulsion, you sit with the anxiety and learn to tolerate those emotions, rather than pivot to another relieving behavior. 

The goal is to demonstrate to yourself that you can experience the stressful situation and tolerate the 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. 

It is important to note that anxiety is a useful and necessary function for our survival, as its our natural alarm for danger. We need anxiety to perceive threats in our environments, and anxiety is even useful for moving us forward at times. Obsessive Compulsive Disorder confuses our danger response and sets off the alarm bells in our brain that say, “We are in danger, this is life or death.” 

When we get some perspective, we can see that not washing our hands immediately after touching a trash can is not, in fact, life or death. But when OCD is part of your life, this stimulus will feel like life or death. It is useful to begin demonstrating to your brain through exposures, that your life is not actually in danger and you can tolerate the anxiety of a stressful stimulus. Exposure and Response Prevention helps your brain right the danger response so you can begin more accurately perceiving threats. 

Exposure and Response Prevention is most effective when the client is motivated to try exposure therapy and has a motivation to change / gain power over their OCD. It is important to note that ERP is not dangerous and that an exposure poses no risk to your emotional or physical health. With ERP you will create a hierarchy of situations with the help of an ERP therapist. This hierarchy will start with situations that are somewhat uncomfortable and progressively increase in difficulty as you proceed through the treatment. Through this process, you will change your brain and see relief from OCD. If you are living with OCD and are ready for life to feel better, there are ERP trained therapists in Denver, Colorado who are ready to join you on your journey.