Exposure Response Prevention Therapy

Exposure Response Prevention (ERP) is a highly effective therapy and evidenced-based treatment. This approach helps individuals struggling with obsessive thoughts, compulsive behaviors, unhelpful ritualistic behaviors, certain anxiety challenges, and/or are diagnosed with Obsessive-Compulsive Disorder (OCD).

How it works

Reducing Obsessions and Compulsions: Exposure Response Prevention Therapy

If you deal with obsessions, we can assume they are leading you to do extreme, compulsive behaviors. Likely, these behaviors are profoundly disrupting the overall quality of your life.

As you are ready, our therapists will implement ERP to facilitate supportive and manageable exposure experiences for you. As you move up your personalized exposure hierarchy, more challenging exposures that may increase your level of anxiety will follow.

During the ERP therapy process, you will have the opportunity to confront your fears through both imaginal and in-person exposures. We will encourage you to sit with your uncomfortable feelings and tolerate anxiety without resorting to your usual compulsive behaviors while also noticing your intense feelings weaken as your fear level decreases.

By working on exposure during and outside of therapy sessions, the intensity of your fears will naturally decrease over time. This will help you reduce unhelpful behaviors, rituals, and other OCD symptoms in your life.

Obsessions and Compulsions

ERP is almost exclusively used to treat people who have Obsessive Compulsive Disorder (OCD). Some common signs and symptoms an individual experiences when they have OCD may include:

  • An intense fear of being contaminated by germs, dirt, etc. 
  • Continual unwanted and/or taboo thoughts involving sex, harm, or religion
  • A strong desire to have physical things be symmetrical or in perfect order
  • Excessive hand-washing
  • A need to check and keep checking things: i.e. if the stove is off, if the iron is unplugged, or if the door is locked

Goals of Exposure Response Prevention Therapy

Overall, the goal for ERP therapy is to expose you to an anxiety-provoking place, circumstance, or situation and guide you through experiencing and feeling whatever feelings you have. While doing this, you will learn that anxiety does not last forever, that things OCD says will happen do not or are unlikely to happen, and that you can tolerate doubt and uncertainty. Our goal is to help you feel in control while using mastery skills to resist any avoidance behaviors or compulsions.

Exposure Response Therapy includes interrupting the cycle of obsessions and any responsive, compulsive behaviors by gradually exposing you to your core fears and then preventing your usual response. You, in a sense, begin to break the chain reactions of your unhelpful behaviors.

Key Therapeutic Elements of Exposure Response Prevention (ERP)

ERP is almost exclusively used to treat people who have Obsessive-Compulsive Disorder (OCD).

During an ERP session, you will work closely with one of our ERP-trained therapists to identify and understand your specific OCD-related fears and obsessions. They will help you interrupt the cycle of obsessions and any responsive, compulsive behaviors you have by gradually exposing you to what, where, and whom you fear. You will develop new behaviors that help you feel less fearful while you begin to master anxiety-provoking situations.

A diagram of OCD obsessive themes, including: harm, contamination, sexuality, perfectionism, religion, and loss of control.

During ERP therapy for OCD, you and your therapist will work together to fully identify and understand:

  • Your obsessions, intrusive thoughts, and urges
  • Any mental and physical rituals you have. This includes behaviors that attempt to reduce your anxiety or keep unwanted consequences from happening
  • What you specifically fear will happen if you do not finish your rituals
  • Actions, places, feelings, people, sounds, food, etc. you avoid so you won’t feel nervous or have intrusive thoughts or compulsions 

At Health and Healing Therapy, our therapists help adults and teens who have OCD by integrating the highlights of ERP. This includes:

  • Providing education on what OCD is
  • Identifying your symptoms and understanding how those symptoms are causing problems, stressors, and getting in the way of your life
  • Completing a comprehensive assessment of your fears
  • Developing an individualized exposure hierarchy
  • Beginning gradual exposure experiences
  • Facilitating the development of skills to help tolerate distress, uncertainty, etc.
  • Guiding response prevention
  • Supporting the breaking of old patterns and the creation of new patterns of behavior that help delay rituals
  • Assisting with changing and modifying rituals
  • Integrating the repetition of new skills, decisions, and reactions
  • Helping to maintain all the new patterns and behaviors that promote more helpful reactions and decrease fears, compulsions, and obsessions

Components of Exposure Response Prevention Therapy

Exposure Response Prevention will help you to develop new reactions while you increase your skills to tolerate uncertainty. In turn, this will decrease and weaken any habit you have of responding to intrusive thoughts with compulsions.

This gradual exposure will allow you to experience your feelings, emotions, and bodily sensations while facing your fears. By braving your recurrent thoughts, images, or impulses with a therapist in a safe environment, you can decrease your compulsions and ritualistic behaviors.

There are several components of Exposure Response Prevention therapy that our therapists who help those with OCD using ERP follow during therapy sessions.

1. Assessment

In the beginning, our therapists will work together with you to gain a greater understanding of your specific worries, obsessions, fears, and associated compulsions.

2. Exposure Hierarchy

Next, you will develop a hierarchy together. This is a list of anxiety-provoking situations, experiences, and feelings that trigger your obsessions.

3. Gradual Exposure

Your ERP therapist will facilitate experiences for you to have gradual exposure to the triggers you identified in your hierarchy. You will start your exposures with  the least anxiety-provoking one and then slowly progress towards more challenging situations.

4. Response Prevention

Throughout your exposure exercises, our therapists will support you in using certain skills you’ve learned and developed that will help you resist the urge to engage in your usual compulsions and/or avoidance behaviors.

There will be certain exposures, experiential actions, and monitoring of your compulsions that we teach you how to do outside of session so you can increase your success by incorporating new changes in your real life.

5. Maintenance and Generalization

Learning about our normal responses and learning to tolerate uncomfortable feelings is key in ERP. When we are triggered, our feelings of fear increase in intensity. Over time, those feelings of fear will decrease. This is the natural process of the ebbs and flows of emotions and feelings. Feelings become stronger and more intense, and then they get smaller, calm, and dissipate.

Successful ERP treatment will help you restructure your thoughts, regulate your emotions, and decrease your behaviors as you learn that your fears, behaviors, and rituals don’t need to control you.

Helping you interrupt the pattern and unhelpful cycle of your compulsive responses will lessen your suffering with OCD-related behaviors. Please reach out to us to get started. You don’t have to suffer alone.

Meet our Therapists

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Create the life you want and deserve.

You can create a life where your fears, worries, obsessions, and compulsions no longer hold you hostage. Our therapists can help you Grow, Heal, and Thrive.