What is Exposure and Response Prevention (ERP)?

Exposure and Response Prevention is a CBT technique used to treat OCD. It is considered the most effective form of treatment for OCD. The goal of ERP is to reduce OCD’s interference with functioning and help the client experience relief and regain control over their life.

What does exposure and response prevention mean?

The exposure component of ERP involves systematically confronting triggers (situations, thoughts, images, objects) that provoke obsessions or anxiety. The therapist and client work together to create a list of exposures and then select the order in which they will be targeted. The exposures are initially done in session with the therapist guiding the session and supporting the client throughout the process. 

The response prevention component involves resisting and not engaging in compulsive behaviors or mental rituals that are performed to get rid of the anxiety that is provoked by a trigger. By not engaging in the behavior or ritual, the cycle of obsessive thoughts leading to compulsive actions is disrupted. During the session, the therapist helps the client to manage the distress that arises from not engaging in the behavior, teaching the system that the behaviors are not necessary to reduce anxiety. 

When exposures and response prevention are done repeatedly, the mind and body become desensitized and less reactive over time. This means the obsessions, anxiety, and need to perform behaviors will reduce in frequency and intensity and can eventually be eliminated. 

This sounds really scary and uncomfortable. 

While this is a more structured and systematic treatment, it is a collaborative process. It always moves at the client’s pace and level of comfort. All exposures and response prevention activities are decided upon ahead of time and the client is in full control of what is targeted. I also incorporate other therapy techniques into ERP sessions, including IFS, Brainspotting, and breathing techniques to support the client through the session and ensure they leave feeling calm.