What is Exposure & Response Prevention (ERP) Therapy? A Beginner’s Guide
Once, I heard someone poignantly describe their experience with obsessive-compulsive disorder (OCD) as feeling claustrophobic in day-to-day activities because they could not stop or escape their intrusive thoughts and compulsive behaviors. Like many people seeking OCD treatment, they were confused by their experience, feeling disconnected from themselves, and disrupted in their life because of OCD and anxiety symptoms.
If you relate to this, you are not alone. Effective, evidence-based OCD and anxiety treatment is available. You have probably heard of Exposure and Response Prevention Therapy (ERP). A mental health professional or doctor may have told you to seek out an ERP Therapist. This is excellent advice and the gold standard for OCD treatment, and it still leaves the question: “What is Exposure and Response Prevention (ERP) Therapy, and how does it help with OCD and anxiety?” That is what I’ll share today. We will explore what ERP Therapy is, who it is for, and the benefits of ERP for OCD and anxiety treatment.
What is Exposure & Response Prevention Therapy?
Exposure and Response Prevention Therapy is an evidence-based treatment under the umbrella of Cognitive Behavioral Therapy (CBT). ERP Therapy for OCD and anxiety heavily focuses on the behavioral component of engaging in exposures and resisting or reducing compulsions during the exposure to break the OCD cycle.
A Brief Review: The OCD Cycle
The OCD cycle is a repetitive chain of events that someone with OCD experiences. It starts with an unwanted, intrusive thought that sets off alarm bells in our brain, warning: “DANGER!” The signal of danger triggers a compulsion to calm the anxiety response and brings temporary relief. The paradox is that the more this cycle repeats, the stronger the OCD and anxiety symptoms become.
What are Exposures?
Exposures in ERP target obsessions in the OCD cycle. It is the process of learning to approach thoughts, situations, images, or objects that induce anxiety and obsessions.
It is important to let you know that, at the start of treatment, exposures are meant to be planned with your therapist in advance. Approaching triggers is inherently uncomfortable and can lead to flooding or becoming overwhelmed with anxiety in an unhelpful way. It is crucial to have your therapist's guidance and support, especially in the beginning, to learn how to create and complete helpful exposures. The goal over time is that you will learn to do exposures on your own.
What is Response Prevention?
Response Prevention targets compulsions, which are the behaviors performed in response to obsessions to regain a sense of safety. Response prevention is the act of working to resist engaging in the compulsion during the exposure to learn to tolerate uncertainty and to grow in confidence that you are capable of doing hard things. This is an essential part of treatment for OCD and anxiety. If work is not being done to reduce and then eliminate compulsions, then the message remains clear to your brain: “I need to do this to be safe.” One of the goals of response prevention in ERP is to learn: “I am safe even when I feel anxious and have scary thoughts.”
Is ERP Therapy just for OCD?
Exposure and Response Prevention Therapy is not just for OCD. It is an effective form of treatment for a variety of anxiety disorders. It can be beneficial and supportive for individuals with phobias, agoraphobia, illness anxiety, separation anxiety, social anxiety, generalized anxiety, and more.
One important thing to look out for is understanding your personal cycle in response to anxiety and intrusive thoughts. If avoidance is your go-to coping strategy for anxiety, and it is pulling you away from your values, you could benefit from ERP. If you are interested in finding out if ERP is a good fit for you, then I always recommend consulting with your therapist or provider as a good next step. If you don’t have a therapist, let’s connect to see if working with me in ERP therapy is a good fit.
What are the Benefits of ERP Therapy for OCD & Anxiety?
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Repeated engagement in exposures and making it a way of being in response to anxiety and OCD can lead to habituation.
Habituation is the process of learning that the distressing intrusive thoughts are “false alarms,” and the anxiety will come down on its own without the compulsion. This often lessens the anxiety response to the intrusive thought over time through repeated exposures.
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OCD and anxiety often lie to us and overestimate the danger of a situation and underestimate our ability to cope with the worst-case scenario.
Through ERP Therapy you can experience a genuine growth in self-confidence. The message of “I can’t handle this,” often turns to “I can tolerate this even if it is hard!” This increased confidence can lead to increased feelings of hope and enjoyment in daily life.
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The OCD cycle or anxiety cycle can often make life small because of compulsions and avoidance. This leads to feeling disconnected from yourself and your values.
Through Exposure and Response Prevention Therapy, you engage in exposures in line with your values to enhance your life. This can lead to a sense of reconnection with yourself and loved ones.
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When you get stuck in the OCD or anxiety cycle it can often feel like you don’t have control of your own life. That’s because OCD and anxiety are driving your decisions.
Once you learn through ERP that you are capable of tolerating anxiety, you can take back agency of your life. This doesn’t mean anxiety goes away. It means you learn to let anxiety have space without making decisions for you. It becomes more of a passenger in your decision-making rather than the driver.
Final Thoughts
The OCD cycle and the cycle of anxiety can shrink lives, making them feel small and claustrophobic. The evidence-based treatment of Exposure and Response Prevention (ERP) Therapy helps break the cycle by teaching you to approach your fears, resist your compulsions, and rebuild your confidence in your ability to tolerate discomfort and handle hard things. ERP Therapy is an effective form of treatment for OCD and many other anxiety disorders.
If you are struggling with OCD and anxiety, there is help for you! If you’re ready to take the next step to speak with someone about ERP Therapy, don’t hesitate to get in touch with me. You can contact me with questions, or you can schedule a free 30-minute consultation to discuss next steps and make sure we are a good fit.
Next week, I will be breaking down what to expect in ERP Therapy. Keep an eye out!
Lauren