What is Exposure Response Prevention (ERP)

Exposure and Response Prevention (ERP) is a powerful treatment for Obsessive-Compulsive Disorder (OCD) that helps people break free from the cycle of obsessive thoughts and compulsive behaviors. Here’s an easy way to understand how it works. 

You have likely heard of Cognitive Behavior Therapy (CBT) before. CBT refers to a group of similar types of therapies used by mental health therapists for treating many issues including but not limited to, depression, PTSD, relationship challenges, and additions. CBT is highly adaptable and can be tailored to treat many other mental health issues. It emphasizes skill-building for long-term coping and resilience. For Anxiety and OCD, a specialized type of CBT is Exposure and Response Prevention (ERP). 

The Exposure in ERP refers to exposing yourself to the thoughts, images, objects and situations that make you anxious and/or start your obsessions. Facing the thing that triggers your fear (in small, manageable steps), for example, if you’re afraid of germs, you might start by touching something you feel is “dirty,” like a doorknob. Or if you’re afraid of leaving the stove on, you might look at it once and walk away without checking again.

While the Response Prevention part of ERP, refers to the part after facing the fear, you don’t do the compulsion you would normally do. This might mean:
 

• Not washing your hands right after touching the doorknob.

• Resisting the urge to check the stove.

• Mixing up the compulsion, for example stop the counting or tapping midway or only do it partially, resisting the urge to complete the ritual. 

• Avoid seeking reassurance from others, even when anxiety increases. 

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All of this is done under the guidance of your therapist at the beginning — though you will eventually learn to do your own ERP exercises to help manage your symptoms.

That said, this strategy of purposefully exposing yourself to things that make you anxious may not sound quite right to you. If you have OCD or anxiety, you have probably tried to confront your obsessions and anxiety many times only to see your anxiety skyrocket. With ERP, the difference is that when you make the choice to confront your anxiety and obsessions you must also make a commitment to not give in and engage in the compulsive behavior, avoidant strategies, or ruminations about what could happen.

 

When you face into your fears and don’t do the compulsive behaviors/avoid, over time you will actually feel a drop in your anxiety level. This process helps your brain learn, and increases your confidence in your abilities to handle OCD and that nothing bad happens if you don’t complete the action. This natural drop in anxiety that happens when you stay “exposed” and “prevent” the compulsive/avoidant behaviors “response” is called habituation. Even if you don’t have a drop in anxiety every time, you are also learning that you can tolerate your anxiety which is called inhibitory learning. The more you practice, the easier it becomes.

Basically, ERP is a therapy that breaks this cycle by teaching your brain that fear isn’t as dangerous as it feels. 
 

Another Way to Think About ERP:

Think of your anxiety as a house alarm system. If an alarm goes off, what does it mean? The alarm is there to get your attention. If an intruder is trying to break into your house, the alarm goes off, wakes you up, gets you to act. To do something. To protect yourself and your family. But, what if the alarm system went off when a bird landed on the roof instead? Your body would respond to that alarm the same way it would if there were an actual threat such as an intruder.

OCD and anxiety take over your body’s alarm system, a system that should be there to protect you. But instead of only warning you of real danger, that alarm system begins to respond to any trigger (no matter how small) as an absolute, terrifying, catastrophic threat.

When your anxiety “goes off” like an alarm system, it communicates information that you are in danger, rather than “pay attention, you might be in danger.”

Unfortunately, with OCD and anxiety, your brain tells you that you are in danger a lot, even in situations where you “know” that there is a very small likelihood that something bad might happen. This is one of the cruelest parts of these disorders.

Now consider that your compulsive behaviors are your attempts to keep yourself safe when that alarm goes off. But, what does that mean you are telling your brain when you engage in these behaviors? You are reinforcing the brain’s idea that you must be in danger. A bird on the roof is the same as a real intruder breaking into your home.

In other words, your compulsive behavior fuels that part of your brain that gives out these many unwarranted alarm signals. The bottom line is that in order to reduce your anxiety and your obsessions, you have to make a decision to stop the compulsive/avoidant behaviors. You need to sit with the anxiety.

However, starting Exposure and Response Prevention therapy can be a difficult decision to make. It may feel like you are choosing to put yourself in (perceived) danger. It is important to know that Exposure and Response Prevention changes your OCD and anxiety and changes your brain pathways. You begin to challenge and bring your alarm system (your anxiety) more in line with what is actually happening to you.

Key Points About ERP for OCD

• It’s a gradual process: You start with easier fears and build up to harder ones.

• You’re in control: A therapist helps you decide what steps feel manageable.

• It gets easier: Over time, your brain stops reacting so strongly, and the compulsions lose their grip.

ERP helps you reclaim your life by showing you that you don’t have to follow OCD’s rules. It’s challenging, but simple and most of all life-changing.