Exposure and Response Prevention (ERP) is one very specific type of therapy. It’s designed to help people overcome specific anxiety disorders including phobias and obsessive-compulsive disorder. People with these conditions tend to avoid their triggers which only worsens the condition. ERP offers a structured, safe way to face the triggers in order to overcome the anxiety around them.
What is Exposure and Response Prevention?
Exposure and Response Prevention is one type of Cognitive Behavioral Therapy treatment. CBT works with people’s thoughts and behaviors to help relieve their symptoms. ERP helps first “expose” people to their thoughts and then manage their “response.”
Exposure to Thoughts or Triggers
Exposure and Response Prevention is a two-part treatment intervention. It becomes with exposure, which may be exposure to thoughts or to triggers.
For example, someone with OCD has obsessions, which are thoughts that they don’t want and can’t control. Exposure asks the person to reveal and sit with those thoughts.
One type of OCD is compulsive hoarding. Someone with this condition has a fear of throwing away their items. Therefore, their exposure might be to imagine throwing the item away.
Similarly, someone with a phobia of heights or spiders might first be asked to imagine the thing that they are most afraid of.
Exposure in ERP is something that happens gradually. For example, the person with a fear of heights isn’t asked to go stand on the roof of the city’s tallest building. They’re simply asked to imagine standing on a small wall. As they continue with therapy, their exposure may grow to:
Imagine standing on the roof of a house.
Actually standing on a three-foot tall bench for thirty seconds.
Standing on that bench for three minutes.
Moving on to stand on top of a ladder.
Standing on top of a house.
Here’s another example. Someone has a hoarding compulsion, so they don’t want to throw anything away. They may go through various steps:
Imagine throwing something away.
Choose one item in the room to throw away. Place it in an empty garbage bin for thirty seconds then remove it.
Place the same item in the empty bin for one hour.
Now throw the item into an actual garbage can in the house.
The next step might be to throw an item into a trash bin outside of the house where you can’t go back to get it.
You get the idea. The actual incremental changes depend dramatically on the individual’s fears, goals, abilities, and needs. Throughout the exposure, they work with the therapist to manage anxiety, express thoughts and feelings, and gain greater insight into the exposure’s impact.
Obviously, exposure is a key part of ERP but it’s only half the job. The other half is “response prevention.” People have a pattern of reacting to their trigger in ways that calm them.
In OCD, this is called the compulsion. The thought is the obsession, the action you take to feel better is the compulsion. For example, the thought is, “my house might burn down if I leave my stove on.” The compulsion is to constantly check and re-check to make sure that the stove is off.
In the exposure, the person starts to get used to the feelings and fears associated with the obsession or trigger. They imagine what it would be like if they left the stove on. Or they practice turning the stove on for three seconds. That’s all exposure.
However, they also have to engage in response prevention in order to break the entire pattern. If the compulsion is to constantly check the stove, then they have to prevent themselves from doing so. Working through therapy, the person might learn to only check once before leaving the house, interrupting themselves from going back to check again.
Someone with a phobia may do all that they can to avoid the trigger. In exposure, they learn to sit with the trigger. Through response prevention, they learn to stop avoidance techniques. For example, someone with a fear of spiders may be able to sit with a spider in a jar in the room. However, they may close their eyes or turn away from the jar. In the response prevention part, they prevent themselves from engaging in that turning away behavior.
Exposure Response Therapy can be a very effective treatment for OCD, including compulsive hoarding, as well as many forms of anxiety. Of course, you should work with a trained and experienced therapist who is familiar with this form of CBT.
Anna M. Hickey, Licensed Professional Counselor practices Counseling in Macomb Michigan. Anna’s practice, Life Transitions specializes in Counseling and Divorce Mediation.