What You Should Know About Exposure and Response Prevention (ERP)

Did you know that there’s a treatment for Obsessive Compulsive Disorder (OCD) that’s been shown to be effective for up to 80% of people with OCD? It’s a type of Cognitive Behavioral Therapy (CBT) called Exposure and Response Prevention (ERP).

What is Exposure and Response Prevention (ERP)?

ERP was developed to treat OCD, and it can be an incredibly effective form of treatment for folks dealing with obsessive thoughts and compulsions. 

To understand ERP, it can help to understand more about how Obsessive Compulsive Disorder works. OCD involves intrusive thoughts that are disturbing and unwelcome. Often, these thoughts create a lot of distress for the person who is experiencing them. When these thoughts pop up and cause distress, people with OCD attempt to relieve the distress through compulsions, which may work briefly. 

After a while, though, the thoughts come back, and the cycle starts again. The compulsions that a person uses to relieve their discomfort eventually become part of their daily routine, which can get in the way of work, family, and other relationships. 

When we think of OCD, we often think of someone who is obsessed with cleaning, but that’s not actually how most people experience the disorder. People may have recurring, unwanted thoughts about harming people they care about, or that something bad will happen if they don’t follow through with their compulsions. Some people experience intrusive sexual thoughts, or thoughts of doing something violent or illegal. These thoughts are not in the control of the person experiencing them, and they can be extremely frightening. 

To try to lessen the fear they feel from these thoughts, people with OCD may develop compulsions or rituals like checking to make sure the smoke detectors work, making sure the baby is still breathing, making sure that the emergency brake is on, or checking that the security system is on. The overwhelming feeling is that if they don’t practice these compulsive rituals, something terrible will happen, and that can be an exhausting way to live. ERP was designed to interrupt this cycle and reduce the anxiety that feeds these intrusive thoughts. 

How does ERP work? 

There are two parts to ERP - the exposure and the response prevention. Within the safety of a therapist’s office, you’ll be exposed to the triggers and thoughts that cause you distress. Then, you’ll practice resisting the urge to perform the corresponding compulsions or rituals. 

First, you’ll work with your ERP therapist to determine what all of your triggers, intrusive thoughts, and compulsions are, so you can work through them in a safe place. This helps you and your therapist determine which triggers and obsessive thoughts cause you the most distress, so you can work your way up from lower levels of distress to higher levels over time. Exposure and Response Prevention works gradually. You aren’t going to be asked to confront your worst fears right away. As you move up the hierarchy of distress, you’ll gain confidence and experience, which help when it comes to the more distressing levels. 

As you’re exposed to your triggers or your intrusive thoughts in ERP therapy, you’ll learn skills from your therapist to help you learn how to sit with discomfort and resist your compulsions. Working with a therapist can help ensure you avoid replacing one compulsion with another, in addition to teaching you skills to help lower your distress level when the unwanted thoughts come up. 

Exposure and Response Prevention works for two reasons - habituation and inhibitory learning. Repeated exposure to your triggers will help you learn to tolerate your distress and discomfort more effectively, which reduces your overall distress level over time. This is known as habituation. Inhibitory learning happens when you learn that your intrusive thoughts don’t always come to pass when you’re exposed to your triggers. ERP helps to prove your obsessions wrong, which helps to lessen their impact. 

What are the benefits and drawbacks of ERP?

ERP is generally known as the gold-standard treatment for OCD, because research has shown that it can be extremely effective. However, it’s important to note that Exposure and Response Prevention takes work, and it’s not always easy. 

Confronting the things you’re afraid of can be terrifying. Effectively learning how to break the cycle of obsessions and compulsions requires work in between therapy sessions, which can be intimidating, especially at first. Folks with OCD are practiced at avoiding discomfort, so learning how to be okay with discomfort takes time and practice. 

Can ERP help with anything else?

Yes! ERP can help with disorders besides OCD, including: 

• Anxiety

• Eating disorders

• Phobias 

How to find an ERP therapist

If you or someone you know is struggling with intrusive thoughts, ERP might be a good fit. Our clinicians at Hope+Wellness have experience supporting clients who have Obsessive Compulsive Disorder. We serve the McLean, Great Falls, Falls Church, Arlington, Alexandria, and the greater Washington DC regions, as well as offering online services in DC, MD, VA, and all PSYPACT states. 

If you would like to talk to one of our therapists, please contact info@hope-wellness.com or get in touch with us here.