What the heck is “ERP”?

By Taylor Newendorp, LCPC

Exposure and Response Prevention (ERP), otherwise known as exposure therapy, is an evidence-based method of treatment within Cognitive Behavioral Therapy (CBT). ERP has been shown to be highly effective in the treatment of Obsessive-Compulsive Disorder (OCD) and a wide range of Anxiety Disorders. These disorders include: Social Anxiety, Panic Disorder, Health Anxiety, and Specific Phobias.

When people struggle with anxiety and doubt the core component of OCD they tend to try and avoid the very things that produce anxiety or perform certain actions to try and “get rid of” uncomfortable feelings. Ultimately people do this to eliminate doubt and uncertainty. Unfortunately, research has shown that avoidance, distraction, and repetitive actions/rituals actually perpetuate and increase anxiety and stress over time. With exposure therapy, you are purposely exposed to a stimulus that produces anxiety or discomfort. The stimulus could be a place, a thought, an image, an object, a situation or something else.  Although this may sound strange, throughout the exposure process you are encouraged to actively resist engaging in your typical response to that trigger. Read on to find out why and how this works! This allows people to learn that their feelings of discomfort and doubts naturally subside on their own without them doing anything about it.

Basic steps/tips for ERP:

  1. Create a list of all triggers that produce feelings of anxiety/distress/discomfort (people, places, things, thoughts, fears, situations, images, objects, physical sensations, memories, etc.). This is often referred to as an Anxiety Hierarchy.
  2. Notate which of those triggers you try to avoid
  3. Rate each item on a scale from 1-10 for how much distress each one causes (1 being low, 10 being high)
  4. Create a similar list of any rituals/compulsive acts you perform and rate how much discomfort it might cause you if you couldnt perform each one
  5. Start with lower-level items on the hierarchy and expose yourself to those triggers while resisting urges to engage in ritual and/or usual response
  6. Rate your anxiety/discomfort level as you are resisting that typical response
  7. Stay with the exposure until your initial anxiety level comes down to at least half of what it was at the beginning of the exposure
  8. Continue with exposures until lower-level items produce minimal anxiety and gradually work your way up the hierarchy

Research has shown, for more than 30 years, that the combination of ERP and CBT is the most effective form of treatment for OCD and Anxiety Disorders. When beginning to use these methods it is important to consult with a professional to gain a thorough understanding of ERP and CBT who can help you create and guide you through exposures specific to your symptoms. However, once learned properly, these are techniques you can use on your own to effectively manage OCD and Anxiety for the rest of your life. Contact us today to start this effective treatment in a trusted professional’s care!

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