Exposure Response Prevention (ERP)
By Megan Pajak, LPC
You know when a song just will not get out of your head until you listen to it for what feels like a gazillion times? It is intrusive and unwanted! Research has shown that when individuals try to suppress something such as an intrusive thought, or in this case a song, it comes back with more intensity next time and repeat. Now can you imagine what it is like to have an unwanted intrusive thought about something that you do not enjoy or have any desire to do. For those who do experience it, whatever the thought is, it can be a terrifying and frustrating experience.
Now, to switch gears for a moment, our bodies have their own security systems, and when something threatens the security system an ‘alarm’ goes off for us to respond and to get to safety. This is great for when we might be in danger, as it protects us. However, when the alarm of our security system goes off when there is little to no evidence that we might be in danger and/or only screams that you are in danger every time it perceives a threat (without sufficient evidence), is where a ‘wire’ in the security system needs to be repaired for accurate communication. For example, your brain and body are sounding the ‘alarm’ for locking up the home at night despite that you already locked all the doors and windows and double-checked a few times for the ‘just in case’.
To dig a bit deeper, our security systems are actually the nervous system, and when the nervous system is threatened, we are going to either fight, flight, freeze, or fawn, until the danger is gone, and we can return to a calmer state. The process of returning to a calmer state is referred to as ‘habituation’ in ERP, which is our body’s way of accommodating to new sensations. *Side note: Fight, flight, freeze, and fawn definitions explained. Fight-is when the adrenaline in our bodies gives us the aggression necessary to fight off the threat. Flight- is fleeing away from the threat. Freeze- is when the mind and body become incapable of moving or making a decision. Fawn- is when the victim does what is necessary to avoid conflict and appease the perpetrator/threat in order to get out of the situation. *
For those who experience anxiety and/or obsessive-compulsive symptoms the most effective therapeutic practice is Exposure Response Prevention (ERP).
What is it?
ERP is an evidence-based therapeutic practice that involves the client repeatedly confronting their fears without engaging in rituals (safety behaviors) to reduce their fear and anxiety. With time, the goal is for the client to learn:
- Feelings of uncertainty, fear, and anxiety themselves are not harmful.
- The feared outcomes are less catastrophic and/or probable than originally predicted.
- Safety behaviors are not necessary to build a tolerance to anxiety, fear, and uncertainty.
- Although unpleasant, you can live with anxiety and regain control despite feeling anxious, fearful, or uncertain.
Broken down: the ‘Exposure’ in ERP is the client exposing themselves to their unwanted intrusive thoughts, images, objects, and situations to trigger their obsessions and induce fear and anxiety. The ‘Response Prevention’ is refraining from engaging in a compulsion or ritual to rid anxiety or fear. So next time when you recognize you are feeling anxious, scared, and uncertain, confront it- do not suppress it. You will survive it.
An example that I have been using in practice is: ‘When we watch a horror movie for the first time, all the emotions and feelings are the most intense during the first viewing (and typically safety behaviors are not done in this scenario), but if I were to ask you to watch that same horror movie 10 times in a row, by the time you reach the 10th time, the initial intensity of emotions and feelings decreases and you survived it’.
References Used:
Abramowitz, J., Deacon, B., & Whiteside, S. (2019). Exposure Therapy for Anxiety: Principles and Practice 2nd Ed. NYC, NY, The Guilford Press.
Gaba, S. (2020). Understanding Fight, Flight, Freeze, and the Fawn Response. Psychology Today.