What is Exposure Response Prevention?




– Carolyn Moriarty, LCPC


Think back to the first time you ever got behind the wheel of a car. If you’re like most people, it was far from a “stress free” experience. There was probably a lot of adrenaline coursing through your veins and your mind was automatically thinking of all the possible worst-case scenarios that could happen. Those feelings and thoughts likely continued to be intense during the first dozen or so times you practiced driving. But if I were to ask you to about how driving feels to you now, chances are it has become a pretty mindless and even “boring” task.

Your body’s ability to adapt to new, scary situations through repetitive exposure is referred to as ‘habituation’ in Exposure and Response Prevention (ERP).


What is ERP?

When people struggle with anxiety, they tend to try and avoid the very things that produce anxiety or perform certain actions to try and “get rid of” uncomfortable feelings and eliminate doubt and uncertainty. Unfortunately, research has shown that avoidance, distraction, and repetitive actions/rituals actually perpetuate and increase anxiety and stress over time.

ERP is an evidence-based method commonly used in the treatment of anxiety disorders, particularly Obsessive-Compulsive Disorder (OCD). Simply put, it involves teaching clients how expose themselves to anxiety-provoking situations or stimuli without engaging in their usual compulsive or avoidant behaviors. The goal of ERP is to help individuals gradually learn that their feared outcomes are unlikely to occur and that their anxiety will naturally decrease over time.


With time, the individual will learn that:  

  • 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, they can live with anxiety and regain control despite feeling anxious, fearful, or uncertain


How does ERP work?

The goal of ERP is to help individuals  learn to tolerate their anxiety and resist the urge to engage in their usual rituals or avoidance behaviors. This allows people to learn that their feelings of discomfort and doubts naturally subside on their own without them doing anything about it.


Here’s what you can expect in an ERP treatment session:

  • The therapist will help a client create a list of triggers (people, places, things, thoughts, fears, situations, images, objects, physical sensations, memories). that produce feelings of anxiety/distress/discomfort This is often referred to as an Anxiety Hierarchy.
  • The therapist will help a client create a similar list of any rituals/compulsive acts they perform to get rid of anxiety. To track progress and help organize the hierarchy, it’s helpful to rate how much discomfort it would cause if the individua was unable to perform each one
  •  A lower-level item on the hierarchy is chosen, so the client does not feel too overwhelmed. With support and guidance, the client will intentionally confront/expose themselves to that triggers while refraining from engaging in ritual and/or avoidance behavior.
  • The client will rate their anxiety level as they are resisting that typical response
  • The client will stay with the exposure until their initial anxiety level comes down to at least half of what it was at the beginning of the exposure
  • The client will continue with exposures until lower-level items produce minimal anxiety and gradually work your way up the hierarchy


It’s important to note that ERP should always be conducted with the guidance of a qualified professional, as it involves helping individuals to their fears, which can feel distressing if not done following the proper technique. A therapist can provide support, guidance, and expertise to ensure that the treatment is tailored to the individual’s specific needs and conducted in a safe and effective manner.



Seeking Mental Health Support

Scheduling an appointment with Chicago Counseling Center . Our therapists specialize providing ERP for OCD and other anxiety disorders. — Meet our team to learn more!


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