What is ERP?
Exposure and Response Prevention (ERP) is a highly effective therapy for OCD that involves gradually exposing individuals to their fears or triggers while preventing the accompanying compulsive behaviors. Through repeated exposure, individuals learn to tolerate anxiety and resist engaging in their usual rituals, leading to a reduction in OCD symptoms and improved quality of life. For more information about ERP, please see and International OCD Foundation. For more information about OCD, view OCD Therapy.
How does ERP work?
ERP, or Exposure and Response Prevention, is a specialized form of therapy for OCD that follows a structured and evidence-based approach. The goal of ERP is to help individuals confront their fears and obsessions while refraining from engaging in the compulsive behaviors or rituals that typically provide temporary relief. ERP operates under a specific framework that allows you to get used to the discomfort of anxiety and uncertainty gradually, over time, so that it’s not overwhelming.
ERP is an approach to treating anxiety, phobias, and OCD that focuses on building tolerance to the discomfort of anxiety and uncertainty. This concept might feel counterproductive to some, “why do I need to feel anxious?” or “why can’t I try to be more certain?” The answer to those questions might feel like a bit of a let down, but it’s true to life. Anxiety and uncertainty are unavoidable; they’re a natural part of the human experience. If our energies are focused on trying to avoid anxiety and uncertainty, we won’t ever learn how to deal with being anxious and uncertain during the times we CANNOT avoid. We also get sidetracked from the other things we want out of life.
ERP helps us get used to the experiences of feeling anxious and uncertain, so that we don’t need to spend so much time and effort trying to avoid or reduce their intensity. And as a side effect, as we learn how to sit with the discomfort of those experiences, they end up feeling less intense.
Framework of ERP
Under the guidance of a trained therapist, individuals will work systematically through a framework aimed at identifying specific anxieties, fears, or situations to address. Then, once you and your therapist have a good understanding and plan, you will begin to implement a structured approach to addressing your anxieties, phobias, and fears. The intended outcome of ERP is to show you that experiencing anxiety and uncertainty actually helps make the discomfort easier to bear. It’s not possible for us to fully avoid anxiety, or to find certainty in uncertain situations, and when we avoid the discomfort of those experiences we’re less equipped to handle them. And by confronting your fears and learning to live with them, you actually feel less anxious.
Identify core fear(s)
What are the intrusive thoughts that pop into your head? When you worry, what are you afraid of? In ERP, you will work with your therapist to identify your core fears. When your worries are consistent, tenacious, and feel hard to ignore, we call them obsessions.
Identify baseline discomfort tolerance
You and your therapist will determine what level of discomfort you can currently tolerate as a starting point. When you confront a fear and your anxiety is triggered, we want the resulting discomfort to feel manageable to sit with, without the need to engage in your compulsion. As you progress through ERP therapy, your baseline discomfort tolerance can increase. You will learn to better tolerate and manage the discomfort.
Trigger your fear
(without engaging in your usual response)
The central point of ERP is learning to tolerate the discomfort of your obsession being triggered and resisting your compulsion. Instead of what you would usually do, we want you to fully experience the discomfort of anxiety and uncertainty that your previously typical response would have reduced. In doing this, you are finally allowing yourself to see that this discomfort is not life-threatening and can be tolerated.
Identify response to fear(s)
You’ll then identify your response when a fear is triggered. These repetitive responses are also called compulsions. You feel compelled to respond to your fears in specific ways that are designed to reduce/eliminate the feared outcome, although they never quite seem to do the trick. Your responses can be external, observable by others, or internal, happening in your mind.
Create an exposure hierarchy
You and your therapist will create a structured step by step plan that outlines specific situations, objects, or activities that trigger anxiety or obsessive thoughts. This creative process gives you a pathway to increasing your anxiety levels over time. Each item in the hierarchy represents a step towards confronting the feared situations or triggers. The purpose of the exposure hierarchy is to guide you through a gradual and systematic exposure process.
Habituation through repetition
ERP has you experience a given trigger multiple times, which allows you to habituate, or get used to, the discomfort. Habituation occurs when your discomfort level drops after repeated exposures to the same trigger. Your body is learning to tolerate the discomfort, and as a result you feel less uncomfortable. Through ERP, you gradually develop greater tolerance for anxiety and uncertainty, and learn that you can resist your compulsions without experiencing the feared consequences.
What is the goal of ERP?
The goal of Exposure and Response Prevention (ERP) therapy is to help individuals with anxieties, phobias, or OCD reduce the power and impact of their obsessions and compulsions. Through gradual and systematic exposure to feared situations or triggers, the therapy aims to desensitize individuals to their anxiety and teach them healthier ways of responding. By resisting the urge to engage in compulsive behaviors, individuals learn that their fears and anxieties are unfounded, leading to a reduction in symptoms and improved daily functioning. The ultimate objective of ERP is to empower individuals to regain control over their lives and live without the constraints of anxiety.
Who can benefit from ERP?
ERP can be utilized with people of all ages. ERP therapy is highly beneficial for individuals who are diagnosed with Obsessive-Compulsive Disorder. ERP is considered the gold standard treatment for OCD and has shown significant effectiveness in reducing symptoms and improving overall well-being. It is suitable for individuals with various types of OCD, including contamination fears, intrusive thoughts, checking behaviors, and symmetry or ordering concerns. ERP can be tailored to address the specific obsessions and compulsions that an individual experiences. ERP is also a helpful treatment for people who experience specific phobias (such as from elevators or spiders), and in treating others forms of anxiety, such as panic or social anxiety.