Exposure and Response Prevention (ERP)

What is Exposure and Response Prevention?

It is possible that you may have heard of Cognitive Behavior Therapy (CBT) before. CBT refers to a group of similar types of therapies used by mental health therapists for treating psychological disorders, with the most important type of CBT for OCD being Exposure and Response Prevention (ERP).

The Exposure in ERP refers to exposing yourself to the thoughts, images, objects and situations that make you anxious and/or start your obsessions. While the Response Prevention part of ERP, refers to making a choice not to do a compulsive behavior once the anxiety or obsessions have been “triggered.” All of this is done under the guidance of a therapist at the beginning — though you will eventually learn to do your own ERP exercises to help manage your symptoms.

That said, this strategy of purposefully exposing yourself to things that make you anxious may not sound quite right to you. If you have OCD, you have probably tried to confront your obsessions and anxiety many times only to see your anxiety skyrocket. With ERP, the difference is that when you make the choice to confront your anxiety and obsessions you must also make a commitment to not give in and engage in the compulsive behavior. When you don’t do the compulsive behaviors, over time you will actually feel a drop in your anxiety level. This natural drop in anxiety that happens when you stay “exposed” and “prevent” the compulsive “response” is called habituation.

Another Way to Think About ERP:

Think of your anxiety as an alarm system. If an alarm goes off, what does it mean? The alarm is there to get your attention. If an intruder is trying to break into your house, the alarm goes off, wakes you up, gets you to act. To do something. To protect yourself and your family. But, what if the alarm system went off when a bird landed on the roof instead? Your body would respond to that alarm the same way it would if there were an actual threat such as an intruder.

OCD takes over your body’s alarm system, a system that should be there to protect you. But instead of only warning you of real danger, that alarm system begins to respond to any trigger (no matter how small) as an absolute, terrifying, catastrophic threat.

When your anxiety “goes off” like an alarm system, it communicates information that you are in danger, rather than “pay attention, you might be in danger.”

Unfortunately, with OCD, your brain tells you that you are in danger a lot, even in situations where you “know” that there is a very small likelihood that something bad might happen. This is one of the cruelest parts of this disorder.

Now consider that your compulsive behaviors are your attempts to keep yourself safe when that alarm goes off. But, what does that mean you are telling your brain when you engage in these behaviors? You are reinforcing the brain’s idea that you must be in danger. A bird on the roof is the same as a real intruder breaking into your home.

In other words, your compulsive behavior fuels that part of your brain that gives out these many unwarranted alarm signals. The bottom line is that in order to reduce your anxiety and your obsessions, you have to make a decision to stop the compulsive behaviors.

However, starting Exposure and Response Prevention therapy can be a difficult decision to make. It may feel like you are choosing to put yourself in danger. It is important to know that Exposure and Response Prevention changes your OCD and changes your brain. You begin to challenge and bring your alarm system (your anxiety) more in line with what is actually happening to you.

How is ERP different from traditional talk therapy (psychotherapy)?

Traditional talk therapy (or psychotherapy) tries to improve a psychological condition by helping the patient gain “insight” into their problems. Talk therapy can be a very valuable treatment for some disorders, but it has not been shown to be effective at treating the active symptoms of OCD.

While talk therapy may be of benefit at some point in a OCD patient’s recovery, it is important to try ERP or medication first, as these are the types of treatment that have been shown through extensive research to be the most effective for treating OCD. Read more about medication for OCD here.