Exposure and Response Prevention

Exposure and response prevention (ERP) is a form of cognitive behavioral therapy (CBT) used to treat a variety of conditions, including anxiety, phobias, and eating disorders. It is considered the gold-standard treatment for obsessive-compulsive disorder (OCD).

Exposure and response prevention is designed to gradually reduce the anxiety that feeds obsessions and compulsions. One way in which this is thought to happen is through a process called habituation,whereby people become less physiologically aroused by triggering stimuli or obsessions after being repeatedly and safely exposed to them.

Further, individuals with OCD, anxiety, phobias, or eating disorders learn over time that the stimuli, thoughts, and feelings that prompt compulsions are more bearable than they anticipated. They also realize that being exposed to their fears does not actually lead to the outcomes they dread. They come to recognize that they are capable of coping with the triggers without resorting to compulsive rituals.

How It Works

Exposure and response prevention can help people manage anxiety-provoking or obsessive thoughts and behavior. It involves two steps:

  • Individuals are directly exposed to stimuli that generally evoke fear, distress, obsessive thoughts, or compulsive, ritualistic behavior (exposure component).
  • They learn therapeutic techniques to help prevent their usual maladaptive response; as a result, they get accustomed to experiencing a trigger but not giving in to the compulsion—this is the response-prevention component.

What to Expect

Exposure and response prevention, which may last a dozen sessions or longer, begins with a thorough assessment, during which the therapist will provide education about the patient’s specific condition and identify their unique triggers and the compulsions they provoke. With the therapist’s guidance, the patient is systematically exposed to objects, situations, mental images, or other stimuli that trigger obsessions.

An important challenge in ERP is the “response prevention” component—learning not to respond to the obsessions with the usual compulsive behaviors. With exposure to increasingly uncomfortable stimuli, patients acquire the ability to tolerate the distress they generate without having to resort to rituals that only wind up perpetuating obsessive-compulsive patterns.

For example, someone with OCD may touch a doorknob in a public restroom and worry intensely that they have been infected with germs. This may cause them to repeatedly wash their hands to the point of physical pain. Exposure and response prevention treatment might involve having the patient hold a public doorknob for a certain period of time without immediately washing their hands.

Sessions typically take place within a therapist’s office but may also incorporate a location that normally triggers symptoms. Eventually, a therapist may direct the client to engage in exposure and response prevention activities on their own. ERP will generally conclude with the therapist and patient making a plan to prevent relapses.

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