Exposure and response prevention (ERP) is a “gold standard” treatment for obsessive-compulsive disorder (OCD), though the best outcomes come from combining it with an SSRI. The approach is sometimes used for other anxiety conditions as well. You may have heard that it involves facing your fears and triggers, and that’s true.
However, you don’t go into ERP unprepared or alone, and you don’t start with your most distressing anxieties. You have a therapist with you in the beginning and during most exposures. You start with the triggers that are the least distressing, and you gradually work your way up.
There’s plenty of misinformation about ERP out there, and even some clinicians who aren’t particularly experienced in treating OCD may have inaccurate ideas. If you familiarize yourself with the main concepts, you can have better conversations with care providers and find a provider with experience in OCD treatment.
In this article, we’ll give you an accurate definition of what ERP is and outline how it works so you’ll know what to expect in treatment.
What is ERP? The fundamentals
ERP treatment usually consists of at least 12 sessions, though this can vary depending on individual needs. It begins with thorough prep work to identify target thoughts and behaviors and plan your exposures. You receive thorough psychoeducation on OCD and ERP principles, and most often, you’ll receive complementary therapies to help you develop coping skills.
It’s kind of like a series of “trust falls” — the team-building exercise where you fall backward, trusting someone will catch you. It’s scary the first time, but as you survive each one, you feel safer and your expectations change. You might be able to relax your body instead of bracing for impact, and you may feel less physically anxious. Eventually, you’ll start to work on coping skills that don’t fuel obsessions the same way that compulsions do, and ERP gives you plenty of opportunities to practice those techniques.
The following are the basic building blocks of ERP:
The exposure component
Exposures are gradual, controlled experiences with feared situations or stimuli. You start by talking with your therapist about your fears. You work with them to create a hierarchy ranking your fears from least to most distressing, and you reflect on compulsions or unwanted response behaviors.
Then, you talk through some exposures that seem manageable for your least-distressing fears. You’ll plan exactly what will happen during the exposures, predict what thoughts, emotions or urges you might experience during each exposure. You and your therapist will plan together to ensure emotional and physical safety.
The response prevention component
Compulsive behaviors only provide temporary relief from fears and anxieties. In fact, engaging in compulsions can actually keep the OCD cycle going. It’s the response prevention element of ERP that results in the most treatment gains.
Resisting compulsions helps you build up a tolerance for uncertainty and discomfort, and it helps you break the cycle of catastrophic or absolute thinking. You may start to practice coping skills during exposures so you’re ready to use them outside of therapy sessions.
Why ERP works neurologically
ERP strengthens connections in parts of your brain that support attention, memory, reasoning, movement, inhibition and reward processing. It may help your brain become less reactive to intrusive thoughts and obsessions over time and with repeated practice and support.
As you encounter your triggers with the guidance and support of a licensed clinician, you gain evidence that feared outcomes are often unlikely or don’t occur. Through a process called habituation, your anxiety responses become less intense. This also helps you build up confidence in your own resilience.
Get a personalized treatment plan that includes ERP at Lightfully
ERP therapy teaches you that you’re stronger than your anxiety by proving you can face your fears gradually and safely with professional support. You don’t have to jump in and take on the toughest exposures right away. You start with something small, and then you take things one step at a time. With some persistence and bravery, you’ll get more confident as you go.
At Lightfully, we provide comprehensive mental health treatment that includes ERP for many clients with OCD and anxiety. We use a method called Precision Care Model (PCM) to create personalized treatment plans. We focus on the basic core processes that make up your mental well-being: your thoughts, emotions, behaviors and relationships. Our programs combine individual treatments with group and family sessions so you can build a strong support network.
If you’re seeking mental health care for OCD, we can help. Please reach out to our Admissions Concierge Team or contact us today.
