Exposure and Response Prevention

Exposure and Response Prevention (ERP) is considered the gold standard treatment for:

  • Repetitive thoughts, obsessions, or images that trigger anxiety, disgust, or shame

  • Intense urges / behaviors to neutralize or avoid unwanted outcomes

  • Intense fear of uncertainty and repetitive efforts to avoid or reduce uncertainty

ERP involves gradually exposing yourself to the scary thoughts, images, words, or situations that make you feel intensely distressed or anxious. At the same time, (this is the response prevention part), during the exposure we are eliminating compulsive behavior and replacing responses that maintain or “grow the fear” with “leaning in” behavioral responses that will reduce distress.

I KNOW! It sounds backwards. I promise, I won’t ask you to lick a toilet seat, or some other “too far” exposure (that could actually make OCD symptoms worsen). Over the years, I have learned that the pace of ERP is important. If we move too slowly, it will not only take a long time to reduce enough of your symptoms, but it will also provide an opportunity for new or old triggers to crop back up (OCD likes to play “whack-a-mole”). Alternatively, if we go too fast, replacement compulsions or increased internal compulsions become a very real risk.

There’s a good chance you’ve tried exposing yourself to the scary thoughts or images only to find that your anxiety intensifies. This is usually because there is a subconscious belief system, mental ritual, or compulsive behavior fueling the intensity that you may be unaware of. In ERP therapy, we work together to identify those, and eliminate them so that when you gradually expose yourself, the distress you experience actually diminishes quickly! When done correctly (and practiced 1 - 2 hours per day), most people achieve significant or total desensitization (to that particular component of the trigger) within 1 week!

ERP begins with a lot of education and symptom identification. I want to train you to be your own therapist and to be an expert in your own OCD so that you are able to maintain treatment gains for the rest of your life. If you’re scared to start, or not sure you’re motivated yet, we will start by building courage and motivation alongside the education component. Next, we scale the distress to the triggers and create an exposure hierarchy. Then we start at the lower end of the hierarchy with exposure and response prevention practice, only moving through the hierarchy when the distress is eliminated. The good news is that ERP tends to have a nice “ripple effect”, meaning that it gets easier to move through the rest of the hierarchy than you would think at the beginning. This is because of the desensitization effect, and a result of building confidence in the ERP process, as well as regaining trust in your courage and strength.

For more information on ERP, visit https://iocdf.org/about-ocd/ocd-treatment/erp/