Exposure with response prevention (ERP) is a form of behavioral therapy that involves gradually confronting a feared situation while resisting compulsions. At The OCD & Anxiety Center, we often utilize exposure therapy for OCD as part of your treatment plan.
Compulsions are behavioral responses aimed at getting certainty about an obsession and relief from distress associated with the obsession. An obsession, such as “I might be contaminated,” could be responded to with a compulsion like excessive hand washing. ERP for this obsession would involve voluntarily engaging in planned behaviors that make the sufferer feel contaminated, such as touching a public surface (exposure), while resisting the urge to wash, avoid, or do other rituals (response prevention). Over time, two things occur:
- The compulsive hand washer in this example begins to habituate to the discomfort (meaning, the pain associated with feeling contaminated diminishes), and
- The brain learns to separate the feeling of contamination from the demand to wash or do other compulsions (a process called inhibitory learning).
How Does Exposure Therapy for OCD (ERP) Work?
Exposure therapy for OCD (ERP) typically begins by establishing a hierarchy of triggering situations, with exercises addressing the easiest first and then working up to more challenging exposures during the course of treatment. Many exposures can be “in vivo,” meaning they involve literally being in the presence of a fear cue (being near or touching a triggering item, visiting a triggering environment, or engaging in a triggering behavior). Imaginal exposures can also be employed, which involve writing and mental exercises that elicit the feared state of mind. Interoceptive exposures can further enhance some exposure strategies, which involve purposely creating feared physical states in the body.
ERP is a collaborative process wherein the therapist and client work together to establish a treatment plan that runs at a pace that will be challenging, but tolerable and effective. An OCD therapist will never ask a client to engage in a behavior that is dangerous, that they themselves will not engage in, or that violates religious or moral beliefs. However, exposures are designed to be challenging and induce discomfort, so part of ERP treatment involves the therapist and client working on motivational issues as well. Exposures are often practiced first in the therapy session and then assigned as daily homework.