What is exposure therapy?

Exposure with response prevention (ERP) is a component of cognitive behavioral therapy, which has been proven effective in the treatment of obsessive-compulsive disorder (OCD). When participating in ERP, the patient and therapist collaborate on strategies for gradually confronting fears, unwanted thoughts, and distressing feelings while reducing or eliminating compulsions.

Compulsions are behavioral responses aimed at getting certainty about an obsession and neutralizing one’s distress. For example, a person with a fear of contamination may excessively wash their hands or a person afraid of intrusive violent thoughts may repeatedly seek reassurance that they haven’t harmed someone.

When a person is suffering from OCD, their brain triggers an alarm response when they are not actually in danger. This leads the person to engage in compulsive behaviors to alleviate distress. These compulsive behaviors, however, reinforce the initial distress by confirming to the triggered brain that there was a real and present danger. To reduce OCD symptoms, a person must stop engaging in the compulsive behaviors that reinforce the brain’s overactive alarm system.

The ”exposure” element of ERP refers to exposing oneself to thoughts, images, objects, and situations that induce anxiety (or other forms of distress) and provoke the urge to engage in compulsions. Exposures typically begin with easier exercises and then work up to more challenging ones during the course of treatment. The “response prevention” element refers to making the conscious, committed choice not to do a compulsive behavior or ritual once the anxiety or obsessions have been triggered. For ERP to be effective, both elements of exposure and response prevention are necessary.

What is the goal of exposure with response prevention therapy?

ERP therapy is an evidence based treatment during which two processes may occur: habituation and inhibitory learning.

Habituation is the process during which one’s distress around a trigger gradually reduces after one is repeatedly exposed to the same triggering stimuli or situations without engaging in compulsions over time.  Inhibitory learning is the process by which one discovers that their distress around a trigger does not need to be responded to and is then able to recall this even when the trigger arises in different contexts. Both the reduction in distress and the increased willingness to experience distress are positive outcomes when doing ERP.

Who is exposure with response prevention therapy for? 

Anyone who struggles with OCD or a related condition, like generalized anxiety disorder, body dysmorphic disorder, social anxiety disorder, panic disorder, illness anxiety disorder, or specific phobias, could benefit from ERP.

How long does a course of exposure with response prevention take? 

The average course of any kind of CBT treatment is 10 to 20 sessions. However, different people might find themselves moving through the process differently depending on insights gained, co-occurring life stressors, and co-occurring conditions.

What can I expect from an exposure with response prevention therapy session?

As a patient, you can expect to begin ERP therapy by collaborating with a therapist on which exposures you’re willing to engage in and think would be most effective for confronting your fears. You will then, together with your therapist, design and practice exposure therapy techniques in the clinical setting. Once appropriate, you will then continue to practice these techniques and ritual prevention skills on your own and in different environments to generalize your learning.

Is exposure with response prevention a stand-alone treatment?

ERP is the behavioral therapy component of CBT. It is a robust treatment option, but many people also benefit from additional therapies that support ERP. These might include pharmacological interventions, mindfulness, and DBT skills for distress tolerance.

What is an example of how exposure with response prevention would be used?

In someone with OCD, an obsession like “I might be contaminated” might trigger 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).

Can exposure with response prevention ever be dangerous?

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.