Everything You Need To Know About Exposure and Response Prevention Therapy

ERP can help stop the problematic cycles of obsessive compulsive disorder. Discover if it’s right for you or someone you love

June 8, 2023

Obsessive compulsive disorder, or OCD, is a serious condition that can disrupt someone’s daily life. It is marked by obsessions, or unwanted intrusive thoughts, and physical or mental actions taken to relieve anxiety associated with the obsessions.

Exposure and response prevention (ERP) therapy is one of the most effective forms of treatment for OCD.

Under the guidance of mental health professionals, people who receive ERP therapy can gradually reduce their anxieties and stop the problematic cycle of OCD.

So how do you know if ERP is right for you or someone you love? And how can you find a provider who is trained to provide ERP?

Keep Reading To Learn

  • How exposure and response prevention therapy works
  • Who benefits from ERP
  • How to find a clinician trained to provide ERP

What Is Exposure and Response Prevention (ERP) Therapy?

ERP therapy is a behavioral therapy that gradually exposes people to situations designed to provoke a person’s obsessions in a safe environment.

A hallmark of ERP is that is doesn’t completely remove distressing situations and thoughts. Not only can distress not be eliminated from someone’s life altogether but doing so would make it impossible for patients to cope during everyday situations.

ERP provides a patient with coping skills for when a triggering situation presents itself, allowing them to then use the skills to prevent their compulsion from taking over.

When getting started with ERP, obsessions will remain a challenge in the short term, but they will no longer seem overwhelming. By further developing coping skills, ERP can free people from the cycle of obsession and compulsion.

Clinicians: Help Your Patients Face Their Fears

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Elizabeth McIngvale, PhD, LCSW, helps mental health professionals navigate the nuances of ERP, dispels myths about the treatment, and answers questions about this intervention.

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How ERP Works

To understand how ERP works, consider its use for a well-known obsession of OCD: a fear of contamination—in most cases, germs.

People whose OCD stems from a fear of germs may continuously wash their hands to the point at which their skin turns raw. The compulsion can make them chronically late for activities. Anyone with these symptoms could potentially benefit from ERP therapy.

For someone who is afraid of catching germs from a doorknob, for example, the way to overcome this fear using ERP would be for them to touch the doorknob. A clinician may then have the individual touch their face and their wallet to address the fear of spreading germs.

An important step in ERP would include the patient stopping themselves from engaging in the ritual of handwashing. This last part prevents the patient from reinforcing the obsession through avoidance. All of these steps help the patient tolerate both the discomfort of having germs on their hand and the uncertainty around what might happen next.

This can seem like a big, frightening change for someone with a fear of contamination. Because of this, therapists usually start with low to moderately anxiety-provoking exposures and work their way up to higher-level exposures.

Learn more about fear, anxiety, and phobias

Who Will Find Exposure and Response Prevention Therapy Most Helpful?

ERP is almost exclusively used to treat people who have OCD. Several common signs of OCD include:

  • An extreme fear of being contaminated by germs, dirt, or other potential pathogens
  • An extreme fear of losing control of oneself and harming either oneself or others
  • Intrusive thoughts that keep entering the mind, causing disruption to sleep habits and daily routines
  • An excessive focus on moral or religious ideals
  • A generalized fear of losing or not having certain things that might be required

It is important to know that these obsessions can lead to extreme, compulsive behaviors that will disrupt the person’s overall quality of life.

Although there has been much research into ERP, it is still unclear which patients with OCD benefit from this treatment. Most people who receive ERP will see improvement, reducing their symptoms through use of the skills learned during treatment.

In general, people who pair ERP with other types of therapy—medicinal or otherwise—will experience the most success.

ERP is only one part of a broader system of management. If you would like to learn more about ERP and other treatment options for OCD, it is important to reach out to your health care providers.

How Do I Find a Therapist Trained in ERP?

If you believe you are having OCD symptoms that impact your quality of life, it is important to reach out to a mental health professional. Mental health professionals include psychiatrists, psychologists, social workers, and mental health counselors.

When it comes to the treatment of mental health disorders, it is important to pursue care as quickly as possible. The sooner someone seeks care, the better the prognosis will be.

For many people, the first step in receiving mental health care is to go through their primary care provider (PCP). After meeting with you, your PCP can provide a referral to a mental health professional.

Even though you may need to wait to get an appointment with a mental health provider, your PCP may be able to provide services that help you control your symptoms in the meantime. However, if your symptoms become dramatically worse before you are able to see a specialist and you are in a crisis, you should go to the nearest emergency department.

Clinician talks with patient

When you are ready to find a therapist, our friends at the International OCD Foundation have a database where you can search for OCD specialists in your area.

Once you meet with a mental health provider, they will set up a comprehensive treatment plan. In some cases, the provider will want to start with ERP. In other cases, they may want to start with other treatment options before starting ERP therapy.

The first step in treatment is to accurately diagnose each patient. If the diagnosis is OCD, this is generally done by comparing a patient’s symptoms to the diagnostic criteria listed in the “Diagnostic and Statistical Manual of Mental Disorders (DSM-5).”

A provider will then set up treatment plans for OCD, which will likely include ERP therapy, along with several other options. If you are interested in pursuing ERP therapy, you should bring up the treatment option at your first visit with your mental health professional.

It is up to the provider to decide whether ERP is the right treatment based on the symptoms.

Don’t forget: it is important to follow your mental health professional’s guidance. At the same time, patients must be their own advocates. Nobody knows yourself as well as you do.

Why Is ERP Important for Treating OCD?

Many studies have shown that almost everyone struggles with intrusive thoughts at some point in their lifetime. For example, plenty of people experience invasive thoughts as they try to fall asleep. While this is a mild issue compared to OCD, it forms the foundation of the research behind exposure and response prevention therapy.

ERP provides people with the skills they need to control their disorder. It helps them learn more about their obsessions, why they happen, and how compulsions stem from obsessions. For this reason, ERP is a key therapeutic component of successful OCD treatment. If ERP is combined with medications, such as SSRIs, it may be even more effective.

Since ERP was first developed in the 1970s, several studies have been done to prove its effectiveness, including a 1993 study that compared behavioral group therapy and individual behavior therapy, a 1997 study in which participants received exposure to obsessive thoughts and response prevention, and a 2006 study that reviewed the treatment outcomes of ERP.

What It Is Like to Experience OCD Treatment Using ERP

ERP therapy will usually start in a clinical setting.

In this environment, the therapist will learn more about the patient’s symptoms. In early sessions, the therapist may ask and answer questions so they can set up a treatment plan for the patient.

The next step is for the therapist to coach the patient on confronting various triggering situations. This could include showing the patient pictures, playing videos, or even going outside of the office into the local community in some way. The therapist will provide instructions and clear support on how to resist obsessions and prevent compulsive behaviors.

Once this layer of treatment has been completed, the next step is for the patient to envision the feared outcomes on their own in the presence of a therapist. At this point, the patient is responsible for trying to avoid completing their compulsive type of ritualistic behavior. This step is highly important in helping people confront OCD.

Once patients can handle these steps in a clinical setting, they will be given homework. The therapist will provide clear instructions for how patients can carry out ERP on their own at home.

The final layer of the treatment process is to discuss relapse prevention planning. The therapist will talk with the patient about how to prevent symptoms from returning.

Comprehensive Guide to OCD

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ERP is commonly used to treat obsessive compulsive disorder. Learn all about this serious mental illness and find hope for treatment and recovery.

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ERP Remains the Cornerstone of OCD Treatment—You Can Do It!

Obsessive compulsive disorder is a serious condition that can dismantle daily routines and create distress. When people have OCD, it is important for them to find treatment options to improve their quality of life.

Under the guidance of mental health professionals, patients who undergo ERP therapy gain the tools they need to target and address OCD symptoms. With ERP, the prognosis of OCD is positive. Exposure and response prevention therapy can make a dramatic difference in the lives and relationships of people with OCD.

Common Misconceptions About ERP Therapy

If you think you or someone you know could benefit from ERP therapy, it is important to understand ERP before you pursue this treatment. Below, we’ve highlighted some common myths and misconceptions.

Myth: ERP Is Designed to Hurt the Patient

Some people believe that deliberately provoking the obsession will make the condition worse. This is not the case. ERP has been proven to be extremely helpful in treating many cases of OCD.

Myth: Facing Fears Is the Same Thing as ERP

ERP involves more than simply facing fears. It involves facing fears and practicing resisting habitual responses to those fears, namely rituals and avoidance.

Facing fears alone without practicing response prevention perpetuates the cycles of OCD and robs the patient of opportunities to learn new ways of relating to the obsessions.

Myth: ERP Is the Same as Flooding

Another type of OCD treatment called flooding aims to make an obsession so bad it overwhelms the patient’s nervous system.

The goal of flooding is to reset the nervous system and allow the patient to deal with obsessions on their own. Exposure and response prevention therapy is the opposite of flooding.

The goal of ERP is to gradually expose patients to their obsessions in a safe and controlled environment. Therapy will then become more intensive as patients demonstrate an ability to handle their obsessions.

The History of Exposure and Response Prevention Techniques

The roots of ERP therapy can be traced back to the early 1900s. Famous behavioral scientists, such as Ivan Pavlov and John Watson, used aspects of ERP when they were exploring classical conditioning.

In 1958, another famous behavioral scientist, Joseph Wolpe, developed a form of systematic desensitization. This technique’s basis was in relaxation training. Its goal was to use an exposure to reduce sensitivity to situations that caused fear or dread.

Systematic desensitization forms the foundation of modern ERP therapy, which was created by Stanley Robinson in the 1970s. ERP was specifically designed to help people struggling with obsessions and compulsions.

Over time, ERP therapy has continued to evolve into its modern form. Even though it has since been fine-tuned to become more effective, its core principles remain the same.

McLean is a leader in ERP therapy to treat obsessive compulsive disorder. If you or a loved one is struggling with OCD, contact us today at 617.855.2776 to learn more about treatment options.

Want to Learn More?

You may find this additional information useful.

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Helpful Links

These organizations have useful information:

International OCD Foundation
The mission of the International OCD Foundation (IOCDF) is to help people affected by obsessive compulsive disorder and related disorders live full and productive lives. The organization aims to increase access to effective treatment through research and training, foster a hopeful and supportive community for those affected by OCD and the professionals who treat them, and fight the stigma surrounding mental health issues.

Peace of Mind
Now part of the IOCDF, this organization provides educational resources and access to self-help tools, offers scholarship opportunities, supports professional training programs, and spreads awareness about OCD and related disorders.

Books About OCD

Here are some of the many books that may help you understand more about obsessive compulsive disorder: