What is Exposure and Response Prevention?

You may have heard of cognitive behavior therapy (CBT). CBT is used to treat various psychological disorders. An important type of CBT used to treat anxiety and OCD is exposure and response prevention (ERP).

The premise behind ERP is that there is anxiety that feeds obsessions and compulsions. The first part of ERP is exposure. Exposure refers to exposing yourself to the thoughts, images, objects, or situations that make you anxious. The response prevention part of ERP refers to preventing yourself from doing a certain behavior (also known as a compulsion) once you have been triggered by the exposure. The purpose of exposure and response prevention is to help you stop feeling anxious or threatened by the object of the obsession.

The strategy of purposely exposing yourself to things that make you anxious may sound strange. If you have OCD or anxiety, you may have noticed that trying to confront feelings of anxiety or obsession leads to you feeling very anxious and afraid. However, when using ERP therapy, individuals actively engage in exposure exercises under the guidance of a trained clinician. This involves facing situations, leaning into the resulting emotions, persevering, and resisting the urge to succumb to compulsive behaviors all while having your therapist coach you along the way.

How Can ERP Help Me?

Although challenging, when you do it correctly, ERP results in the following:

1. Initial heightened anxiety, uncertainty, and obsessive thoughts.
2. Recognition that these feelings and thoughts, while distressing, are manageable and won’t hurt you.
3. Feelings of anxiety gradually subside when the compulsive response is prevented—something known as habituation.
4. A realization that your fears are not as likely to come true as you once believed.
5. Improved ability and confidence to manage everyday anxieties and uncertainty.

Another Way to Think about ERP

Consider anxiety as your body's alarm system. In a typical scenario, an alarm signals potential danger, prompting protective action. However, in OCD, this alarm system overreacts to even minor triggers, treating them as imminent and catastrophic threats. For example, a fire alarm is used to signal a threat and help you to protect yourself. But what happens if the fire alarm goes off each time you burn food when cooking? You don’t want your body to respond the same way when there is not an actual threat or danger.

 Unfortunately, with OCD and anxiety, your brain tells you that you are in danger a lot, even when in a situation where you “know” that there is a small likelihood of anything bad happening. Having your brain send alarm signals when nothing is wrong is not good for you physically or mentally (link to stress page).

If you consider compulsive behaviors as attempts to keep yourself safe when the alarm goes off, you can see how you are actively reinforcing the brain’s idea that you must be in danger –when you are not.

To alleviate anxiety and obsessions, the decision to cease compulsive behaviors becomes crucial, challenging the brain's unwarranted alarm signals.

Starting ERP might seem daunting and in the beginning, you may feel like you are willingly placing yourself in danger. However, ERP therapy changes your anxiety and OCD and changes your brain. So, in the long term, you will challenge the anxiety (alarm system) and bring it more in line with actual circumstances. Thus, you’ll develop a healthier response –allowing you to feel more joy and focus on more meaningful pursuits rather than obsessions and com