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What Is Exposure and Response Prevention Therapy?

If you or a loved one have Obsessive-Compulsive Disorder (OCD) and are looking for treatment, you likely noticed that Exposure and Response Prevention (ERP) is the most commonly recommended form of therapy for OCD. In fact, along with serotonin reuptake inhibitors (SRIs), it has consistently been shown to be one of the most effective treatments. ERP is also often recommended for anxiety.

ERP is a form of behavioral therapy that subjects people to situations and stimuli that trigger their obsessions, fears, or anxieties, while helping the person develop coping strategies for the resulting distress. This treatment can help someone with OCD prevent compulsive responses. Ultimately, ERP aims to liberate people from obsessive patterns and compulsive behaviors, allowing them to live better, healthier lives.

How Does ERP Work?

We cannot learn to adjust to distress by simply getting rid of or suppressing it; this is why response prevention is key. When people don’t turn to compulsions or unhealthy coping mechanisms, they become empowered to learn how to accept and confront their fears and obsessions, instead of acting desperately to neutralize or escape them. Of course, it is still difficult to manage negative thoughts at times. However, through ERP, these negative thoughts no longer present the same unsolvable problem.

Psychologists call the process of becoming accustomed to something “habituation.” Patients work with therapists to habituate to the feelings of obsessions or anxiety, while reducing their dependence on compulsions and defense mechanisms. The result is that they spend less time and energy avoiding or obsessing over their fears. 

The purpose of ERP is to shift one’s attention towards unpleasant feelings and thoughts—not to get rid of them. When we feel capable of dealing with discomfort, our obsession and fears (which used to create a sense of profound uncertainty) are no longer reinforced by avoidant behaviors. These behaviors often make us feel as though the contents of our every thought are important and reflective of our true nature. When we eliminate the overwhelming need to know everything about ourselves, the future, and where we stand in the world, we are able to live a healthier life with less unnecessary suffering.

Who is ERP Right For?

Research shows that everyone experiences some degree of anxiety and at least some of the intrusive thoughts associated with OCD. When alone or uncertain, you may have thoughts along the lines of: “There’s nothing stopping me from crashing my car right now,” or “What if I don’t really love my partner?” 

Those without OCD or anxiety disorders usually disregard distressing thoughts as strange and random occurrences. However, those with these conditions feel compelled to eliminate or neutralize these thoughts. In the same way, obsessions and compulsions reinforce each other; since the person had to avoid a thought with a compulsion, they believe that thought must have been quite important (and hence worthy of even greater fear). In most cases, severe anxiety disorders and OCD symptoms do not resolve themselves on their own.

This is where ERP comes in. Traditional cognitive approaches, such as Cognitive Behavior Therapy (CBT), ask patients to challenge their obsessions. These approaches can reinforce the belief that thoughts have significance, and that we have moral responsibility for our thoughts. Although cognitive interventions can be beneficial in many ways, recent studies comparing ERP and CBT have shown that ERP is more effective when treating OCD and certain anxiety disorders.

Are There Downsides to ERP? 

Unfortunately, ERP often causes a fair amount of distress for patients, especially during the early stages of treatment. Nevertheless, ERP advocates and clinicians suggest that the distress of treatment usually ends up being insignificant compared to the suffering of untreated patients who live their lives in anguish over obsessive thoughts and compulsions.

ERP is all about short-term pain for long-term gain. However, this must be done carefully by a clinician whose expertise you respect and trust. 

Here are a few questions to ask yourself before deciding on ERP as a treatment: 

  • What are your goals, and will ERP help you achieve them? 
  • What are your limits for the amount of distress you’re prepared to go through? 
  • For how long are you willing to undergo the treatment? 
  • What kind of support system do you have outside of therapy? 

These questions can help you determine if ERP is the right fit for you.

Contact Life Adjustment Team Today!

If you’re ready for treatment, Life Adjustment Team can help. At LAT we have the training, knowledge, and experience to help you or your loved one take on your OCD or anxiety and find a treatment plan that works. Our Team has a proven track record of helping people gain self-confidence, find direction, and overcome their problems. Contact our Clinical Team to get started today!