What is Exposure and Response Prevention Therapy?
Published January 18th, 2024
6 min read
Everything you need to know about ERP for OCD.
Written by Simon Spichak
Exposure and response prevention therapy (ERP) is a first-line therapy for obsessive-compulsive disorder (OCD). It is a modified form of cognitive behavioural therapy (CBT) that helps you confront fears, intrusive thoughts, and obsessions in a healthy way while also helping you learn to resist compulsions. While ERP might be sufficient for some people, others might require taking psychiatric medications to boost the effectiveness of the therapy.
What does ERP treat?
ERP is commonly used to treat people with OCD. It can also help treat the following conditions and disorders:
Fears and phobias
Repeated intrusive thoughts
How does ERP work?
With the help of a supportive therapist, ERP helps people with OCD and similar mental health conditions challenge their thoughts and behaviours.
Learning about your obsessions and compulsions
The first step of ERP involves learning about the events or situations at the root of your OCD. To ensure that bad things don’t happen, people with OCD perform rituals or compulsions that address some of these anxieties or fears.
During the session, the therapist will acknowledge your beliefs and the risks associated with these events and situations. They will work with you to understand that these risks might be exaggerated and might not require compulsions to prevent bad things from happening.
Some common obsessions include:
A fear of themselves or their living space being dirty or contaminated
A belief you’ve done something wrong or forgotten to do something around the house
Uncomfortable or shameful thoughts about harming oneself or others
Unwanted or shameful thoughts about sex, religion, or morality
These obsessions lead to compulsions, including:
Compulsive cleaning
Constant checking, i.e. that the door is locked or the oven is off
Ruminating on past events to convince yourself that you’re not a bad person or won’t act out unwanted or shameful thoughts
Exposure and response prevention
The next step involves exposing you to situations and events to learn that nothing disastrous will happen if you don’t act out your compulsions. This part of therapy involves working closely with the clinician to figure out a plan of action that doesn’t completely overwhelm you.
For example, if you have a fear of contamination, ERP could start by having you touch a table in a coffee shop. Then, with the same hand, they might ask you to touch your face, phone, or other objects in your home. This directly confronts the fear of contamination while slowly teaching you that nothing overly disastrous will happen even when you resist acting out your compulsion to clean or sanitize your hands or living space.
How will I know ERP is working?
You will be exposed to situations that cause you stress and anxiety. That means at the start of therapy, you might start to feel more uncertain, and it might even amp up intrusive or obsessive thoughts.
As you’re exposed to these stressful situations, you’ll learn that these thoughts can’t hurt you. You’ll find yourself ruminating less and less, and your symptoms will gradually improve. The drop in anxiety occurs because you become used to these situations — your brain no longer associates them with anxiety — a process called habituation.
You’ll feel better, less anxious, and less uncertain over time. It will be easier for you to prevent compulsive behaviours as well. Overall, it might take 12 to 16 weekly sessions until you notice an improvement in symptoms.
Do I need to take medications for OCD as well?
Speak with your therapist and psychiatrist if you’re considering taking medications. Combining ERP with these drugs is thought to boost the effectiveness of the treatment.
Common medications prescribed for OCD include:
Anafranil (generic name: clomipramine)
Celexa (generic name: citalopram)
Effexor (generic name: venlafaxine)
Lexapro (generic name: escitalopram)
Luvox (generic name: fluvoxamine)
Paxil (generic name: paroxetine)
Prozac (generic name: fluoxetine)
Zoloft (generic name: sertraline)
What makes ERP different from other forms of therapy?
While other forms of talk therapy might be effective for anxiety or depression, ERP, in particular, is especially effective for treating OCD. Other forms of talk therapy could help later on in your mental health journey.
Takeaway
ERP is an effective form of therapy that can help people with OCD regain control over intrusive thoughts, obsessions and worries.
Over the course of 12 to 16 sessions, your therapist will slowly expose you to stressful situations while preventing you from acting out compulsions. This will help your brain and body get used to these situations and events, reducing symptoms.
Resolvve’s therapists are trained to provide ERP. So, when you’re ready to take the next step, you can book a free consultation.
Please note that this post is written for educational purposes; it is not therapy. If you need to talk to a professional, please book a consultation with a psychotherapist through Resolvve.
