In this series, I dig a little deeper into the meaning of psychological terms. This week’s term is exposure and response prevention.
Exposure and response prevention (ERP) is a type of cognitive behavioural therapy used to treat obsessive compulsive disorder (OCD). It’s similar to prolonged exposure therapy, which is used in anxiety disorders and PTSD, but it has the added piece of response prevention. The client is exposed to anxiety-provoking stimuli that trigger the obsessive thoughts, and then they deliberately force themselves not to respond to those thoughts by performing a compulsive behaviour ritual.
Near the start of therapy, the therapist and client construct a fear ladder. This ranks different stimuli in terms of the level of fear they provoke. Work begins on the least feared stimuli and then moves up the ladder as the therapy progressed.
Prevention of the compulsive behavioural response results in habituation, as the fear response decreases with repeated exposure to the anxiety-provoking stimuli. This takes some time, so there must be a strong commitment to the therapy to be able to make choices that won’t decrease anxiety in the short term, and may actually increase anxiety and agitation initially.
New learning is instilled about the temporary nature of the fight-or-flight response, and the natural tendency of the parasympathetic nervous system to kick in after about an hour of exposure to settle down the physiological response. As behaviours change, more balanced cognitions are established, which then produces changes in emotional response.
When a feared outcome is something that may or may not occur, the focus isn’t on proving that it’s unlikely; instead, the aim is to learn to better tolerate uncertainty without resorting to compulsive behaviours. Learning around uncertainty also occurs in relation to the connection between feared stimuli/outcomes and the presence of obsessions; sometimes the two are connected, but other times they aren’t, meaning they’re not inextricably linked.
Extinction occurs when the client is able to establish that the feared outcome is unlikely and the formerly anxiety-provoking stimuli aren’t dangerous. This is a type of implicit learning, which is learned through practice rather than simply being told by someone else that the stimulus is safe.
OCD hijacks the natural danger response system, sending out alarm signals that aren’t based in actual danger. Responding as though a stimulus is actually dangerous ends up feeding into the faulty alarm system, and further impairing the brain’s ability to distinguish between safe and unsafe.
Starting ERP can seem profoundly counterintuitive since it goes against the message that the brain is screaming. However, research has shown that ERP is effective for OCD, and it’s more effective than talk-focused therapies. It is as effective as medication and has more lasting effects.
Have you ever tried ERP therapy? How has it worked for you?
- Clinical Research Unit for Anxiety and Depression: Obsessive-Compulsive Disorder Patient Treatment Manual
- NHS Inform: Obsessive compulsive disorder (OCD) self-help guide
- Anxiety Canada. (n.d.). Self-help: Managing your OCD at home.
- Bostan, S.N. (2018). Exposure and response prevention for OCD. Psychology Today.
- International OCD Foundation. (n.d.). Exposure and response prevention (ERP).
The post Psychotherapy Alphabet Soup: CBT, DBT, ACT, and More provides an overview of a variety of different therapeutic approaches.
The Psychology Corner has an overview of terms covered in the What Is… series, along with a collection of scientifically validated psychological tests.
Ashley L. Peterson
BScPharm BSN MPN
Ashley is a former mental health nurse and pharmacist and the author of four books.
9 thoughts on “What Is… Exposure and Response Prevention”
It’s interesting to me that I feel I relate to all of the above. However, I think this was only addressed at the very beginning of my therapy back in 2015. I would honestly have to look through my files.
Shit. Maybe I need some of this! 😂 Good read! I suspect myself of some obsessive compulsive behaviors and seeing danger where it does not usually exist. Ive kind of just learned to live with it.
Yeah funny how things that are maybe kind of weird can start to seem like an everyday thing that we just deal with.
True. I find I can become obsessive compulsive about anxious thoughts. It takes some heavy writing to better understand the insecurities that lay beneath the surface and then to rationalize the danger away. Maybe this isn’t OCD but it feels obsessive at times. This seems to help me but it also takes some time to accomplish.
For some of us, securing good mental health seems to be a lifelong commitment where if we stop asking ourselves “why do we do this?” we can begin to slip backwards.
Im enjoying your articles. Keep up the good work.
Wow, I’ve never heard of ERP! I can see how it totally makes sense, though. I don’t have full-blown OCD, but I know I wouldn’t just take my therapist’s word about whether something is safe. When I can, I just hold my breath and jump off the diving board of my fears.
Good for you!