Exposure and response prevention (ERP) is a therapy that is used primarily to address symptoms of OCD. However, it can also be effective in treating anxiety, panic and phobias. ERP works by desensitizing the cues to obsessions (distressing thoughts) and compulsions (distressing behaviors to alleviate distressing thoughts) through a series of guided exposures. As this is occurring, your brain will experience new insights that challenge what your brain was expecting to occur, often resulting in rapid reduction of distress associated with the cue.

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Often, when we think of engaging in exposures, our minds imagine having to hold a living mouse if we have a fear of mice. When I suggest ERP to clients, they often tell me that “It sounds awful” because they have this similar type of thought. While holding a live mouse is a form of exposure, it isn’t ERP. In exposure and response prevention, we take time to first educate you about obsessions and compulsions, the role that different regions of your brain have in causing this response, build scripts to talk back to the worry, develop a plan for engaging in guided imaginary exposures and then start engaging in the exposures with the least anxiety provoking item. Frankly, if we started with the most distressing item you would likely never return to therapy. We also discuss whether engaging in actual, real-life exposure is appropriate; not all obsessions are appropriate to actually enact. Once you start engaging in exposures and learn what to expect, as well as how to appropriately engage in the exposure, you will find yourself moving through the guided exposures quickly.

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What does this look like in practice? Going back to the mouse phobia example, we might start with having you look at a small still image of a mouse for a brief period of time until your distress level reduces significantly. From there you would then look at a larger image of a photo of a mouse, eventually working up to watching a video of a live mouse moving around.

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Please reach out to schedule an appointment if you are experiencing obsessions, compulsions, fears, panic or phobias and would like to explore exposure and response prevention counseling.