Written by: Matt Hunter, M.S., LPC, NCC
Exposure & Response Prevention (ERP) is a Cognitive Behavioral Therapy (CBT) technique that has been extensively researched and shown to be effective in treating Obsessive-Compulsive Disorder (OCD). It is a specific form of exposure therapy in which the goal is to slowly reduce the cognitive and behavioral response to a stimulus, sometimes referred to as a trigger. This habituation process is closely related to the systematic desensitization used for phobias where the goal is to expose the client gradually to a feared situation until the person becomes desensitized and the fear subsides. Basically, the fear response loses its power over time.
In ERP, the goal is to identify and prevent the pattern that reinforces and builds the fear response by slowly breaking the association of psychological and physiological reactions to the need for the safety behavior. This goal is attained by the client intentionally and voluntarily refraining from escape responses during the gradual exposure through a hierarchy of increasingly fearful client-identified stimuli.
In a June, 2006 article in the Canadian Journal of Psychiatry, Jonathan Abramowitz states that “within the span of about 20 years, the prognosis for individuals with OCD has changed from poor to very good as a result of the development of ERP.” The article goes on to suggest that the minority of patients that do not benefit from the treatment are typically those that drop out early or refuse treatment altogether. Therefore, it is important to note that while working through the exposure, clients may experience some anxiety; however, the therapist minimizes this effect by allowing clients to design their own hierarchies and move through them at their own pace. In addition, working on breathing, cognitive responses, and mindfulness practices prior to starting the exposure ensures that the client has tools available should the anxiety become overwhelming.
At the same time, experiencing some anxiety is a critical part of the CBT process. An essential cognitive shift for the client is to replace the unattainable goal of eliminating anxiety to the goal of managing anxiety with the belief that she or he is capable of handling it. A useful tool in desensitizing clients to the physical signs of anxiety is the use of interoceptives. Furthermore, allowing clients to set their own pace using “baby steps” is vital to building self-efficacy or the belief that clients have the ability to challenge their worries and fears. Small victories lead to bigger challenges and supply cognitive evidence with which to challenge automatic self-defeating thoughts. Lastly, OCD symptoms are known to correlate with life stress and typically get worse over time. Therefore, early intervention and the introduction of coping skills may add to the effectiveness of ERP.