Exposure and Response Prevention

What is exposure and response prevention (also known as EX/RP or ERP)

Exposure and response prevention is a specific form of cognitive behavioral therapy that was developed for people with obsessive-compulsive disorder or OCD. There are two main components of exposure and response prevention:

1. Exposure involves approaching situations that trigger intrusive thoughts in a gradual and supportive manner. This part involves first figuring out what situations bring up obsessions, or the distressing and uninvited thoughts people with OCD experience.  Before beginning exposure, a therapist and client make a list or "hierarchy" of exposure situations.

2. Response prevention involves setting goals to reduce and eventually get rid of compulsions or "quick fixes" for intrusive thoughts. This process involves finding alternative strategies to cope more effectively with intrusive thoughts.

What is the research support for ERP?

Exposure and response prevention has the strongest research support of any treatment for kids and adults with OCD. There have been dozens of studies with thousands of people with OCD, which suggest that about 70% will experience meaningful change after this treatment, and up to 50% will not even have OCD anymore afterwards (here are major studies that support these estimates in kids and adults). Several psychiatric and psychological practice guidelines recommend ERP as the gold standard treatment for OCD based on this research.

Will ERP work if there are no compulsions? What about if symptoms are related to bad thoughts, morality, or other topics not related to orderliness or contamination?

ERP has been shown to work for all different obsessions and compulsions, and a good therapist is able to personalize ERP to your specific circumstances. Many studies have asked this exact question. By and large, these studies find that the way OCD presents in an individual is not associated with different treatment outcomes. 

I'm worried I will not be able to handle ERP - it sounds too overwhelming!

A lot of people are concerned about the idea of facing their obsessions head on and no longer using compulsions to help themselves feel safe or less distressed. I am blown away every time I work with someone with OCD and see their resilience in facing these situations. ERP is certainly challenging, but with the right support and preparation, it can be a completely life-changing therapy. A good ERP therapist pushes their clients to step outside their comfort zone, but also does so compassionately and only at the pace their client feels ready.

How frequently do ERP sessions occur?

A standard "course" of ERP can be just as effective when you have sessions once per week, twice per week, or on a daily basis for a set period of time. For example, research has shown that 15 sessions spaced over 15 weeks often leads to just as much improvement as 15 sessions spaced over three weeks. In my practice I offer "intensive" courses of ERP in which we do therapy on a more frequent basis, the standard being one session per day for three weeks.