What Is Exposure and Response Prevention (ERP) Therapy?

ERP therapy is a behavioral therapy that gradually exposes people to situations designed to provoke a person’s obsessions in a safe environment.

A hallmark of ERP is that is doesn’t completely remove distressing situations and thoughts. Not only can distress not be eliminated from someone’s life altogether but doing so would make it impossible for patients to cope during everyday situations.

ERP provides a patient with coping skills for when a triggering situation presents itself, allowing them to then use the skills to prevent their compulsion from taking over.

When getting started with ERP, obsessions will remain a challenge in the short term, but they will no longer seem overwhelming. By further developing coping skills, ERP can free people from the cycle of obsession and compulsion.

How ERP Works

To understand how ERP works, consider its use for a well-known obsession of OCD: a fear of contamination—in most cases, germs.

People whose OCD stems from a fear of germs may continuously wash their hands to the point at which their skin turns raw. The compulsion can make them chronically late for activities. Anyone with these symptoms could potentially benefit from ERP therapy.

For someone who is afraid of catching germs from a doorknob, for example, the way to overcome this fear using ERP would be for them to touch the doorknob. A clinician may then have the individual touch their face and their wallet to address the fear of spreading germs.

An important step in ERP would include the patient stopping themselves from engaging in the ritual of hand-washing. This last part prevents the patient from reinforcing the obsession through avoidance. All of these steps help the patient tolerate both the discomfort of having germs on their hand and the uncertainty around what might happen next.

This can seem like a big, frightening change for someone with a fear of contamination. Because of this, therapists usually start with low to moderately anxiety-provoking exposures and work their way up to higher-level exposures.

Who Will Find Exposure and Response Prevention Therapy Most Helpful?

ERP is almost exclusively used to treat people who have OCD. Several common signs of OCD include:

• An extreme fear of being contaminated by germs, dirt, or other potential pathogens

• An extreme fear of losing control of oneself and harming either oneself or others

• Intrusive thoughts that keep entering the mind, causing disruption to sleep habits and daily routines

• An excessive focus on moral or religious ideals

• A generalized fear of losing or not having certain things that might be required

It is important to know that these obsessions can lead to extreme, compulsive behaviors that will disrupt the person’s overall quality of life.

Although there has been much research into ERP, it is still unclear which patients with OCD benefit from this treatment. Most people who receive ERP will see improvement, reducing their symptoms through use of the skills learned during treatment.

In general, people who pair ERP with other types of therapy—medicinal or otherwise—will experience the most success.