What is Exposure Response Prevention (ERP)?
Exposure response prevention is a technique used by therapists during cognitive behavioral therapy (CBT). It is especially beneficial as a treatment for OCD rituals. CBT is based on the premise that people's thoughts can influence their actions, and that changing their thoughts can in turn change their actions. Included in CBT are several techniques, such as cognitive restructuring and ERP.
So what exactly is ERP? ERP tackles disorders in which a person always reacts in an undesirable way in response to a specific trigger. The use of exposure response prevention for OCD helps the person with OCD respond to the trigger in a different way, with a decreased sense of anxiety.
How does this work? In general, the therapist simply places the person with OCD in a situation with the trigger – a less intense version of the trigger, if possible – and encourages the person with OCD to resist giving in to the compulsions or rituals that would usually follow. Because the trigger is weak and the set-up feels less real than usual, this ERP step allows the person with OCD to feel more in control.
When they do not give in to the trigger by completing a ritual, it creates a sense of success. Perhaps more importantly, it lessens the person's anxiety when faced with the trigger, because they have seen that they can overcome their need to react to it.
An Example of ERP for OCD
A typical ERP session might go as follows. First, the therapist will suggest that the OCD person writes down a list of obsessions that should be dealt with. The list might include touching doorknobs, shaking hands, and avoiding cracks in the sidewalk. The therapist then chooses one of the obsessions to work on, probably the one that creates the least amount of anxiety in the patient.
The patient will then create the situation that usually triggers compulsions. For example, if they are working on "touching doorknobs," the patient will gently touch a doorknob with one finger for a short amount of time, while resisting the need to complete a compulsive ritual (e.g., hand washing) during the entire period.
This period of time is continually extended, and more of the hand is used to touch the doorknob until the patient's anxiety levels rise, peak, and eventually subside. Once this happens, touching doorknobs will no longer produce the same amount of anxiety, and the therapist can move on to another trigger for obsessions and compulsions.
For some obsessions and compulsions, it is impossible or difficult to present the trigger to the person with OCD especially in the therapy room. In these cases, therapists often resort to imaginal exposure. They record the person with OCD talking about the trigger in great detail; they might describe how anxious they feel as they pass a train station because they worry about accidentally driving onto the track. When this recording is played back to them, it acts as a substitute for the trigger.
The use of exposure response prevention for OCD can be extremely helpful, and people with a mild case of OCD can even practice the technique at home. Those with more intense OCD, however, should see a qualified professional instead.
OCD Center.org, https://www.ocdcenter.org/treatments/ocd-cbt-erp.php
Centre for Addiction and Mental Health, https://www.camh.net/About_Addiction_Mental_Health/Mental_Health_Information/OCD/ocd_treatments.html#exposure
Saint Louis Behavioral Medicine Institute, https://www.slbmi.com/anxiety_center/exposure_response_prevention.htm