Exposure and Response Prevention, or ERP, is a type of therapy to treat OCD and high levels of anxiety. ERP is known as the “gold standard” treatment for OCD because it trains the brain to realize that just because your brain recognizes something as a threat, does not mean it is a threat. According to the International OCD Foundation, “the Exposure in ERP refers to exposing yourself to the thoughts, images, objects, and situations that make you anxious and/or start your obsessions. While the Response Prevention part of ERP, refers to making a choice not to do a compulsive behavior once the anxiety or obsessions have been ‘triggered.’”
You might be asking yourself, “Wait what? I should intentionally make myself anxious? How would that help?” Or maybe, you are thinking, “I am anxious all the time, how is this any different from the anxiety and distress I face every day?”
How does ERP treat OCD?
The bottom line is that ERP trains the brain that you are resilient and can handle the discomfort that comes with the trigger. Over time, anxiety and distress go down and the brain recognizes that what it initially viewed as a threat, is not a threat. It is necessary to retrain the brain in this way because by engaging in compulsions, you inadvertently train your brain that everything that feels like a threat, is a real a threat and that only compulsions can make that threat go away. While compulsions temporarily lower anxiety and distress levels, they create the long-term message that the trigger is dangerous and you have to do compulsions to get through it. This leads to increased anxiety the next time you come across that same trigger and feeling like the compulsions are all the more necessary to stay “safe.” Over time, not only does your distress increase when coming across the trigger, but the time spent doing compulsions increases too.
With ERP, however, you sit with the anxiety and allow yourself to experience the distress. While this is very uncomfortable, over time, the level of anxiety and distress decreases because you are training your brain that you are resilient and can handle the discomfort that arises. The more that you do ERP, the less that trigger feels like a threat.
What can I expect from ERP in therapy?
A trained ERP therapist recognizes and validates that this process can be intimidating. They work with you to create a hierarchy, or a baby step approach, to beginning ERP. This looks like first working on triggers that cause a milder level of anxiety and discomfort and slowly working your way up to higher levels when you feel safe and ready. You always have the right to say that something is too much and you want to stop, and while a therapist might highlight your resiliency, they will never force you to do an exposure.