ERP is a type of behavioral therapy designed to treat obsessive-compulsive disorder (OCD). It involves exposure to obsessive fears so that a person may eventually respond to them compulsion-free.
If you have OCD, ERP can likely help you break any undesired habit cycles. Here’s what to know.
What does ERP therapy do?
Exposure response prevention (ERP) therapy is a type of exposure therapy and cognitive behavioral therapy (CBT) that’s been proven to be very effective at treating OCD . Due to its efficacy, it’s considered a first-line treatment for the disorder.
The goal of ERP is to help people overcome what is essentially an overactive stress response to feared stimuli. Ideally, they realize they’re safer than they previously believed and that they no longer need to engage with the obsessions and compulsions.
OCD is characterized by obsessive, fearful thoughts and repetitive actions intended to lessen the fears. Though it can feel overwhelming and challenging to manage OCD, ERP can help break the obsessive-ritual cycle.
According to the International OCD Foundation (IOCDF) , ERP therapy involves:
- An exposure portion in which the person is directly exposed to the thoughts, situations, images, objects, etc. that may be triggering the obsession and causing stress, fear, or anxiety. For example, someone with contamination OCD may be prompted to touch a public doorknob despite their fear of doing so.
- A response prevention portion involves the person making a conscious choice to avoid the ritual compulsive response after the obsession has been triggered. For example, someone with contamination OCD might typically sanitize their hands 10 times in response to touching a doorknob. During therapy, they might be asked to do so just once.
Over time, the goal is to avoid seeing the trigger as an obsessive or all-encompassing threat. The United Kingdom’s National Health Services reports that for milder OCD cases, this might take between 8 and 20 sessions with a therapist combined with at-home exercises.
This combination therapy can help those with OCD experience an improvement in their day-to-day quality of life.
Examples of ERP therapy techniques
Though ERP is typically done via in vivo exposure, or directly facing the fear in real life, there’s some evidence that virtual reality or imaginal exposure may help , but more research and other developments are needed to know for sure.
Some examples of ERP therapeutic techniques include :
- working with your therapist to identify the thoughts, patterns, and behaviors characteristic of your obsessions and compulsions
- facing your fears and acknowledging obsessive thoughts without attempting to neutralize them with compulsions
- working with your therapist initially to help you start with situations that provoke the least fear and anxiety and then working your way up to more challenging scenarios
Some examples of these techniques in action include:
- Someone with symmetry OCD might start with photos of disordered objects, then move on to seeing disorganization in real life, and then on to leaving objects out of symmetry themselves.
- Someone with hoarding OCD might build structures to avoid bringing in new items and then watch videos of others decluttering their spaces before attempting to donate or throw out things they no longer need.
- Someone with contamination OCD might be instructed to go outside, come back inside, and wash their hands instead of engaging in excessive sanitization or bathing.
FAQs about ERP therapy
Can you do ERP therapy on your own?
A small 2018 review of studies noted that self-directed ERP may be a cost-effective alternative to visiting a therapist. That being said, those who visited a therapist for ERP benefitted more than those who attempted treatment solo.
One of the major barriers for those who do ERP on their own (or even with support from a therapist) is sticking to the treatment plan. Since it can feel very scary to confront your fears, professional support— especially in the early treatment stages — can be very helpful.
Caution should be advised to not put yourself in overly stressful situations without mental health support as this could lead to further trauma.
Several variations of ERP therapy, such as group sessions, teletherapy, online recordings, or workbooks, may be more cost-effective for some.
Does ERP rewire the brain?
In a 2017 study , researchers found that ERP-based CBT resulted in “robust and extensive” increases in brain connectivity in participants.
Notably, researchers found connections to be much stronger between the:
- cerebellum (the part of the brain involved in movement/thinking processes)
- striatum (which is key to motor and reward systems)
- the prefrontal cortex (which is involved in behaviors like attention, memory, and response inhibition)
Not only did the therapy appear to repair damaged or abnormal brain connections, but it also strengthened connections across various networks.
Does ERP make symptoms worse at first?
According to the IOCDF , an initial rise in anxiety, fear, or obsessive thoughts is normal. Organization experts suggest that though this can be stressful, it’s temporary — and to remember that part of the process is realizing that your thoughts cannot harm you.
As you observe these thoughts, experts say they will begin to diminish. You’ll realize that your fears are much less likely to occur than previously thought, and you’ll be able to form a healthy fear and risk assessment system.
How do I find an ERP therapist?
Tools like the IOCDF’s provider locator or the American Psychological Association (APA) psychologist locator can help you narrow down reliable professionals who specialize in treating OCD. If you are looking for online therapy, you can also narrow down your options using these tools.
Every professional on the IOCDF site has experience in ERP. On other sites like the APA’s, you may have to ask about their professional experience.
NOCD has a site as well as a mobile application with many resources for overcoming OCD.
If your insurance covers part of or all ERP costs, check your provider’s directory for specialists or ask whether it covers out-of-network experts.
Ultimately, the goal is to find a professional you feel comfortable with and one who meets your needs. It’s important to take the time you need during your (typically free) consultation to ask any questions that may put you at ease.
Takeaway
ERP provides significant relief for many people with OCD. Evidence suggests that treatment can permanently eliminate harmful habit cycles and create lasting beneficial changes in the brain.
If you think you have OCD, speaking with a professional is a great first step toward greater peace of mind and an improved quality of life.
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