What is ERP (Exposure and Response Prevention) and How Does it Work?

Exposure and Response Prevention (ERP) is one of many tools in a Cognitive Behavior Therapy (CBT) toolbox. When it comes to OCD, however, it is one of the most important and effective tools. You may even see it referred to as “the Gold Standard” of OCD therapy. So what exactly is it and how does it work?

Put most simply, it is facing your fears, but in a deliberate, humane way. Let’s use the non-OCD analogy of being afraid of the water. You may know lots of people who like to swim and let’s say they are encouraging you to come with them. You resist, even though they reassure you that you’ll be fine. Maybe there’s a part of you that believes that you’d be okay in the water, and maybe you can even go to the pool and watch your friends swim, but when it comes to you actually getting into the pool, your anxiety skyrockets and your body seems to be telling you that it’s dangerous. It tells you to do everything in your power to avoid or escape this danger. Even if there’s a part of you that intuitively “knows” that it’s not dangerous, your anxious thoughts and the anxiety in your body are screaming at you otherwise.

ERP is a very deliberate and humane strategy to get you into the water and to start enjoying life with your friends. It identifies a series of steps (an “Exposure Hierarchy”) to make this possible (vs. having to do the “impossible” and just jump into the deep end of the pool). Maybe it starts with you sitting on the edge of the pool with your legs in the water. Perhaps you then go sit on the submerged steps in the shallow end of the pool. Each step might feel challenging because, after all, you are facing your fears, but because you are doing this gradually you are not overwhelmed and you can resist the urge to get out of the water, or do something else to make yourself “safe.” Even though you feel anxious about the water, you begin to realize that you can get in and stay in for longer than you would have imagined. Gradually, you find yourself moving into deeper water, perhaps even dunking your head under at some point. Eventually, you venture out to the point that you can no longer touch the bottom and you find yourself floating or swimming. Your anxiety might spike occasionally and your brain might be telling you that it’s still possible to drown, but you find that these warnings seem less compelling over time and that they don’t have to control your choices. After awhile you find yourself paying more attention to interacting with your friends than to any anxious thoughts.

How this applies to OCD is that when you have the courage to face your obsessive concerns (get into the pool) through ERP exposure and then resist the urge to make it better by escaping or doing some other compulsive act, you are learning something new and very important, life changing, actually. You are proving to yourself that you don’t need to avoid or compulsively act in order to feel better. You learn that you can tolerate the anxiety and uncertainty about not being able to guarantee that everything will turn out just as you want it to. And when you know this, the world opens up again and you start getting your life back.