Exposure and Response Prevention Therapy
ERP: The Gold Standard for OCD Treatment
Exposure and Response Prevention (ERP) therapy is a form of Cognitive Behavioral Therapy (CBT) designed to help people with OCD confront their fears and reduce compulsive behaviors. Newport offers high-intensity ERP therapy as the primary form of treatment at our specialized OCD programs.
What Is
ERP Therapy?
Exposure and Response Prevention (ERP) therapy, sometimes known as Exposure and Ritual Prevention, is considered the gold standard of care for treating those struggling with obsessive-compulsive disorder (OCD) and anxiety disorders. It works by gradually exposing patients to their fears in a controlled and supported environment, with a highly trained therapist.
While compulsions may provide temporary relief from anxiety, they ultimately keep the cycle of obsessions and compulsions going. ERP breaks that cycle, helping patients learn to tolerate their anxiety without resorting to compulsions.
What Is
OCD?
Obsessive-compulsive disorder (OCD) is a mental health condition characterized by ongoing obsessions and compulsions as the primary symptoms. Obsessions are unwanted and disturbing thoughts, images, or urges that create extreme anxiety. Compulsions are the behaviors or thoughts that people with OCD use to try to manage their anxiety.
For example, some people may be worried about germs or getting sick from being around other people. In response, they will engage in compulsive behaviors such as repetitive handwashing or sanitizer use.
History of ERP Therapy
The use of ERP therapy for OCD started in the 1970s. It was formulated by Stanley Robinson, who drew from previous research in this area, including studies on classical conditioning.
The basis of ERP therapy comes from behavioral scientist Joseph Wolpe. Wolpe’s method of systematic desensitization exposed patients to anxiety-provoking situations. Then they used relaxation skills to reduce distress and sensitivity to triggers.
How ERP Therapy Works
The primary objective of ERP therapy is to equip OCD clients with the skills to manage distress and discomfort without resorting to compulsive behaviors. Rather than attempting to eliminate the triggers associated with their obsessions, ERP focuses on helping individuals confront and engage with potentially distressing situations or thoughts.
During ERP sessions, therapists expose the client to triggering situations or images. They then help them learn to replace their repetitive, compulsive actions with new strategies. Over time, the frequency and intensity of the client’s obsessions begin to diminish, and the intrusive thoughts become less frightening and overwhelming.
Here are the various steps of ERP therapy:
In the psychoeducation component of ERP, teens and young adults with OCD learn more about the disorder and how their obsessions and compulsions work. They will also learn how ERP works, what the goals of ERP therapy are, and the different components of the process.
To begin ERP therapy, patients work with their therapist to make a list of their triggers, using a system called the Subjective Units of Distress Scale (SUDS). They rate the severity of each obsession in terms of how much distress it causes them. Early in therapy, the patient and therapist will focus on a trigger that is less intense for the patient. As ERP continues, they will work with more distressing triggers.
During the exposure phase of ERP therapy, the patient is exposed to a trigger that creates obsessive thoughts, distress, and discomfort for them. Types of exposure include:
- In vivo exposure: directly facing an actual feared object or situation
- Imaginal exposure: vividly imagining the anxiety trigger, such as a past traumatic experience
- Interoceptive exposure: inducing physical symptoms that create distress, such as spinning around to induce the dizziness that a patient may feel during a panic attack
- Virtual reality exposure: facing OCD anxieties using simulations of the feared experience, such as flying or driving on a highway
After the exposure step, the patient and therapist work to reduce the compulsive behavior that they typically turn to after a trigger.
The therapist gives clear instructions on how to tolerate distress and avoid or reduce compulsive rituals. Response prevention strategies include:
- Learning to tolerate anxiety
- Delaying OCD rituals
- Modifying the rituals
- Avoiding rituals completely
Therapists can provide ERP therapy in either individual or group sessions. Patients start by using response prevention techniques in therapy sessions. Next, they begin practicing them outside of sessions. They do exposure homework, which involves exposing themselves to triggers and then resisting the urge to engage in compulsive rituals.
An essential part of the ERP therapy process is relapse prevention planning. The patient and therapist develop a clear plan to keep OCD symptoms from returning.
Effectiveness of ERP Therapy
Exposure and Response Prevention techniques appear to work on a neurobiological level as well as a cognitive level, directly impacting the brain. Furthermore, ERP therapy works through habituation, or the gradual decrease in fear and anxiety as the patient has repeated exposures.
Another mechanism in ERP therapy is inhibitory learning. This is the process through which new experiences inhibit fear-based beliefs. That is, ERP patients find out that not completing compulsive behaviors doesn’t result in terrible things happening. As a result, they are less fearful, and it becomes gradually easier for them to resist compulsions.
Over time, patients learn to accept and live with some level of uncertainty, rather than constantly trying to avoid any anxiety or unknown. Through ERP therapy, young people with OCD gain the skills they need to confront their fears and move into a thriving, empowered life.
The ERP work helped me get back to how I was before OCD crept in. Just being able to be in proximity to my brother and to simply touch door handles in my house. Being able to share a bathroom with my family and use the same faucet as them. Doing things that I would have never done before.
Sam
B.
,
Newport alum
Benefits of ERP Therapy
A meta-analysis of 30 studies has demonstrated that ERP therapy significantly improves symptoms in OCD patients, particularly those with comorbid anxiety and depression. Studies indicate that ERP can reduce anxiety symptoms by an average of 48 percent and depressive symptoms by 44 percent, with longer treatment sessions correlating with greater effectiveness.
ERP therapy offers numerous benefits, including:
- Reduced anxiety: By facing fears head-on, individuals often experience a significant decrease in anxiety levels over time.
- Improved coping skills: Patients develop better strategies for managing anxiety, leading to increased resilience.
- Better quality of life: As time-consuming and intrusive compulsive behaviors diminish, individuals can engage more fully in daily activities and relationships.
- Long-term results: ERP therapy equips young adults with tools to handle future triggers.
Signs and Symptoms of OCD
If you think you or a loved one might have OCD, the first step is a full OCD assessment with a mental health professional. A psychiatrist or other mental health clinician can assess whether an individual is struggling with OCD or another type of anxiety, using criteria listed in the Diagnostic and Statistical Manual of Mental Disorders (DSM-5).
OCD is also associated with anxiety issues such as severe generalized anxiety and social anxiety, panic disorders, body dysmorphia, agoraphobia, skin-picking, and trichotillomania (hair-pulling).
To be diagnosed with OCD, individuals typically meet the following criteria:
- Presence of obsessions, compulsions, or both
- The obsessions or compulsions consume significant time, typically more than one hour each day
- Symptoms lead to considerable distress or interfere with daily activities, including social interactions, work obligations, or other important life events
- The symptoms cannot be attributed to the effects of substances, alcohol, medications, or any other medical conditions
- What you are experiencing is not part of another mental health disorder, such as generalized anxiety disorder, eating disorders, or body image issues
Results-Driven Care
Learn how OCD patients experienced significant reductions in symptoms and improved general functioning through our specialized programming.
ERP as Part of a Comprehensive Treatment Plan for OCD
At Newport, we offer specialized OCD treatment for teens and young adults, and treat children case-by-case as needed. Each client’s personalized treatment plan includes three hours of daily ERP therapy delivered in group and individual sessions by clinicians with advanced ERP training, and 90 minutes each day of exposure homework.
In addition to ERP, our program integrates psychiatric care and medication management, family therapy, and experiential activities such as art, adventure, and music therapy. We also incorporate an accredited academic program for teens and a life skills component for emerging adults.
Contact us today to discover more about our specialized OCD treatment for teens and young adults, and to schedule an assessment for yourself or a loved one.
Frequently Asked Questions
ERP therapy, or Exposure and Response Prevention therapy, is a type of Cognitive Behavioral Therapy specifically designed to help individuals with obsessive-compulsive disorder (OCD) and other anxiety disorders. It involves exposing the patient to anxiety-provoking stimuli or situations (exposure) while helping them refrain from engaging in compulsive behaviors or rituals (response prevention) that they typically use to alleviate their anxiety.
ERP therapy works by gradually exposing individuals to their fears in a controlled and supportive environment. This exposure helps them learn that their anxiety decreases over time without the need for compulsive behaviors. The process typically involves creating a hierarchy of feared situations, starting with less anxiety-provoking scenarios and gradually moving to more challenging ones, allowing patients to build coping skills and reduce their anxiety.
Yes, ERP therapy has been shown to be highly effective for treating OCD and related anxiety disorders. Numerous studies indicate that it can significantly reduce symptoms and improve overall functioning. Many individuals experience long-lasting benefits, especially when combined with other therapeutic approaches or medication when necessary.
The duration of ERP therapy can vary depending on the individual’s specific needs, the severity of their symptoms, and their progress. Typically, treatment can last from several weeks to several months, with sessions usually occurring weekly. Some individuals may require longer treatment, while others may see improvements more quickly.
