Exposure and Ritual Prevention (ERP)
Based on principles from Cognitive Behavioral Psychology, Exposure and Response Prevention (EXRP) was developed to treat Obsessive Compulsive Disorder and phobias by using interventions that allow the individual to gradually be introduced to stimuli that provoke obsessive thoughts without performing the rituals/compulsions that reinforce that thought. EXRP offers a healthier way to reduce stress that has been managed by the act of the rituals. The use of rituals, also called compulsions, creates a cycle that reinforces the fear but also feels rewarding because it reduces distress in the moment. However, that stress always creeps back up and the ritual doesn’t create a long term solution, in fact it is more time consuming and more impairing than the thoughts on their own. Rituals can take the form of behaviors, mental reviewing and repeated actions as a way to try to manage distress.
The use of EXRP in therapy relies on interventions called exposures, which can be “in-vivo,” which means conducted in real life situations in session, and “imaginal,” in which a story is created to allow the individual to address a wide range of possible obsessions and compulsions that you wouldn’t be able to address in life and/or in session. The combination of in-vivo and imaginal exposures will provide tools to address multiple areas where symptoms are present and can be used in the future to manage new or returning symptoms. You can expect to work together with your EXRP therapist to decide on a list of exposures, starting with least distress to most distressing, that you will address over the course of on average 20 sessions, either twice weekly one hour sessions or 90 to 120 minute sessions once a week is recommended but the therapy can be flexible to meet the individual’s treatment needs. After learning an exposure in session, the individual will practice that exposure in-between sessions which allows the brain, emotions, and stress response system to adjust to a new way of responding to stress and fear. The learning curve of this type of therapy can feel overwhelming and it is important to process and address those concerns with your therapist in session. The main goal is to help you find relief from the symptoms in the long run, which does not mean that we are working to get rid of stress, worried thoughts, or all behaviors but rather a different way to respond to that stress that will provide sustained relief.
Due to the rewarding nature of rituals, often OCD symptoms do not resolve on their own and other forms of therapy such as CBT, talk therapy, narrative therapy, and other processing based interventions can perpetuate or worsen OCD symptoms as they do not address the key reinforcer of the cycle, the rituals/compulsions. Seeking services with a therapist trained by a certified course in Exposure and Response Prevention is important so that you receive the care you deserve. Often individuals suffer with unmanaged OCD out of lack of awareness of treatment options, stigma around the symptoms, or maybe because they have sought help in the past but it hasn’t provided the skills they actually needed. By learning to engage in exposures, the obsessions lose their intensity and powerful feelings of fear lessen because you will have learned a new way to respond to stress based in self-compassion and tolerance instead of a fear.
Please reach out if you have additional questions about this type of therapy and/or are looking to see if it could be a good fit for you. If you would like to read more about OCD and EXRP, here are some helpful sources: