ERP Therapy

Exposure and response prevention (ERP) therapy helps you face fears in a safe, step-by-step way. It’s the gold standard treatment for obsessive-compulsive disorder.

In this behavioral therapy, you practice being around things that make you anxious, like certain thoughts, images or situations. At the same time, you work on not avoiding the fear or turning to rituals (repeated behaviors that make you feel safe).

Over time, this teaches your brain to handle anxiety better.

ERP is a form of exposure therapy, which is a type of cognitive behavioral therapy (CBT). This talk therapy uses structure and goal setting to guide treatment.

What conditions does ERP therapy manage?

ERP is the main treatment for obsessive-compulsive disorder. It works through “response prevention,” which means learning not to perform the compulsion after an obsessive thought. This helps break the habit and reduce anxiety over time.

How does exposure and response prevention work?

If you have OCD, you may live with upsetting thoughts. These are called obsessions. They can make you feel anxious about an outcome that hasn’t happened yet. To feel better, you may repeat certain behaviors or avoid situations. These actions, called compulsions, bring short-term relief. But over time, this actually makes the obsessions and compulsions stronger.

Therapy helps break this cycle. In ERP, you’ll face your fears without doing the rituals or avoiding the situation. Over time, this teaches you to handle the anxiety and see that the feared outcome doesn’t happen.

What happens during ERP therapy?

Treatment can vary depending on your needs, but most ERP therapy follows similar steps:

1. Assessment and planning: Your therapist explains how ERP works. They’ll ask about your triggers, obsessions and compulsions to create a plan that fits you.
2. Practicing exposure: In each session, you slowly face your triggers. You practice resisting rituals or avoidance.
3. Processing exposure: After exposure, you and your therapist talk about what happened and how you managed it.

Between sessions, you’ll practice these skills on your own. This is similar to homework from school. When you face a trigger, you’ll use what you learned instead of avoiding it. If you have trouble, you can bring it up in your next session.

Exposure is slow and steady. It usually starts with smaller triggers that cause less anxiety. As your skills grow, you’ll work up to more difficult ones. Your therapist will also teach coping tools to manage stress and reduce the risk of relapse (repeating rituals or behaviors again).

It’s important to remember that relapses don’t mean you’re flawed or a failure. They’re a normal part of feeling better. Your therapist can help you build new skills so you’re ready to handle them in the future.

ERP exercises

There are two common exercises that you might do, including:

• Imaginal exposure: You imagine a situation that triggers your obsessions (like picturing a worst-case scenario). Your therapist may have you write the scenario down and read it out loud to make it less powerful.
• In vivo exposure: You face your fear in real life. You might touch a surface without washing your hands or resist moving objects back into order.

Both of these help you approach difficult feelings in a safe way. They may teach your brain that anxiety will fade without rituals.

How successful is ERP?

Exposure and response prevention therapy can be an effective treatment, especially for obsessive-compulsive disorder. Studies found that more than 6 out of 10 people who underwent ERP therapy had fewer OCD symptoms. The same study also found that more than 3 out of 10 people were fully symptom-free when they completed therapy.

Results can vary from person to person. Talk to your provider about what results you can expect.

What are the benefits of ERP therapy?

Some of the main benefits of ERP include:

• Better sleep
• Better stress management
• Fewer symptoms
• Greater overall well-being
• Less time spent on cycles of obsessions and compulsions
• More confidence
• Stronger coping skills

What are the risks?

One of the hardest parts of ERP therapy is facing your fears. This might make you feel anxious or stressed. You may even dread going to therapy at first because it can take an emotional toll. This can make therapy feel so intense that you may struggle to stick with it.

But you’re not dealing with these fears alone. Your therapist will be there to support you. They’ll help you manage whatever emotions come up.

During therapy, you’ll need to share your biggest fears with someone new. This can be challenging. And it’s normal to feel this way. Over time, as you feel more comfortable, it should get easier to open up.

ERP therapy takes work, and it isn’t always a walk in the park. But the process is gradual, and you won’t be pushed too far too quickly.

How long will it take for me to feel better?

There’s no set timeline for how long this should take that works well for everyone. Most people attend weekly sessions for at least a few months. Sometimes, intensive daily programs work, too. Your healthcare provider will give you options based on your goals.

Each session is built to fit your needs. Tell your provider if things feel like they’re moving too fast or if you’re struggling. Just like learning anything new, it takes practice. You don’t need to rush.

When should I call my therapist?

Let your therapist know if:

• Your symptoms are getting worse or harder to manage
• You struggle to practice ERP exercises on your own
• You feel stuck or overwhelmed

Since this treatment can be very stressful, it may bring up difficult emotions. Reach out to your provider if you have thoughts of suicide. You can always call or text 988 (U.S.) to reach the Suicide & Crisis Lifeline. Someone is available to talk to you 24/7.

Can you do ERP by yourself?

You can practice some parts of ERP at home. There are different apps and self-help books available. But you’ll get the most benefit by working with a trained therapist. They can help you manage challenges, emotions and stresses that come up. They can also teach you techniques you might not know about to make the process easier.