The power of exposure and response prevention (ERP)

Exposure and response prevention (ERP) is a type of therapy that’s considered the gold standard of care for obsessive-compulsive disorder (OCD). OCD involves two main parts: obsessions and compulsions. Obsessions are unwanted thoughts or fears that cause anxiety, and compulsions are behaviors or mental rituals done to try to reduce that anxiety. For example, someone might fear they left the stove on (obsession) and check it over and over (compulsion) to feel safe.

ERP is a type of cognitive behavioral therapy (CBT) that encourages people to slowly and gradually face the situations that trigger their anxiety without doing the usual compulsions. This is all done with the support of a trained therapist who helps guide the process. 

Over time, this approach can help reduce anxiety and weaken the urge to act on obsessive thoughts and compulsive behaviors. ERP works by “retraining” your brain so your triggers hold less power and you feel more in control of your thoughts, emotions, and behavior. 

How ERP works

ERP doesn’t require you to immerse yourself in whatever you’re afraid of all at once. For example, if you’re afraid of heights, you won’t have to go to the roof of a tall office building. Or if you have obsessive thoughts like, “If I don’t wash my hands 10 times, I’ll get seriously sick,” you won’t be asked to completely forgo your hygiene routine. 

On the contrary, ERP is a slow, gradual process that allows you to build upon your successes over time. There may be some moments of discomfort as you move through ERP, but your provider will be there to support you. 

Here’s how ERP works:

1. Identifying the stressor: People who live with anxiety disorders, phobias, OCD, or other mental health conditions may have various fears or triggers. Instead of trying to address them all at once (which would likely be overwhelming), you and your provider will choose an area of focus. This could be any thought, object, situation, or sensation that leads to anxiety, obsessions, or compulsions.
2. Exposure: Once you’ve identified the fear you want to focus on, it’s time to brainstorm ways to gradually engage with it. This may sound like a scary thing to do. But remember that ERP is a gentle process, and your therapist will be there as your guide. You might start by simply thinking about something related to your trigger or viewing an image of your trigger for a brief period of time.
3. Response prevention: As you engage with your trigger, your mind and body will likely start sending you anxious signals, and you may become uncomfortable. This is all part of the process, and, again, your therapist will be there to help you explore this experience in a safe space. While it may take some time, the goal of ERP is to help you see that your discomfort will subside even when you don’t engage in a compulsion, avoidance, or other unhelpful behavior.

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When ERP can be used

Research indicates that ERP can improve brain function. These changes in the brain are linked to a significant reduction in OCD symptoms, helping you feel more in control over time. 

It’s also been used to treat other mental health conditions, including:

• Panic disorder
• Post-traumatic stress disorder (PTSD)
• Social anxiety disorder
• Generalized anxiety disorder (GAD)
• Tourette syndrome
• Phobias

All of these conditions have unique symptoms that require individualized care. However, what they have in common is anxiety or distress that’s often driven by perceived threats or internal discomfort. ERP can help alleviate these symptoms by reducing anxiety, increasing distress tolerance, and retraining the brain to identify the difference between a real and perceived threat. 

Getting started with ERP therapy

If you’re interested in starting ERP therapy, the first step is to find the right provider for your needs. ERP therapists are licensed mental health professionals who receive specialized training in ERP. When you reach out to a therapist, let them know that you’re specifically looking for someone with extensive training and experience in ERP. You can ask them about the populations they serve and conditions they treat. 

Remember, your first few interactions with a provider are a chance for you to ensure that you’re the right fit for one another. Most therapists sincerely want to help people find the best care for their needs, so they’ll welcome your questions and concerns. If the person you’re speaking to doesn’t have the ERP experience you’re looking for, it’s OK to keep looking. You can also ask them if they can provide a referral for an ERP therapist in their practice or network.

Find care with Rula

ERP is an evidence-based therapy used to treat OCD, anxiety, phobias, PTSD, and more. It works by encouraging people to slowly and gradually engage with their triggers under the supervision of a trained therapist. Over time, this exposure helps the brain learn to detect the difference between real and perceived threats so triggers become less distressing. While ERP may involve some temporary discomfort as you face your fears, it can help you manage your symptoms, strengthen your mental health, and improve your quality of life.

At Rula, we’re committed to delivering a comprehensive behavioral health experience that helps people feel seen and understood so they can get back to feeling their best. 

Rula makes it easier to find a licensed therapist or psychiatric provider who accepts your insurance so you don’t have to choose between affordable care and excellent care. With a diverse network of more than 15,000 providers, 24/7 crisis support, and appointments available as soon as tomorrow, we’re here to help you make progress — wherever you are on your mental health journey.

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