Exposure Response Prevention (ERP)

ERP is the number one treatment for anxiety disorder, especially OCD and eating disorders. In order to understand how ERP works, it is important to understand what anxiety is. Anxiety is anticipation of a future threat. Everyone has anxiety for adaptive purposes; however, too much anxiety can be debilitating. Anxiety produces a number of body sensations, including fatigue, restlessness, and sweating. Anxiety exists on a continuum. It becomes a “disorder” when it interferes with one’s life. For example, when the body interprets physical anxiety catastrophically, a person may experience a panic attack.

The exposure in ERP refers to exposing the individual o he thoughts, images, objects, and situations that make him/her anxious. The response prevention aspect refers to making a choice not to do a compulsive behavior once he anxiety has been triggered. ERP is done under the guidance of a licensed professional.

The goal of ERP is for the patient to understand that anxiety is harmless and temporary. Those with anxiety disorder often feel that their anxiety is never-ending and dangerous; thus, people with anxiety often avoid participating anxiety-provoking activities. The most effective way a person can reduce his/her anxiety is to face anxiety-provoking situations, rather than avoiding them. Although he/she may feel otherwise, there is nothing someone can’t do when feeling anxious.

People with anxiety worry “what if _____(negative outcome) happens? There are three behaviors that highly anxious people will display in an attempt to avoid this negative outcome with 100% certainty. These behaviors are: avoidance behavior, reassurance-seeking, and compulsions. When an individual performs one of these three behaviors, they are essentially fueling their anxiety, thus reinforcing the behavior. Therefore, the primary goal of ERP treatment is to teach the individual to live with uncertainty. Moreover, those with higher levels of anxiety often experience OCD and/or eating disorders, as they have difficulty accepting uncertainty about whatever they happen to be suck on. It is important for these individuals to learn how to live in uncertainty, without relying on constant reassurance.

ERP begins with the individual designing an “exposure hierarchy,” which is a list detailing the main situations or sources of anxiety used to guide his/her progression through the treatment. Then, under the guidance of a therapist, the individual may perform one or multiple of the following “exposures”:

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Live Exposure—This is a hands-on technique in which the affected individual performs the physical activity which typically produces anxiety. For example, if a person avoids eating fatty foods in fear of getting fat, he/she may be instructed to eat a plate of french fries under the supervision of a therapist.

Imaginal Exposure—This is a technique in which the individual imagines performing an anxiety-provoking situation, followed a verbalized “worst casinerio” situation. For example, an individual scared of stepping on a crack in the sidewalk may be instructed to say “today I am going to step on a crack on the sidewalk. This will result in something bad happening. Then I’ll have a horrible day and everyone I know will die.” Then, the individual should read this over and over again in the therapist’s office; thus, his/her anxiety will peak in the office, followed by a slow decline.   

Interoceptive Exposure—This is a cognitive behavioral therapy tequnicqie used in the treatment of panic disorders, which refers to carrying out exercises that bring about the physical sensations of a panic attack, such as hyperventilation via breathing through a straw.

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