Exposure & Response Prevention Therapy (ERP)

What is ERP?

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Exposure and Response Prevention (ERP) is a behavioral therapy that is widely regarded as the gold-standard treatment for Obsessive Compulsive Disorder (OCD). It uses a structured framework to provide slow, gradual exposure to feared thoughts, sensations, people, animals, objects, and/or situations. The client is taught to resist their urges to neutralize their fear by doing compulsions; instead, the client practices tolerating their discomfort and monitoring how the distress moves through their body in waves before eventually dissipating.

What problems can be treated using ERP?

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In addition to OCD, ERP can be very effective at treating the following issues:

  • Panic Disorder

  • Social Anxiety Disorder

  • Phobias

  • Body-Focused Repetitive Behaviors (BFRBs)

  • Generalized Anxiety Disorder (GAD)

How long will treatment take, and how many sessions will I need?

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Mild to moderate symptoms: Three to five months; 12 to 20 weekly sessions 

Severe or complex symptoms: Six months to one year; 25 to 50 weekly sessions

What can I expect from treatment?

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Because ERP is a manualized treatment protocol, you can expect sessions to be moderately to highly structured, dependent on the severity of your symptoms. Exposure exercises will not be started right away; first, we will spend some time learning to understand your OCD (or other disorder), identifying and discussing your fears, obsessions, and/or compulsions, and figuring out your internal and external triggers. 

Whenever you feel ready to start practicing exposures, we will start with your least intense fear and create a hierarchy of exercises for you to practice, starting with short, easy exposures and slowly working up to longer, more difficult exposures. When you have reached the point that you feel the fear has become manageable, we will move on to the next fear and repeat the process.

In order for ERP to be successful, a high level of client participation outside of weekly sessions is required in order to make steady progress and improvements. Homework will be given at the end of most sessions, with the expectation that the client spends a minimum of 10-15 minutes daily engaging in exposure practice during the following week. In addition to exposure exercises, homework may include reading, keeping logs/trackers, journaling, and practicing mindfulness.