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Exposure and Response Prevention

Exposure and Response Prevention (ERP) is a form of cognitive behavioral therapy that assists

people in coping with anxiety-provoking thoughts or obsessive thoughts and behaviors through

exposure to stimuli that induce their maladaptive responses. By confronting their fears, clients

learn to handle them more effectively. Often used with those suffering from such conditions as

obsessive-compulsive disorder (OCD) and posttraumatic stress disorder (PTSD), ERP can help

clients overcome their fearful and anxious thoughts, behaviors, and actions.

Why some people undergo ERP

Clients can seek therapy to help them overcome any number of fears. These fears can generally

be broken down into several categories:

• Fear of inanimate objects

• Fear of living creatures

• Fear of specific situations

• Fear of specific thoughts, fears, or images

• Fear of a possible reaction


Many people with strong fears cope by avoiding the thoughts and actions associated with their

fears. Although the motivation behind avoidance is understandable, it can be counterproductive.

While fears and anxiety can initially be reduced as a result of avoidance, in the long term, these

feelings become more intense. This is because the person does not ever learn that the situation

they are avoiding is not actually dangerous. Over time, their list of fears tends to grow. This can

produce a vicious cycle of avoidance and increased levels and sources of fear.

How ERP Works

1) The therapist decides if the exposure will be gradual or at an accelerated pace. If the

therapist selects gradual exposure, he or she creates a hierarchy of fears for the client, which

range from least to most fear-inducing.

2) The therapist decides between in vivo (real) or imagined exposure. In vivo exposure is

preferred, when possible.

3) The therapist helps the client break down their fears into manageable steps. For example,

a client who is afraid of dogs can be encouraged to first think of a dog, then to look at a picture

of a dog, then to look at a real dog in their presence, and so forth until they are able to pet the

dog and feel comfortable around dogs.

4) Prolonged exposure is repeated until the client has completely habituated and the fear

reaction is extinguished.

Who Can Benefit From ERP

Beyond treating OCD and PTSD, people suffering from conditions such as anxiety and phobias can be helped with ERP. Research has demonstrated the efficacy of ERP for these conditions and

disorders, and in some cases, it has become the preferred therapeutic choice for treatment. You

may wish to consider speaking with a mental health professional if you feel that you can be

helped by ERP.

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