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.