Exposure Response Prevention or ERP is a technique delivered as part of Cognitive Behavioural Therapy (CBT). It is used to treat a number of anxiety problems including phobias and obsessive compulsive disorder (OCD).
What is ERP Therapy?
ERP is the process of gradually and repeatedly exposing someone to a fear, uncomfortable thoughts, images, situations, or feelings, while preventing them from engaging in any behaviours that reduce the anxiety/fear. This includes any compulsive or avoidant behaviours they would normally turn to help them cope.
This type of therapy can be challenging and might make you feel more anxious at first, but it is very effective and has a solid evidence base to back the approach.
A typical ERP session may include:
– agreeing on an agenda for that day
– checking in on homework progress, like exposure you did outside of therapy
– discussing your progress since the last session
– talking about any new triggers that have come up
– problem-solving about any challenges during homework
– practicing exposures and rating them on a scale
– debriefing on the exposures and reflecting on what you learned
– discussing homework to do outside of therapy for the following week
ERP Therapy takes about 90 minutes to complete. During this time, the persons’ anxiety will begin to reduce, and their fears subside as they develop ‘habituation’. In simple terms, this means getting used to the fear.
Habituation is a form of non-associative learning in which an innate response to a stimulus decreases after repeated or prolonged presentations of that stimulus. In other words, ERP helps you to see that uncomfortable feelings will reduce and eventually go away over time.
How Does ERP Work?
First, you work with your therapist to understand your fear, phobia or OCD. You’ll discuss the triggers, how you are currently managing and what safety behaviours you have in place. You may also develop some SMART goals for therapy.
If your fear steams from a traumatic event, you may need to do some work to settle the trauma before doing ERP. When you are ready, your therapist will work with you to develop a hierarchy of fears or things you are avoiding as part of the phobia or OCD.
Let’s say you want to overcome your fear of spiders. You would spend time with your therapist thinking about all the ways you avoid spiders. You will explore if you can draw a spider, say the word or watch a video of a spider. You then list your fears from most scary to least scary before deciding where you can start on the hierarchy. Once you have chosen, you will then begin to develop an ERP experiment with your therapist.
As I’ve explained, ERP involves exposing yourself to a trigger for your fear or obsessions and refraining from performing your usual safety behaviours or compulsions. Sometimes the experiments you set with your therapist are around delaying rituals, compulsions or safety behaviours or reducing them gradually. ERP therapy happens at your own pace. The aim is not to overwhelm you, but to change your relationship with your fears.
ERP often involves tolerating anxiety. This can be uncomfortable, but the results are worth it. If your brain has been telling you to avoid spiders for years, it will not be happy when you change your behaviour. But, for example, if you want to travel around Australia in campervan, changing your relationship with our eight-legged friends will be very useful!
Can I Do ERP On My Own?
Although ERP has a number of clear steps, it is best practice to work with a therapist that’s trained in delivering evidence-based treatments. A trained professional will have the knowledge and experience to help you understand your experiences, fears, and goals. They’ll also be able to teach you how to get the best from ERP and maintain the results.
How Many Sessions Will I Need?
The number of sessions you will need depends on several things including how long you have been struggling, your motivation to change and the support you have around you. The usual treatment course is between 6-20 sessions.