What is Exposure and Response Prevention?
Exposure and Response Prevention (ERP) is a type of Cognitive Behavioural Therapy (CBT), that was specifically developed to treat Obsessive-Compulsive Disorder (OCD).
OCD involves having intrusive thoughts, images, or impulses that one finds distressing. Typically people try to push these thoughts out of their mind, or perform an action to “neutralize” the thought. For example, if someone has intrusive thoughts about germs, they may want to wash their hands. If they worry about having left the stove on, they may check the stove.
Ironically, the more people try to repress, neutralize, or get rid of these distressing thoughts, the more these thoughts resurface – thereby becoming obsessions. Unfortunately, the ways that people try to neutralize these thoughts only works in the short-term. For example, if you feel dirty and you wash your hands, it does provide temporary relief. However, you will soon feel dirty again, and will feel the need to wash your hands again. If you wash, it once more provides temporary relief. You therefore learn: When I feel dirty I wash my hands and the dirty feeling goes away. However, you may become trapped in a vicious cycle of feeling dirty and washing your hands over and over and over again, all day long. As you can see, there is logic to OCD. However, the logic becomes problematic when it no longer feels like a choice, and you start to feel trapped in a cycle you feel you cannot get out of.
Exposure and Response Prevention aims to:
- Expose people to the thoughts, images, objects and situations that they have been trying to avoid or get rid of, such as thoughts about germs. Then….
- Response Prevention: You prevent yourself from doing the neutralizing behaviour (e.g. hand washing).
How does Exposure and Response Prevention work?
When you intentionally face your fears you learn to overcome them. You can start out small and work your way up to more stressful situations. You break the pattern of OCD. Unfortunately, anxiety does rise then you face your fears. However, anxiety cannot stay high forever – it does goes down via a phenomenon called habituation. When you resist giving into your compulsions, you learn that anxiety is tolerable, it will go down, and you do not need to give into your urges. When you do not give into the urge, you experience a feeling of success. This success is reinforcing and allows you to take the next step, to overcome an even more challenging situation.
Exposure and Response Prevention is more than just a “talk therapy” – there is an important behavioural component, necessary for new learning to take place.