By Tori Mahoney, LMHC
Exposure Response Prevention (ERP) Therapy is a specific treatment modality used to target certain types of anxiety. Harborside clinician Tori Mahoney utilizes this therapy with clients and shared some details about what this technique looks like in practice!
Q: What is ERP?
Anxiety create a cycle of avoidance that further perpetuates anxiety. When people feel scared or worried about something, we naturally avoid it, it as our brains are wired to avoid discomfort. When we avoid something we find scary, we feel short-term relief, however, this grows anxiety in the long-term. This happens because we are never giving our brains the chance to learn that the thing we are worried about is not as scary as we thought. This is where exposure and response prevention (ERP), or exposure therapy, is helpful. In short, exposure therapy/ERP is when you practice things that you find scary or difficult intentionally. While exposure therapy and ERP are essentially the same treatment, the terms differ. The term exposure therapy is typically used for anxiety disorders, such as generalized anxiety disorder or social anxiety disorder, which is simply exposing ourselves to the things of which we are afraid. While, exposure and response prevention (ERP) is used when describing exposures for people with OCD. Response prevention means that you are exposing yourself to the feared situation (i.e., a dirty doorknob) while preventing a compulsive response (washing hands).
Q: What is ERP used to treat?
Exposure therapy/ERP is used to treat a wide range of anxiety disorders, such as but not limited to, generalized anxiety disorder, social anxiety disorder, obsessive compulsive disorder OCD, phobias, separation anxiety disorder, panic disorder, selective mutism, and avoidant restrictive food intake disorder (ARFID).
Q: What should I expect from an ERP session?
There are a few different ways to do exposure therapy. Some exposures are “in vivo exposures”, which means you are directly facing the thing you fear. Other exposures are “imaginal”, in which you are imagining the feared stimulus by writing a story or imagining a situation in your head.
Exposure therapy begins with creating something called a fear hierarchy or exposure hierarchy, which is a list of all the different exposures you will do. The hierarchy is formed by ranking your perceived level of anxiety on a scale of zero to ten.
Once you are done creating this hierarchy, under your therapists guidance, you will begin in-session exposures, which will always start by choosing an exposure goal and identifying your level of distress on the scale of zero to ten. Then, your therapist will guide you through your exposure, coaching you to confront the thing you are afraid of. For example, if you are struggling with social anxiety, you might make a phone call to make a dinner reservation. Afterwards, you will rate your level of distress again, and will process how the exposure went. Your therapist will also assign out-of-session exposures for you to work on in your daily life between sessions- practice makes progress! Exposure therapy is done gradually and at your own pace, so you will start with an exposure that provokes only a small amount of anxiety. As you build your confidence, you will work your way up the hierarchy!
Q: How do I know if ERP is working for me?
There are a few ways you will know if ERP is working for you. First, you may notice yourself having lower and lower distress levels during exposures. Your anxiety may be an eight the first time you do it and a five the second time, all the way until it is no longer causing you any anxiety! Second, you may not be avoiding things as much as you were prior to starting exposure therapy. All of a sudden, you may not dread making that phone call, and simply just do it. This means your brain and body are learning that the things we are afraid of are not dangerous and we can handle anxiety!
