Exposure and Response Prevention Therapy

Exposure and Response Prevention (ERP) Therapy is a subset of Cognitive Behavioural Therapy (CBT). As implied by its name, ERP Therapy exposes clients to their fears with the goal of moderating their behavioural responses. Used to treat anxiety-related symptoms such as Generalised Anxiety Disorder, Social Anxiety Disorder and phobias, ERP Therapy is extremely well-known as one of the most effective means of treating Obsessive-Compulsive Disorder. While exposing clients to items or scenarios that trigger their anxiety, ERP Therapy aims to help them acknowledge and come to terms with their obsessive thoughts, while regulating their compulsive behaviours.


How is ERP Therapy Carried Out?

To help clients break the pattern of thoughts, emotions, and behaviours that they associate with a certain item or scenario, ERP Therapy aims to consistently expose them to these stimuli under the careful guidance of a mental healthcare professional. These exposures are incremental in nature, allowing clients to improve progressively in handling their fears. For example, if a client has a fear of spiders, his or her first session might comprise of exposure to a picture of a spider. Subsequent sessions might focus on exposure to videos of spiders, while final sessions would involve exposing the client to an actual spider. At all stages, the professional will work together with the client in developing an adaptive response to these stimuli.


There are three common ways of implementing ERP Therapy:

   Professionals may ask clients to picture an imaginary scenario that causes them anxiety; for example, asking a client with Social Anxiety Disorder to imagine performing in front of a large crowd.

   Professionals may also expose clients to a real-life example of their anxieties; for example, asking a person with a fear of heights to look out of a high-rise window.

   For conditions such as Panic Disorder which heavily involve physical sensations like shortness of breath or heightened heart rate, professionals may purposefully incite these sensations in clients and help them confront these sensations. All these methods of exposure can be used together or separately in the therapeutic process.


How does ERP Therapy Differ from CBT?

ERP Therapy and CBT are both used in the treatment of OCD, with research suggesting that the former is more effective. This is because CBT trains clients to actively challenge their obsessive thoughts with the goal of rectifying their compulsive behavior. While effective in some ways, researchers suggest that challenging these thoughts actually reinforces their significance to the client, limiting the effectiveness of CBT. On the other hand, ERP Therapy works through the prevention of compulsive behaviors in response to their obsessive thoughts. This then teaches clients to tolerate and eventually shift their perceptions of such thoughts, resulting in greater resolution of obsessive-compulsive thoughts and behaviors. In the end, however, the effective of therapies differ from person to person, and both therapies are still viable means of combating OCD.


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