Exposure and Response (Ritual) Prevention (ERP)

What it Is

There is a general consensus in the evidence-based world that Exposure and Response (Ritual) Prevention (ERP) is the “gold standard” for most clients who exhibit an Anxiety Disorder such as OCD, Social Anxiety, Panic Disorder, Phobias, and some forms of PTSD. Intentionally inducing anxiety by activating certain thoughts which create specific feelings or through deliberate behaviors that activate a physiological or mental response, is part of exposure-based therapies.  With this in mind, another significant element of exposure-based therapies is what is called Response or Ritual Prevention.  The aim of this aspect of exposure based therapies is to reduce avoidant coping strategies that only temporarily relieve the anxiety and often perpetuate and prolong it’s presence.  These protective behaviors can include things like excessive hand washing or cleaning, using drugs or alcohol, attempts to rationalize or reassure oneself, procrastination or perfectionism, or seeking reassurance from others. 

How it Works

In Exposure and Response (Ritual) Prevention (ERP) a therapist will guide the client either in the actual situation (In Vivo) or through the use of their imagination (Imaginal), to make themselves vulnerable to their distress, without resorting to protective behaviors.  In their specific forms, ERP exercises are primarily used by CBT therapists for anxiety disorders such as OCD, PTSD, Social Anxiety and Phobias (e.g. fear of flying). 

The goal is not to eliminate a person’s distress by repeatedly doing exposures or activating their fear system, but to help clients to realize that the distress they experience is tolerable, manageable, and is not going to inhibit them.  When this new learning occurs, a person can make the choices in their lives that they normally would have avoided.

References:

Barlow, D. H. (Ed.). (2014). Clinical handbook of psychological disorders: A step-by-step treatment manual. Guilford publications.

Craske, M. G., Kircanski, K., Zelikowsky, M., Mystkowski, J., Chowdhury, N., & Baker, A. (2008). Optimizing inhibitory learning during exposure therapy. Behaviour research and therapy, 46(1), 5-27.

Craske, M. G., Treanor, M., Conway, C. C., Zbozinek, T., & Vervliet, B. (2014). Maximizing exposure therapy: an inhibitory learning approach. Behaviour Research and Therapy, 58, 10-23.