Exposure and Response Prevention (ERP): How Facing Fear Can Help with Anxiety
If you’re feeling stuck in what seems like an endless anxiety loop, ERP may offer a path forward. At Carolinas Counseling Group, we’re here to help.
What is ERP and How Does It Work?
Exposure and Response Prevention (ERP) is a form of cognitive behavioral therapy (CBT) that helps people gradually confront their fears in order to treat anxiety disorders and obsessive-compulsive disorder (OCD).
Anxiety often involves avoidance – people may attempt to lessen feelings of anxiety by steering clear of things that trigger distress. For example, someone with a fear of heights might avoid taking elevators or visiting tall buildings. Avoidance can also take other forms, such as distracting oneself, seeking reassurance, or trying to suppress anxious thoughts. While avoidance is understandable and may momentarily ease distress, it ends up reinforcing anxiety long-term by teaching the brain that the feared situation is dangerous1,2. This creates a self-perpetuating cycle that can keep people trapped in anxiety and fear.
ERP interrupts this cycle by intentionally and repeatedly exposing an individual to the feared situation without engaging in avoidance1. This teaches the brain that the feared situation is not actually dangerous, decreasing anxiety and distress long-term1,2.
What Can You Expect During ERP?
ERP typically unfolds in several phases:
Preparation – Your counselor will provide you with more information about the anxiety cycle and work with you to identify anxiety triggers and avoidance behaviors.
Hierarchy Building – You and your counselor will create a hierarchy of anxiety triggers, ranking them from the least distressing to the most distressing. This hierarchy will act as a blueprint for doing exposures.
Performing Exposures – Your counselor will lead you through performing the exposures, starting at the bottom of the hierarchy and gradually working your way through the list at a manageable pace for you. These exposures may involve: writing and reading through imaginary scenarios, repeating words or phrases, role playing, looking at photos or videos, or simulating the feared situation in real time without doing your typical avoidance behaviors. Your counselor will also talk with you about ways to complete exposures outside of sessions, building real-life practice into your routine.
Reviewing Progress – You and your counselor will regularly check in about how exposures are going and make any necessary changes to best support your progress.
It’s important to remember that while performing exposures will temporarily elicit anxiety, you are teaching your brain that the feared situations are not a threat. With time and consistency, this can help reduce anxiety in the long run1.
Who is ERP For?
ERP is an evidence-based form of therapy for concerns such as social anxiety disorder, phobias, panic disorder, and OCD1,2. If you or a loved one are navigating one of these concerns, we at Carolinas Counseling Group are here to help. I enjoy incorporating ERP into my work with clients, and Courtney Kelly, Dr. David Russ, Dr. Chris McCarthy, and [others at CCG who use erp] also utilize this approach. To learn more or connect with one of our providers, please feel free to schedule an appointment.
References:
Hezel, D. M., & Simpson, H. B. (2019). Exposure and response prevention for obsessive-compulsive disorder: A review and new directions. Indian journal of psychiatry, 61(Suppl 1), S85–S92. https://doi.org/10.4103/psychiatry.IndianJPsychiatry_516_18
Kaczkurkin, A. N., & Foa, E. B. (2015). Cognitive-behavioral therapy for anxiety disorders: An update on the empirical evidence. Dialogues in Clinical Neuroscience, 17(3), 337–346. https://doi.org/10.31887/DCNS.2015.17.3/akaczkurkin
