Exposure & Ritual Prevention (ERP)

EXPOSURE & 
RESPONSE PREVENTION
(ERP)

WHAT IS ERP?

Sometimes called Exposure and Ritual Prevention, ERP is a type of behavioral treatment for OCD and Anxiety. practiced as a part of Cognitive Behavioral Therapy (CBT). ERP involves two components. First, people gradually expose themselves to experiences that provoke anxiety. For instance, someone with Harm OCD might start by saying certain words like “snap” or “stab.” In some cases, people face things they have been avoiding completely. In the example of Harm OCD, someone might start using kitchen knives again. The second step is to prevent compulsions or safety behaviors after doing exposures. This is the response prevention. For the person with Harm OCD, this could involve refraining from seeking reassurance about if they seem capable of harming someone.

WHAT IS ERP HELPFUL FOR?

ERP is the “gold-standard” treatment for OCD. ERP is also a treatment for Generalized Anxiety DisorderSocial Anxiety DisorderIllness Anxiety Disorder (or Hypochondria)Panic DisorderSpecific Phobias, and Body Dysmorphic Disorder. Treatment varies for each based on the diagnosis. For example, worry exposures are a form of imaginal exposure exercise used to treat Generalized Anxiety Disorder. Interoceptive exposures, or exposures that target physical symptoms, are often used in the treatment of Panic Disorder

Many people are nervous about ERP. Please keep in mind that through the therapy process, people typically experience increased willingness to feel anxious. They also learn how to open up to and accept anxiety through Mindfulness and Acceptance & Commitment Therapy. Ultimately, it is always an individual’s decision to do exposures or not, even within the context of this therapeutic approach. An ERP Therapist is respectful of their Client’s experience and will never force a Client to do anything.

HOW DOES ERP FOR OCD AND ANXIETY WORK?

ERP helps in a number of ways. First, when a person avoids triggers or performs compulsions or safety behaviors, they teach themselves that they are in danger, even if they rationally know they are not. For instance, each time a person with OCD checks a lock repeatedly, they teach themselves that there is a high risk that they forgot to close the door. They are training their brains.

More than that, when a persons avoids, they do not learn what happens when they face their fears. Often, the outcome they are afraid of doesn’t come to pass. Even when feared outcomes happen, people generally find that they are able to handle them. For example, if someone has Social Anxiety and a fear of public speaking, they may avoid public speaking. As a result, they never see what happens when they do speak in public and thus remain convinced that they are not capable of handling their stress.

Also, by facing fears without doing safety behaviors or compulsions, people get to experience their ability to tolerate anxiety and distress. Instead of just understanding their ability to feel things theoretically, they have proof of what they can face and survive. They learn to feel their feelings so that their feelings do not limit them. For example, people who are afraid of the symptoms of panic in Panic Disorder learn about their resilience and ability to feel panic symptoms first hand. As a result, their panic is no longer in charge.

WHAT IS THE GOAL OF ERP?

Over time, people tend to become less fearful of triggers. People “habituate,” that is to say they get used to the things that used to cause fear. So the first time that you drop rumination about whether your thoughts are signs of a problem yet to come, you may be deeply afraid. As you continue this practice, however, it usually becomes progressively easier to tolerate the unknown.

That being said, habituation isn’t the goal of ERP. In recent years with the advent of the Inhibitory Learning model, the focus has shifted from habituating to triggers to building distress tolerance. Habituation is a side effect of learning to be unconditionally accepting of thoughts and feelings. When you use ERP to try to get rid of your anxiety, you’re now trying to avoid feelings again which was the problem in the first place. The goal is to be with thoughts, anxiety and uncertainty and to make space for these experiences.

Ultimately ERP is an exercise that builds the response prevention muscle for its use in daily life. Exposures are everywhere. They are the triggers that people regularly face. The key is to help individuals face their triggers without doing the compulsions and safety behaviors that consume their lives.

INTERESTED IN ERP THERAPY?

Are you or a loved one looking for help with OCD, Anxiety, or BDD? Lauren uses ERP to support Individuals with these mental health concerns. You can learn more about the treatments and services she provides here.

LOCATIONS

Lauren is a licensed psychotherapist in

several states. Learn more about where

Lauren sees Clients, below.

Pastel skies and a pristine beach in Northern California, one of the areas where Lauren does ERP for OCD and Anxiety .

CALIFORNIA

When she is offering face to face, Lauren does in-person therapy in Newport Beach. She also provides online ERP for OCD and Anxiety throughout California. Her Clients span from San Francisco down to Southern Orange County and San Diego.

The red rock spires of Bryce Canyon in Utah, one of the states where Lauren offers ERP for OCD and Anxiety .

UTAH

Lauren provides ERP for OCD and Anxiety in the state of Utah. Since she provides teletherapy, she works with people who live in different areas of the Beehive State – from Salt Lake City and its suburbs, like West Jordan, Syracuse, Highland and Riverton, to Park City and St. George.

Clear turquoise waters in the Keys, one of the places where Lauren practice ERP for OCD and Anxiety in Florida.

FLORIDA

Lauren also offers ERP for OCD and Anxiety online in Florida, and sees people from all corners of the Sunshine state. Whether you’re from Naples, Orlando, Miami, or Boca Raton, Lauren can provide specialized counseling remotely in your area.

The iconic red rock and lush greenery of Sedona, one part of Arizona where Lauren offers ERP for OCD and Anxiety online.

ARIZONA

Lauren also practices teletherapy in Arizona. If you’re seeking help with your fears in Phoenix, Sedona, Scottsdale or Tucson, Lauren offers ERP online across the Grand Canyon State.

The lavender fields of Provence, France, one international locale where  Lauren provides counseling.

INTERNATIONAL

In addition to all of the locations previously listed, Lauren offers ERP for OCD and Anxiety via teletherapy to a number of countries internationally.

Cozy couch and computer: all you need for teletherapy and what your treatment for depression with Lauren could look like.

ONLINE

Online therapy isn’t right for everyone. An assessment must be done to determine if online therapy is appropriate for your needs. You can reach out here to learn more.

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For more information about working with Lauren

call 310-824-5200 ext. 4 to speak with Client  

Coordinator Lisa O’Reilly at the 

OCD Center of Los Angeles

310-824-5200 ext. 17

lauren@ocdla.com

1151 Dove St., Ste. 295
Newport Beach, CA 92660

©2021 by Lauren McMeikan Rosen, LMFT.

Disclaimer: The information contained on this website is intended for informational and education purposes only and is not meant to be a replacement for therapy. If you are interested in treatment, you can email me and I will happily provide you with more information