What is Exposure & Response Prevention (ERP)

When people have developed an anxiety disorder, they typically have experienced unwanted intrusive thoughts; worries and/or unpleasant physiological sensations; feelings of anxiety; fear; disgust; a sense of uncertainty or doubt; imperfection and incompletion; etc.

Since these internal thoughts and feelings are experienced as extremely distressful and scary, it makes sense to do something to make them go away.   Most frequently people engage in avoidance, escape and/or other compulsive behaviors in an attempt to get rid of the distressful inner experiences. 

Because these behaviors usually bring about immediate relief, people end up engaging in them every time they feel distressed and/or anticipate distressing situations.

Not only do the maladaptive responses cause dysfunction, they provide short-term symptom reduction and prevent you from learning that avoidance, escape and other compulsive behaviors are not necessary to prevent your feared outcome from coming true, that your discomfort will dissipate on its own and that you can tolerate varying degrees of anxiety.

For example, a person may get “triggered”, meaning something brought up a thought or physiological sensation, the person misinterprets that thought or sensation as important, significant or dangerous, experience a fear response, anxiety or strong sense of disgust.

ERP is the “B” (behavioral) component of CBT.  The goal of ERP is extinguish the conditioned response by repeatedly and gradually exposing the person to the unwanted thoughts and feelings associated with the learned threat associations.

 You and your therapist will work collaboratively to create an exposure list (hierarchy) to gradually confront during exposures.  After repeated exposures, you will learn that your expected outcome is very unlikely to occur and/or is much more tolerable than you anticipated.  This process leads to new learning that you are in fact safe and can tolerate varied levels of anxiety.