What Is ERP?
It is one of the oldest modalities, and still one of the most effective. Exposure and Response Prevention (ERP) is a behavioral therapy that helps you gradually face thoughts, feelings, situations, sensations, or experiences that trigger anxiety—while learning to respond differently.
The basic idea is pretty simple: instead of organizing your life around avoiding discomfort, you practice approaching it.
Exposure means gradually facing something you've been afraid of or avoiding. Response prevention means reducing the behaviors you normally use to escape the discomfort, get reassurance, or make yourself feel certain or safe.
Over time, you can learn that you don't have to eliminate anxiety or uncertainty before moving forward with your life.
What Can ERP and Exposure Therapy Help With?
Exposure-based therapy is best known as a leading treatment for Obsessive-Compulsive Disorder (OCD), but exposure principles can also be used for a variety of anxiety-related concerns.
Depending on your individual needs, exposure work may be helpful for OCD, anxiety disorders, panic attacks and panic disorder, phobias, social anxiety, health anxiety, and trauma-related fears or avoidance when clinically appropriate. ERP really can be used for just about any problem.
The type of exposure—and whether exposure is appropriate at all—depends on what you're experiencing and your treatment goals.
How Does ERP Work?
We basically just throw you into the fire ... Just kidding. ERP isn't about throwing you into your biggest fear and telling you to deal with it.
We work collaboratively and gradually to identify the things you've been avoiding and the behaviors that may be keeping the cycle going. Then we develop opportunities for you to practice approaching discomfort without automatically escaping, avoiding, checking, seeking reassurance, or performing other compulsions.
For example, someone with OCD might practice allowing an intrusive thought to be present without trying to figure out what it means. Someone with a phobia might gradually approach a feared situation. Someone with panic might practice experiencing uncomfortable physical sensations without immediately trying to make them stop.
The Goal Isn't to Get Rid of Fear
This is an important part of exposure therapy: the goal isn't necessarily to make fear disappear.
Modern exposure therapy often incorporates ideas from inhibitory learning. Rather than repeatedly facing something until you no longer feel anxious, exposure can help your brain develop new learning that competes with what fear has taught you.
You may learn:
“I can tolerate this feeling.”
“I don't have to know exactly what will happen.”
“Anxiety doesn't mean I'm in danger.”
Sometimes anxiety decreases during an exposure—and sometimes it doesn't. Success isn't measured by whether you stopped feeling afraid. It can be measured by whether you were willing to experience fear, uncertainty, or discomfort without falling back into the same patterns of avoidance or compulsions.
Ultimately, exposure is about developing greater confidence that whatever thoughts, feelings, sensations, or uncertainty come your way, you can learn to tolerate them and keep moving toward what matters to you.
Can ERP Be Done Online?
Yes. ERP and exposure therapy can be done through telehealth.
In fact, online therapy can sometimes be especially useful for exposure work because we can work with fears and triggers in the environment where they actually occur.
Depending on your treatment plan, we may conduct exposures together during an online session, develop exercises for you to practice between sessions, or incorporate limited in-person or real-world exposure work when appropriate.
Interested in Working Together?
I provide online ERP and exposure therapy to adults located in New Jersey, New York, Illinois, Pennsylvania, and Florida, with limited in-person exposure work when clinically appropriate. Feel free to visit the rest of my website. Contact me to learn more about ERP therapy, current availability, insurance, and scheduling a consultation.