Exposure and Response Prevention (ERP) is the gold-standard behavioral treatment for Obsessive–Compulsive Disorder (OCD) and related anxiety conditions.
Here’s a clear breakdown:
What ERP Is
- Exposure = Gradually and intentionally facing the thoughts, images, objects, or situations that trigger anxiety or obsessive fears.
- Response Prevention = Choosing not to perform the usual compulsive behavior (checking, washing, mental ritual, reassurance seeking, etc.) that temporarily relieves anxiety.
The goal: teach your brain that anxiety can decrease on its own without compulsions, breaking the OCD cycle.
How ERP Works
Assessment & Hierarchy
- You and a therapist identify your obsessions and compulsions.
- Create a “fear ladder” (from least distressing triggers to most distressing).
Exposure Practice
- Start with mild-to-moderate triggers.
- Example: If contamination OCD is the concern, exposure might be touching a doorknob and not washing hands right away.
Response Prevention
- Resist the compulsion (e.g., no handwashing for a set period).
- Notice that anxiety rises at first, then gradually falls without ritualizing.
Repetition & Generalization
- Practice exposures regularly in different contexts until they feel manageable.
- Move up the hierarchy over time.
Why ERP Works
- Habituation: Anxiety naturally decreases when you stay in the situation.
- Learning new associations: The feared event doesn’t happen, teaching your brain it’s safe.
- Empowerment: You learn you can tolerate distress without rituals.
Example (Checking OCD)
- Fear: “If I don’t check the stove, the house will burn down.”
- Exposure: Turn off stove once and walk away.
- Response Prevention: Do not go back to check again, even when anxious.
- Outcome: Anxiety spikes, then fades. Over time, checking loses power.
ERP is usually done with the support of a trained therapist, but self-guided versions exist too.
Shervan K Shahhian
LIBERTY PSYCHOLOGICAL ASSOCIATION 