Exposure and Response Prevention (ERP)
What is Exposure and Response Prevention?
Exposure and response prevention (ERP) is a highly effective, evidence-based treatment for OCD, OC spectrum disorders, and anxiety disorders. ERP involves gradually exposing clients to triggers in a safe, supportive environment while encouraging them to resist engagement in compulsions, negative behavioral responses, and safety behaviors. The exposure part of ERP involves purposefully exposing clients to that which is triggering to them, examples of which are specific images, media, situations, objects, stories, and activities. The response prevention part of ERP involves encouraging clients to resist maladaptive behavioral responses when triggered, while allowing uncomfortable, distressing thoughts, emotions, and physical sensations to pass on their own. During ERP, clients learn to tolerate distress and discomfort. Clients may also habituate to emotions, such as anxiety and disgust, and their accompanying sensations, the result of which is them lessening in intensity and then dissipating. Over time, ERP leads to clients no longer being triggered and a reduction in and even the elimination of compulsions, avoidance, reassurance seeking, and safety behaviors.
What Happens During Exposure and Response Prevention with Children and Adolescents?
Because the children and adolescents with whom we work may be hesitant to engage in exposures, engagement in exposures is undertaken with a spirit of collaboration between the client and their therapist. Exposures are applied in a graduated manner, meaning clients are offered less triggering exposures to start and work their way up to engagement in more triggering exposures. Clients are offered calming tools and other coping strategies to help them to manage the uncomfortable thoughts, emotions, and physical sensations that arise when engaging in assigned exposures and when exposed to triggers in everyday life. We are mindful of the importance of only offering developmentally and age appropriate exposures to children and adolescents. If there is ever a question about the appropriateness of an exposure, the therapist will check with a client’s parents before engaging that client in the proposed exposure. We believe that each client, no matter how young they are, has a right to self-determination, so if a client is uncomfortable with any suggested exposure, we will work with them to find another way to apply exposure.