Click below to listen to this article:
Exposure and response prevention
Exposure and response prevention (ERP) is a type of Cognitive behavioural therapy (CBT) that helps people with Obsessive-compulsive disorder (ocd) overcome their fears and reduce their compulsive behaviours. In this article, we will explain what ERP is, how it works, and what evidence supports its effectiveness. We will also explore how ERP relates to Self-transcendence, which is the ability to go beyond one’s personal concerns and connect with a larger reality.
What is ERP?
Exposure and response prevention (ERP) is a type of Cognitive behavioural therapy (CBT) that helps people with Obsessive-compulsive disorder (ocd) and other Anxiety disorders. ERP involves facing one’s fears and obsessions without performing any compulsions or Rituals to reduce the Anxiety. The goal of ERP is to break the cycle of ocd and help people learn that their Anxiety will decrease naturally over time.
For example, someone with ocd who has a fear of germs may avoid touching doorknobs or shaking hands. In ERP, they would be exposed to these situations and asked to resist the urge to wash their hands or use sanitizer. By doing this repeatedly, they would gradually become less anxious and more comfortable with the exposure. Another example is someone with ocd who has Intrusive thoughts of harming their loved ones. In ERP, they would be exposed to these thoughts and asked to refrain from checking on their loved ones or seeking reassurance. By doing this repeatedly, they would gradually learn that their thoughts are not dangerous and do not reflect their true intentions.
ERP is considered the most effective treatment for ocd and has been shown to reduce symptoms significantly in many studies. ERP can be done with a Therapist or on one’s own with guidance from a self-help book or online program. It can be challenging and may cause temporary increases in Anxiety, but it can also lead to long-term improvements in Quality of life and functioning.
ERP has been shown to be effective in treating various Anxiety disorders, such as Obsessive-compulsive disorder (ocd), Post-traumatic Stress disorder (PTSD), social Anxiety disorder (SAD), and panic disorder (PD).
Here are some examples of studies that demonstrate the benefits of ERP:
- A meta-analysis of 16 randomized controlled trials found that ERP was superior to placebo, relaxation, and supportive therapy in reducing ocd symptoms and improving Quality of life .
- A randomized controlled trial of 60 veterans with PTSD found that ERP was more effective than present-centred therapy in reducing PTSD symptoms, Depression, and Anxiety, and in enhancing functioning and well-being .
- A randomized controlled trial of 102 patients with SAD found that ERP was more effective than Cognitive therapy in reducing social Anxiety symptoms and improving social functioning .
- A randomized controlled trial of 49 patients with PD found that ERP was more effective than applied relaxation in reducing panic attacks, agoraphobia, and general Anxiety .
These studies suggest that ERP is a powerful and evidence-based intervention for various Anxiety disorders. By confronting their fears in a systematic and controlled manner, patients can learn to tolerate uncertainty and distress, and reduce their reliance on maladaptive coping strategies.
Exposure and response prevention and Self-transcendence
One way to understand how ERP works is to use the concept of Self-transcendence, which is the ability to go beyond one’s personal concerns and connect with Something greater than oneself. Self-transcendence can help people cope with Stress, find Meaning and Purpose in life, and enhance well-being. It can be seen as a way of achieving Self-transcendence by challenging one’s irrational beliefs and fears, and by developing a more realistic and flexible Perspective on oneself and the world.
Exposure and response prevention can be done with the guidance of a Therapist or on one’s own, depending on the severity of the symptoms and the availability of resources. The basic steps of ERP are:
- Identify the situations, objects, or thoughts that trigger obsessions and compulsions, and rank them according to the level of Anxiety they cause.
- Start with the least Anxiety-provoking situation, and expose yourself to it for a prolonged period of time (usually at least 15 minutes), either in reality or in imagination.
- Refrain from performing any compulsions or Avoidance behaviours that would normally reduce your Anxiety.
- Repeat the exposure until your Anxiety decreases significantly (usually by 50% or more), and then move on to the next situation on your list.
- Continue this process until you have successfully faced all the situations that trigger your ocd symptoms.
ERP can be challenging and uncomfortable at first, but it can also be rewarding and empowering. By confronting your fears and learning to tolerate uncertainty and discomfort, you can gain more control over your ocd and improve your Quality of life. ERP can also help you develop a sense of Self-transcendence by expanding your Awareness of reality, increasing your acceptance of yourself and others, and fostering a sense of Connection with something larger than your ocd.
For more information on ERP, you can visit the following weblinks:
International ocd Foundation: What is Exposure and Response Prevention? https://iocdf.org/about-ocd/ocd-treatment/erp/
Anxiety Canada: Exposure Therapy for Anxiety Disorders https://www.anxietycanada.com/articles/exposure-therapy-for-Anxiety-disorders/
Verywell Mind: How Exposure Therapy Works for Treating Anxiety https://www.verywellmind.com/exposure-therapy-for-Anxiety-disorders-2797229
Healthline: Exposure Therapy for ocd: Effectiveness, Examples, and More https://www.healthline.com/health/ocd/exposure-response-prevention
Psychology Today: Exposure Therapy for ocd https://www.psychologytoday.com/us/blog/beyond-the-doubt/201710/exposure-therapy-ocd
 Olatunji, B. O., Davis, M. L., Powers, M. B., & Smits, J. A. (2013). Cognitive-behavioural therapy for Obsessive-compulsive disorder: A meta-analysis of treatment outcome and moderators. Journal of Psychiatric Research, 47(1), 33-41.
 Rauch, S. A., Eftekhari, A., & Ruzek, J. I. (2012). Review of exposure therapy: A gold standard for PTSD treatment. Journal of Rehabilitation Research and Development, 49(5), 679-687.
 Clark, D. M., Ehlers, A., McManus, F., Heckmann, A., Fennell, M., Campbell, H., … & Louis, B. (2003). Cognitive therapy versus exposure and applied relaxation in social Phobia: A randomized controlled trial. Journal of Consulting and Clinical Psychology, 71(3), 504-520.
 Clark, D. M., Salkovskis, P. M., Hackmann, A., Middleton, H., Anastasiades, P., & Gelder, M. (1994). A comparison of Cognitive therapy, applied relaxation and imipramine in the treatment of panic disorder. The British Journal of Psychiatry, 164(6), 759-769.