Understanding Exposure and Response Prevention (ERP) Therapy at the Center
At the Center for Anxiety, OCD, and Cognitive Behavioral Therapy, we specialize in exposure and response prevention (ERP) for treating obsessive-compulsive disorder (OCD) and other anxiety-related disorders. Located in Philadelphia and serving Pennsylvania, New Jersey, and most of the country via telehealth, our psychologists are experts in helping individuals manage their fears and compulsions with personalized ERP strategies.
What is Exposure and Response Prevention (ERP)
ERP is a type of cognitive-behavioral therapy that involves gradual exposure to fear triggers in a controlled setting, while teaching individuals to resist performing compulsive behaviors or rituals—also known as ritual prevention. This approach, which is one of various forms of exposure psychotherapy or exposure therapy, is especially effective for OCD and related conditions and is also quite effective for various specific fears, phobias, and forms of anxiety.
What is Exposure and Response Prevention Training?
ERP training involves teaching individuals how to confront their fears and resist compulsions effectively. Through this training, people learn to manage OCD symptoms and apply skills learned in therapy to real-life situations.
Exposure and Response Prevention (ERP) Therapy
An evidence-based form of CBT for obsessions, compulsions, panic, and specific fears and phobias
More Information about Exposure and Response Prevention Therapy
ERP and Related Forms of Exposure Therapy and CBT
ERP is related to prolonged exposure (PE) for PTSD. And exposure therapy, along with response prevention is often integrated into cognitive behavioral therapy (CBT) for various conditions, including social anxiety, performance anxieties, shy bladder syndrome or paruresis, panic disorder, generalized anxiety, body dysmorphic disorder, misophonia, hoarding, eating disorders, and other areas.
The History of Exposure and Response Prevention
The roots of exposure psychotherapy and ERP trace back to early behavioral science, with foundational work by figures like Ivan Pavlov and John Watson and later developments by Joseph Wolpe in systematic desensitization. The modern form of ERP therapy was developed by Victor Meyer and significantly advanced by Edna Foa—under whom our center’s director studied for two years. Influential contributions also come from Jonathan Grayson, whose work deeply informs our practice.
The evolution of ERP includes older theories like Mowrer’s two-factor model, emotional processing theory, and coping self efficacy and newer concepts like inhibitory learning theory, the cognitive theory of disconfirmatory learning through behavioral challenges, and ideas of willingness and acceptance of thoughts of emotions.
The History of Exposure and Response Prevention
What are the basic techniques of exposure and response prevention? ERP involves several methods and techniques tailored to individual needs, including:
- Self monitoring: Identifying situations, fears, obsessions, and rituals or responses.
- Psychoeducation: Educating individuals about OCD, specific content areas, and ERP.
- In vivo exposures: Directly facing real-life situations that trigger fears.
- Imaginal exposures: Confronting fears through guided imagery.
- Thought exposures: Addressing obsessive thoughts and mental rituals.
- Response prevention: Resisting the urge to perform compulsive behaviors, also known as ritual prevention.
- Delaying responses and rituals: Increasing the time between obsession and unhelpful responses or compulsions.
- Modifying rituals: Altering compulsive behaviors to lessen their impact.
- Reviewing progress: Evaluating improvements and adjusting strategies.
- Addressing new triggers: Identifying and responding to emerging concerns.
- Reflecting on learning: Discussing insights gained through exposures and response prevention.
These methods often help patients to better understand, confront, and detach from their fears, to feel better able to cope, and to break the OCD cycle.
What Are Examples of ERP Therapy?
Three common examples of exposures in ERP therapy include:
- Germ contamination concerns: Touching a doorknob without washing hands afterward to break the cycle of fear and compulsion.
- Fears of harm: Taking reasonable risks deliberately and confronting intrusive thoughts of being responsible for causing harm without performing checking rituals
- Fear of having Illnesses: Facing situations that trigger health anxiety without seeking excessive reassurance or medical tests.
Does ERP Work for "Pure O" OCD and Obsessive Overthinking?
Can ERP therapy help with OCD largely involving obsessive overthinking? Yes, years of clinical research and experience have shown that ERP can be effective for patients whose OCD involves obsessive overthinking and those with so-called “pure O” OCD, where outward behavioral rituals aren’t a prominent feature. Overtly clear behavioral rituals, like those often depicted on television, may be present but are not always part of OCD. Learn more about these misconceptions in our blog article, “Uncovering the Truth: A Closer Look at the Misunderstood Realities of OCD Beyond the Stereotypes.”
ERP for Kids and Teens
ERP is highly adaptable for younger patients. Our approach for children and teens involves age-appropriate techniques and parental involvement to ensure supportive and effective treatment. Through exposure and response therapy and related methods, we help young patients understand their fears, resist compulsions, and gain confidence in managing OCD symptoms.
ERP Combined with Other Methods
Finding a provider who has expertise in OCD, anxiety, or your specific condition, and someone whom you trust and like, is crucial. At our center, we may combine exposure therapy and ERP with other treatments based on individual needs. These can include other forms of CBT, inference-based cognitive behavioral therapy (I-CBT), acceptance and commitment therapy (ACT), or dialectical behavior therapy (DBT). Working together, we develop a comprehensive treatment plan that may integrate ERP with these approaches, either concurrently or sequentially.
How Long Does ERP Therapy Take?
The duration of ERP therapy varies based on individual needs. When doing weekly sessions, progress usually occurs over months but can vary from case to case. When therapy is done in an intensive format, meeting multiple times per week, progress often seems to occur more quickly. This option might be advisable in some cases but not necessarily for everyone.
Can You Do ERP Therapy on Your Own?
Yes, it is possible to undertake exposure and response prevention (ERP) therapy on your own, and there are self-help books available to guide you (see resources below). However, many individuals find that they benefit from the guidance of an expert professional or another support figure, especially in the initial stages. After completing ERP therapy with a psychologist or another qualified mental health professional, many patients are equipped to maintain and apply the therapy techniques independently, continuing their progress and managing symptoms on their own.
Explore ERP Resources
To support your understanding and application of ERP, we offer various resources, including books and worksheets:
- Exposure worksheet
- Treating Your OCD with Exposure and Response (Ritual) Prevention Therapy Workbook by Elna Yadin, Edna Foa, and Tracy Lichner
- Freedom From Obsessive Compulsive Disorder: A Personalized Recovery Program for Living with Uncertainty by Jonathan Grayson
- Stopping the Noise in Your Head: the New Way to Overcome Anxiety and Worry by Reid Wilson
- Freeing Your Child from Obsessive-Compulsive Disorder: A Powerful, Practical Program for Parents of Children and Adolescents by Tamar Chansky
- Stuff That’s Loud: A Teen’s Guide to Unspiraling When OCD Gets Noisy by Ben Sedley and Lisa W. Coyne
Connect with Us for Specialized ERP Therapy
If you’re ready to start your journey with ERP therapy, contact the Center for Anxiety, OCD, and Cognitive Behavioral Therapy today. We specialize in ERP and other evidence-based cognitive and behavioral therapies and are here to guide you towards overcoming OCD and related anxiety disorders.
Follow us on Facebook, X, Instagram, and LinkedIn for more information. Learn about specific disorders and effective treatments on our pages dedicated to OCD, body dysmorphic disorder, panic disorder, social anxiety disorder, and emetophobia.
Embark on your path to a more fulfilling life free from the grips of OCD and anxiety with expert ERP therapy at the Center for Anxiety, OCD, and Cognitive Behavioral Therapy.
Center for Anxiety, OCD, and
Cognitive Behavioral Therapy, LLC
1518 Walnut Street, Suite 800
Philadelphia, PA 19102
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Our physical office is conveniently located in the Rittenhouse Square area of Philadelphia. The facility is easily accessible to Center City, Graduate Hospital, South Philadelphia, University City, West Philadelphia, Fairmount, Manayunk, Roxborough, East Falls, Chestnut Hill, Northern Liberties, Fishtown/Kensington, as well as the Philadelphia Main Line area (including Wayne, Villanova, Bryn Mawr, Gladwyne, Radnor, Haverford, Ardmore, Wynnewood, Narberth, Merion, Lower Merion Township), and Montgomery, Delaware, Chester, and Camden Counties.
