Table of ContentsView AllTable of ContentsDefinitionProcessConditionsFrequently Asked Questions
Table of ContentsView All
View All
Table of Contents
Definition
Process
Conditions
Frequently Asked Questions
Exposure and response prevention (ERP) is a form ofcognitive behavioral therapyconsidered the gold standard for treatingobsessive-compulsive disorder(OCD).It is also used to treatanxiety,phobias, andeating disorders.
Read on to learn how ERP works, what it treats, how to find a specialist, and more.
Kemal Yildirim / Getty Images
What Is Exposure and Response Prevention?
Exposure and response prevention is a two-step process. ERP starts with exposure to the very things that cause you discomfort. Then, with the help of a trained specialist, you learn how to prevent your ritualized or compulsive response via a process called habituation (becoming more comfortable with the stimuli), as follows:
History of ERPERP’s roots can be traced back to the 1960s, when a British psychologist, Vic Meyer, developed a successful treatment for helping people with OCD stop compulsive rituals.Throughout the late 1970s and early ’80s, clinical psychology professor Edna Foa and colleagues at the University of Pennsylvania fine-tuned ERP techniques and gave exposure and response prevention its name.
History of ERP
ERP’s roots can be traced back to the 1960s, when a British psychologist, Vic Meyer, developed a successful treatment for helping people with OCD stop compulsive rituals.Throughout the late 1970s and early ’80s, clinical psychology professor Edna Foa and colleagues at the University of Pennsylvania fine-tuned ERP techniques and gave exposure and response prevention its name.
ERP Therapy vs. Talk Therapy
Instead of just talking about obsessive behaviors or anxiety-inducing situations, ERP therapy exposes people to their fearful stimuli in a safe environment. At the same time, the therapist coaches and teaches the patient how to cope in real time.
Although ERP can be performed using one’s imagination (imaginal exposure) or withvirtual realitytechnology, it usually takes place in real-world situations. Unlike talk therapy—which generally takes place in an office setting, on the phone, or via video chat—ERP patients are encouraged to face a fear-inducing situation, object, or activity in real life.
How Does ERP Therapy Work?
ERP exposes people to situations that trigger intrusive thoughts or obsessions. As the triggering situation is experienced, patients learn new coping skills that prevent them from acting on their compulsions. With practice and gradual habituation, ERP reduces anxieties and prevents compulsive responses.
Throughout this process, the patient works closely with their provider to identify specific external stimuli (places, situations, objects, etc.) and internal stimuli (intrusive thoughts, panicky feelings, etc.) that trigger behavior related to OCD, severe anxiety, phobias, or eating disorders.
After someone’s obsessions, compulsions, or aversions are cataloged, the patient is asked to share intimate details of a feared outcome if a ritual or avoidance behavior isn’t performed.
Over time and with each new exposure, the patient learns how to avoid responding in maladaptive (negative) ways.
What Can ERP Therapy Treat?
ERP therapy can be used to treat people with:
Obsessive-Compulsive Disorder
ERP is the first-line behavioral therapy for OCD. An older 2005 study found that 62% of people with OCD responded to their initial ERP treatment sessions. If they completed the 12-week program, success rates jumped to 86%.
ERP remains the gold standard for treating OCD.
Anxiety and Phobias
As part of ERP therapy, patients create a list that ranks anxiety-provoking triggers and phobias from most distressing to least distressing. With the help of a trained specialist, patients are exposed to things that trigger anxiety or phobias and become better at coping with varying degrees of distress as they realize that feared stimuli are safe.
Eating Disorders
When using ERP to treat eating disorders, a patient might create a fear of food hierarchy and gradually be exposed to specific foods or situations that typically trigger ritualized behaviors. A 2020 review found that ERP was slightly more effective than other CBT treatments for preventing unhealthy responses to binge and purge cues.
How to Find an ERP SpecialistThe International OCD Foundation has aresource directoryof therapists who use ERP in their practice. Visit theIOCDF’s homepageto get help and learn more about ERP specialists.
How to Find an ERP Specialist
The International OCD Foundation has aresource directoryof therapists who use ERP in their practice. Visit theIOCDF’s homepageto get help and learn more about ERP specialists.
Summary
Exposure and response prevention therapy is the gold standard for treating obsessive-compulsive disorder. It’s also an effective way to cope with social anxiety, phobias, and eating disorders.
Unlike talk therapy, which doesn’t require exposure to triggers, ERP usually takes place in real time. ERP forces people to face what they fear most. Being exposed to things that trigger obsessive thoughts or compulsions isn’t easy, but it gets easier as patients learn response-prevention techniques and master new coping skills.
A Word From Verywell
ERP isn’t an easy or quick fix for OCD and other mental health disorders; it’s hard work and takes dedication. Facing what scares you most or triggers obsessive behaviors or phobias is scary. It’s important to stay committed and do your ERP exercises regularly and with the guidance of a mental health professional. Don’t get discouraged if you don’t see immediate results. ERP therapy can take a while to work but can make a notable difference.
ERP is one form of CBT. Cognitive-behavioral therapy may sound like a single type of therapy, but it’s actually a mix of cognitive therapies(CT) and behavioral therapies (BT). Under the CBT umbrella, exposure and response prevention is one of the behavioral therapies.Learn More8 Benefits of Therapy
ERP is one form of CBT. Cognitive-behavioral therapy may sound like a single type of therapy, but it’s actually a mix of cognitive therapies(CT) and behavioral therapies (BT). Under the CBT umbrella, exposure and response prevention is one of the behavioral therapies.
Learn More8 Benefits of Therapy
Learn MoreHow Obsessive-Compulsive Disorder Is Treated
When someone with obsessive thoughts does ERP therapy, they purposefully expose themselves to situations that trigger these thoughts but learn not to act on them. ERP won’t completely void intrusive thoughts. However, over time, it’s possible to master coping skills that make these thoughts less invasive, and habituation makes them less potent with repeated exposure.Learn MoreWhat Is Magical Thinking?
When someone with obsessive thoughts does ERP therapy, they purposefully expose themselves to situations that trigger these thoughts but learn not to act on them. ERP won’t completely void intrusive thoughts. However, over time, it’s possible to master coping skills that make these thoughts less invasive, and habituation makes them less potent with repeated exposure.
Learn MoreWhat Is Magical Thinking?
Learn MoreWhat Is Social Anxiety Disorder?
10 SourcesVerywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read oureditorial processto learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.Hezel D, Simpson Hb.Exposure and response prevention for obsessive-compulsive disorder: A review and new directions.Indian J Psychiatry. 2019;61(7):85. doi:10.4103/psychiatry.IndianJPsychiatry_516_18Elsner B, Jacobi T, Kischkel E, Schulze D, Reuter B.Mechanisms of exposure and response prevention in obsessive-compulsive disorder: effects of habituation and expectancy violation on short-term outcome in cognitive behavioral therapy.BMC Psychiatry. 2022;22(1):66 doi:10.1186/s12888-022-03701-zInternational OCD Foundation.How is OCD treated?.Meyer V.Modification of expectations in cases with obsessional rituals.Behaviour Research and Therapy. 1966;4(4):273-280. doi:10.1016/0005-7967(66)90023-4Foa EB, Goldstein A.Continuous exposure and complete response prevention in the treatment of obsessive-compulsive neurosis.Behavior Therapy. 1978;9(5):821-829. doi:10.1016/S0005-7894(78)80013-6American Psychological Association.What is exposure therapy?.Tipura E, Zanesco J, Clément F, Renaud O, Pegna AJ.Am I really seeing what’s around me? An ERP study on social anxiety under speech induction, uncertainty and social feedback.Biological Psychology. 2022;169:108285. doi:10.1016/j.biopsycho.2022.108285Foa EB, Liebowitz MR, Kozak MJ, et al.Randomized, placebo-controlled trial of exposure and ritual prevention, clomipramine, and their combination in the treatment of obsessive-compulsive disorder.AJP. 2005;162(1):151-161. doi:10.1176/appi.ajp.162.1.151Law C, Boisseau CL.Exposure and response prevention in the treatment of obsessive-compulsive disorder: current perspectives.Psychol Res Behav Manag. 2019;12:1167-1174. doi:10.2147/PRBM.S211117Butler RM, Heimberg RG.Exposure therapy for eating disorders: A systematic review.Clinical Psychology Review. 2020;78:101851. doi:10.1016/j.cpr.2020.101851
10 Sources
Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read oureditorial processto learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.Hezel D, Simpson Hb.Exposure and response prevention for obsessive-compulsive disorder: A review and new directions.Indian J Psychiatry. 2019;61(7):85. doi:10.4103/psychiatry.IndianJPsychiatry_516_18Elsner B, Jacobi T, Kischkel E, Schulze D, Reuter B.Mechanisms of exposure and response prevention in obsessive-compulsive disorder: effects of habituation and expectancy violation on short-term outcome in cognitive behavioral therapy.BMC Psychiatry. 2022;22(1):66 doi:10.1186/s12888-022-03701-zInternational OCD Foundation.How is OCD treated?.Meyer V.Modification of expectations in cases with obsessional rituals.Behaviour Research and Therapy. 1966;4(4):273-280. doi:10.1016/0005-7967(66)90023-4Foa EB, Goldstein A.Continuous exposure and complete response prevention in the treatment of obsessive-compulsive neurosis.Behavior Therapy. 1978;9(5):821-829. doi:10.1016/S0005-7894(78)80013-6American Psychological Association.What is exposure therapy?.Tipura E, Zanesco J, Clément F, Renaud O, Pegna AJ.Am I really seeing what’s around me? An ERP study on social anxiety under speech induction, uncertainty and social feedback.Biological Psychology. 2022;169:108285. doi:10.1016/j.biopsycho.2022.108285Foa EB, Liebowitz MR, Kozak MJ, et al.Randomized, placebo-controlled trial of exposure and ritual prevention, clomipramine, and their combination in the treatment of obsessive-compulsive disorder.AJP. 2005;162(1):151-161. doi:10.1176/appi.ajp.162.1.151Law C, Boisseau CL.Exposure and response prevention in the treatment of obsessive-compulsive disorder: current perspectives.Psychol Res Behav Manag. 2019;12:1167-1174. doi:10.2147/PRBM.S211117Butler RM, Heimberg RG.Exposure therapy for eating disorders: A systematic review.Clinical Psychology Review. 2020;78:101851. doi:10.1016/j.cpr.2020.101851
Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read oureditorial processto learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.
Hezel D, Simpson Hb.Exposure and response prevention for obsessive-compulsive disorder: A review and new directions.Indian J Psychiatry. 2019;61(7):85. doi:10.4103/psychiatry.IndianJPsychiatry_516_18Elsner B, Jacobi T, Kischkel E, Schulze D, Reuter B.Mechanisms of exposure and response prevention in obsessive-compulsive disorder: effects of habituation and expectancy violation on short-term outcome in cognitive behavioral therapy.BMC Psychiatry. 2022;22(1):66 doi:10.1186/s12888-022-03701-zInternational OCD Foundation.How is OCD treated?.Meyer V.Modification of expectations in cases with obsessional rituals.Behaviour Research and Therapy. 1966;4(4):273-280. doi:10.1016/0005-7967(66)90023-4Foa EB, Goldstein A.Continuous exposure and complete response prevention in the treatment of obsessive-compulsive neurosis.Behavior Therapy. 1978;9(5):821-829. doi:10.1016/S0005-7894(78)80013-6American Psychological Association.What is exposure therapy?.Tipura E, Zanesco J, Clément F, Renaud O, Pegna AJ.Am I really seeing what’s around me? An ERP study on social anxiety under speech induction, uncertainty and social feedback.Biological Psychology. 2022;169:108285. doi:10.1016/j.biopsycho.2022.108285Foa EB, Liebowitz MR, Kozak MJ, et al.Randomized, placebo-controlled trial of exposure and ritual prevention, clomipramine, and their combination in the treatment of obsessive-compulsive disorder.AJP. 2005;162(1):151-161. doi:10.1176/appi.ajp.162.1.151Law C, Boisseau CL.Exposure and response prevention in the treatment of obsessive-compulsive disorder: current perspectives.Psychol Res Behav Manag. 2019;12:1167-1174. doi:10.2147/PRBM.S211117Butler RM, Heimberg RG.Exposure therapy for eating disorders: A systematic review.Clinical Psychology Review. 2020;78:101851. doi:10.1016/j.cpr.2020.101851
Hezel D, Simpson Hb.Exposure and response prevention for obsessive-compulsive disorder: A review and new directions.Indian J Psychiatry. 2019;61(7):85. doi:10.4103/psychiatry.IndianJPsychiatry_516_18
Elsner B, Jacobi T, Kischkel E, Schulze D, Reuter B.Mechanisms of exposure and response prevention in obsessive-compulsive disorder: effects of habituation and expectancy violation on short-term outcome in cognitive behavioral therapy.BMC Psychiatry. 2022;22(1):66 doi:10.1186/s12888-022-03701-z
International OCD Foundation.How is OCD treated?.
Meyer V.Modification of expectations in cases with obsessional rituals.Behaviour Research and Therapy. 1966;4(4):273-280. doi:10.1016/0005-7967(66)90023-4
Foa EB, Goldstein A.Continuous exposure and complete response prevention in the treatment of obsessive-compulsive neurosis.Behavior Therapy. 1978;9(5):821-829. doi:10.1016/S0005-7894(78)80013-6
American Psychological Association.What is exposure therapy?.
Tipura E, Zanesco J, Clément F, Renaud O, Pegna AJ.Am I really seeing what’s around me? An ERP study on social anxiety under speech induction, uncertainty and social feedback.Biological Psychology. 2022;169:108285. doi:10.1016/j.biopsycho.2022.108285
Foa EB, Liebowitz MR, Kozak MJ, et al.Randomized, placebo-controlled trial of exposure and ritual prevention, clomipramine, and their combination in the treatment of obsessive-compulsive disorder.AJP. 2005;162(1):151-161. doi:10.1176/appi.ajp.162.1.151
Law C, Boisseau CL.Exposure and response prevention in the treatment of obsessive-compulsive disorder: current perspectives.Psychol Res Behav Manag. 2019;12:1167-1174. doi:10.2147/PRBM.S211117
Butler RM, Heimberg RG.Exposure therapy for eating disorders: A systematic review.Clinical Psychology Review. 2020;78:101851. doi:10.1016/j.cpr.2020.101851
Meet Our Medical Expert Board
Share Feedback
Was this page helpful?Thanks for your feedback!What is your feedback?OtherHelpfulReport an ErrorSubmit
Was this page helpful?
Thanks for your feedback!
What is your feedback?OtherHelpfulReport an ErrorSubmit
What is your feedback?
