Exposure and Response Prevention Therapy (ERP)

What is Exposure and Response Prevention (ERP)?

Exposure and Response Prevention, or ERP, is a type of Cognitive Behavioral Therapy (CBT) and the most effective, evidence-supported treatment for the treatment of OCD with or without medication.

In ERP treatment, clients are gradually and repeatedly exposed to the thoughts, images, or situations that bring on obsessions, while resisting their compulsions or physical rituals. Through increased frequency and intensity of the exposure, clients reach a point at which they feel so accustomed to the trigger that they no longer partake in these behaviors.

How does ERP work?

ERP works by exposing the individual with OCD, little by little, to the thoughts, images, or situations that trigger obsessions.

Dr. Jerry Bubrick, director of the Obsessive-Compulsive Disorder Service at the Child Mind Institute, states, “Though it’s uncomfortable, people learn they can can tolerate the anxiety that comes with it and they get better.”

By directly confronting the obsessive thought in a systematic process, the individual gradually becomes accustomed to it, learning that the feared outcome does not occur and feeling less tempted to engage in physical compulsions.

At first, facing the situation that triggers obsessions or compulsions can induce high levels of anxiety for the client. With time and under the guidance of a trained therapist, however, these levels of anxiety naturally drop as the individual learns to respond differently to the situation. Ultimately, this leads to a reduction in the frequency and intensity of the obsessions and compulsions.

Dr. Bubrick explains, “When we systematically and slowly introduce [individuals] to things they’re afraid of, they feel the anxiety, but they learn how to get used to it and how to adapt, and it doesn’t bother them anymore.”

Length of ERP treatment

Some degree of relief can generally be found from ERP in about 10 to 20 sessions, though the time it takes to see results and reduce obsessions varies for each individual. Response times depend highly on the severity of obsessions and rituals, the therapist's ability to gently push the client, and the client's ability to consistently attend therapy and engage with the treatment.

"The practice of working through one’s fears and anxieties is different for every individual," explains Kevin Ashworth, Clinical Director of the NW Anxiety Institute. He continues, "Learning to accept one's fears and develop a new perspective to overcome them can take as little as one session, while fears that have been maintained for years typically require three months to see significant change."

Does ERP work?

ERP has been shown to be helpful in about 75 – 85% of individuals. Extensive research supports that ERP is the first-line treatment for individuals with OCD, and that most individuals are able to tolerate the treatment.

After just a few sessions, many individuals realize just how much control they have over their own brain patterns, and that engaging in physical compulsions is not necessary to effectively control anxiety. Finding a therapist with expertise in OCD is critical to the success of treatment, as there are nuances in treatment that a qualified expert will understand how to navigate.

What types of ERP treatment are there?

The type of ERP treatment that an individual receives depends heavily on the individual’s unique obsessions, compulsions, and life circumstances.

Dr. Fugen Neziroglu, co-founder and director of the Bio Behavioral Institute, explains, “Sometimes, this takes a lot of creativity, especially when you have a pure obsession and you need to create the situation in real life.”

For example, someone with contamination or germ OCD may feel compelled to excessively hand wash or shower due to fear of “infecting” others. For those with severe OCD, this cleaning compulsion can heavily impact their personal activities, relationships, school, and career. ERP asks the individual to face going to the supermarket, school, or work while resisting the urge to constantly hand wash or shower after every encounter.

Whatever the obsession may be, Dr. Fugen emphasizes, “A good therapist will work with you outside of the office, go where the problem is, or come to your home.”

New to therapy? Learn about how to find a therapist here.


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