How Exposure and Response Prevention Therapy Helps Reduce Compulsive Behaviors

Are obsessions and compulsive behaviors controlling your life? Have you considered trying ERP? You may be thinking, "what is exposure and response prevention therapy?” Here's the breakdown of what ERP is and how it can effectively combat the challenges of OCD and related anxiety disorders.

We all know the story. The little caterpillar slips inside its cocoon and soon emerges as a beautiful butterfly. We use the butterfly story as a metaphor for change, but we skip over the critical part—the actual process of changing. While inside that cocoon, the caterpillar goes through a sometimes tricky alteration of who it is. Changing our behaviors to treat intrusive thoughts and urges can be just as challenging. The lesson we can take from the caterpillar is that with commitment and time, change is possible.

Unlike the caterpillar, we have mental health professionals and effective treatments to assist in our life changes. For example, treatment is available to reduce obsessive-compulsive disorder (OCD) and its hold on one's life. Our "cocoon of change" is called Exposure and Response Prevention Therapy, or ERP.

What is Exposure and Response Prevention Therapy?

Exposure and Response Prevention Therapy (ERP) techniques are based in Cognitive Behavioral Therapy (CBT). CBT works in two ways. First, it assists in altering our cognition (thought patterns) that have stopped us from addressing our fears. Second, it addresses the behaviors needed for us to confront those fears slowly.

During a typical ERP session, the therapist will help the patient address some of their obsessive thoughts and compulsive behaviors in a controlled, safe environment. For example, if someone is obsessed with the idea of getting sick, their therapist might help them take an action that they usually would avoid, such as shaking hands. The first step is always assuring the patient is calm and comfortable. Next, the patient and therapist will go through the action mindfully and discuss it thoroughly before trying it in a safe situation. After exposure, the therapist and the patient will discuss the response, what feelings arose, and what fears seemed unfounded. Over time, through exposure, the obsessions often lessen and become more manageable. Then the compulsive behavior, like washing hands after shaking, is less likely to happen.

When dealing with anxiety-related conditions like OCD, the cognition/behavior cycle is altered using Exposure and Response Prevention Therapy (ERP). This treatment is very effective in dealing with anxiety-inducing thoughts. We learn to sit with uncomfortable feelings instead of acting, allowing anxiety to fade by challenging our fears.

During ERP, patients learn to recognize their “flight or fight" response and take control of how they deal with it. Usually, the response simply identifies the fears and feelings associated with the distressing stimulus rather than acting on the anxiety.

ERP may also include other therapeutic approaches, including medications to assist in the healing process. But often, ERP therapy is an effective approach to OCD on its own.

How Does Exposure and Response Prevention Therapy Work?

Similar to Cognitive Behavioral therapy, ERP has two parts to its process to affect compulsions and obsessions.

Exposure Therapy

"Exposure" in ERP refers to exposing the patient to the thoughts, images, objects, and situations that make them anxious and start obsessions. Of course, avoiding all anxiety-causing stimuli is not only impossible but doesn’t benefit the patient. However, by introducing or exposing us to the distressing stimuli in a calm, controlled manner, the anxiety over the stimulation will be far less overwhelming. To manage reactions to distressing stimuli, we learn the next component of ERP, which is "response prevention."

Response Prevention Therapy

In ERP therapy, the "response prevention" component is learning how to not do (respond) to a compulsive action once exposed to the anxiety-inducing stimulus. Through exposure, patients realize whether to carry out a compulsive behavior once triggered by exposure.

The strategy of purposefully exposing the patient to things that make them anxious may not sound quite right. However, those with obsessive-compulsive disorder have probably tried unsuccessfully to end the obsessive-compulsive cycle many times and found that it actually made the anxiety worse.

ERP treatment is different because, through the treatment, we will learn skills to face our fears. During ERP, patients work with a trained therapist to help them stay committed to not giving in to compulsive behaviors. Eventually, they often find that the less they give in to the compulsive actions, the less anxiety they experience in general.

Are There Other Treatments for Obsessive-Compulsive Disorder?

Are there other treatments out there for OCD? Yes, but none have been as successful as Exposure Response Prevention therapy. Decades ago, OCD was thought of as an untreatable mental disorder. Now widely accepted by psychologists as the go-to treatment for OCD, ERP therapy has helped many patients find relief.

Research has shown that the most effective OCD treatment involves a combination of therapy and medications.


Therapy includes ERP, cognitive therapy, and education. Cognitive therapy helps the patient's overall mental health by addressing other issues like depression and allows the patient to gain insight into how their beliefs and fears started. Educating the patient on their OCD and how the treatments work is an essential component of therapy.


A class of medications called serotonin reuptake inhibitors, or SRIs, have been shown to enhance the effectiveness of CBT treatments, especially ERP therapy. A combination of ERP therapy and SRI medications has been shown to be 70% effective in treating OCD.

Is Exposure and Response Prevention Therapy the Right Therapy?

At first, Exposure and Response Prevention Therapy may sound complicated, frightening, and even dangerous. But as many patients discover, it brings welcome relief for OCD symptoms. Under the care of a licensed professional, ERP therapy is entirely safe and can be very effective. The therapist may vary the intensity of the ERP therapy based on the patient’s needs.

To experience the benefits of ERP therapy for OCD, we must be committed to change. Ambivalence about changing behaviors will sabotage anyone’s efforts. Think of the caterpillar emerging from the cocoon. Change can take time. The commitment isn't huge—in some cases, only 15-20 minutes per week focusing on their urges. Nevertheless, many people feel it's worth the dedication and effort, especially when it can open a new world of freedom for those with OCD and related anxiety disorders.

What Should I Expect from ERP Therapy?

When undergoing ERP, patients should expect change—both physical and mental. Physically, researchers studying Exposure and Response Prevention Therapy have observed the changes in the brain after ERP. This evidence-based therapy for OCD offers clients hope and inspiration for their future as it promotes life-changing results.

Mentally, expect the OCD to change. The patient will feel less overwhelmed by anxieties and more in control of compulsive responses to these anxieties. Expect some difficulties and uncomfortable feelings to continue but know that these moments will become less upsetting throughout ERP therapy.

Exposure and Response Prevention therapy can empower patients to overcome many obsessions and compulsions that control their lives. Once someone decides they're ready to manage their obsessions and anxiety, ERP can offer the tools to help them succeed. The power to change is within each of us whenever we're ready to begin. ERP may sound intimidating at first, but often when patients begin working with a trusted therapist, those fears melt away, and they start to feel more control over their behaviors.

At Goodman Psychologist Associates, we offer Exposure and Response Prevention Therapy for OCD both in-person and virtually. Our caring staff can find the right therapist, assist with scheduling, and help the patient escape the vicious cycles of fear and reaction, obsession, and compulsion. Contact us today.

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