A few weeks ago I did an Instagram post about the response prevention part of exposure. Lots of people wanted to know more about this. I got the sense that the concept was foreign to many, so this seems like a good time to start to address it little by little.
Remember the The Anxious Morning is not therapy nor a substitute for therapy. I cannot diagnose you in a morning newsletter, nor should anyone ever diagnose you on the Internet. Ever. This is a very cursory definition of what ERP is and how it is applied.
ERP stands for Exposure and Response Prevention. You’ll often hear it referred to as the “gold standard” treatment for OCD. That is an accurate statement. Let’s break down the acronym.
E = Exposure.
Exposure is the act of intentionally coming into contact with tasks, places, people, or situations that are likely to trigger your anxiety, panic, or feelings of discomfort. Most people have at least heard of this part. If you have harm OCD and get triggered around knives or sharp objects, exposure might be holding a knife or walking around with a knife. If you are agoraphobic, exposure might be driving to a park two miles from home. These are typical examples.
RP = Response prevention.
This is really the most important part. Tomorrow on The Anxious Morning we’ll go over why. For now, just know that response prevention refers to the act of intentionally NOT engaging in responses to discomfort that are usually used to soothe that discomfort. For example, if you like to tap on your cheekbone, pop breath mints, call for help, repeat a mantra, or perform some kind of vagus nerve ritual (sorry, had to take the swipe) when you feel anxious, agitated, or in a state of panic, response prevention describes the act of intentionally NOT doing those things, even when you really want to do.
ERP is therefore a method used to intentionally create an anxious state (exposure) while intentionally not engaging in rituals or behaviors designed to soothe that state (response prevention). I know that at face value this seems ridiculous and like something you would NEVER want to do, but it is an incredibly effective form of treatment.
Is ERP only used to treat OCD?
You will hear the term ERP used most often in the context of OCD treatment, but in reality any exposure therapy is ERP in some form. If you are doing exposure for panic disorder or agoraphobia, you also have to refrain from engaging in your escape or safety rituals. Repeatedly dragging yourself through the supermarket (for example) while you sniff lavender, tap your cheek, talk on the phone to your safe person, and literally RUN through the place to get out as quickly as possible, is technically exposure, but it’s not going to be very helpful because its E without the RP.
So no matter the anxiety issue we’re addressing, if we are addressing it with E, we also have to include the RP to get any real desired result.
Come back tomorrow and we’ll talk about why.
103. What Is ERP And When Is It Used?