The method is predicated on the idea that a therapeutic effect is achieved as subjects confront their fears and discontinue their escape response. The behavioral process is called Pavlovian extinction or respondent Extinction (psychology) An example would be of a person who repeatedly checks light switches to make sure they're turned off. They would carry out a program of exposure to their feared stimulus (leaving lights switched on) while refusing to engage in any safety behaviors.

It differs from Exposure Therapy for phobia in that the resolution to refrain from the avoidance response is to be maintained at all times and not just during specific practice sessions. Thus, not only does the subject experience habituation to the feared stimulus, they also practice a fear-incompatible behavioral response to the stimulus. While this type of therapy typically causes some short-term anxiety, this facilitates long-term reduction in obsessive and compulsive symptoms.

Exposure and Response therapy is primarily used for the treatment of obsessive-compulsive disorder.

More than 7 million people in the United States are affected by Obsessive-Compulsive Disorder (OCD), a mental illness that causes patients to have consistent worry and intrusive, stressful thoughts that they compensate for by performing compulsive rituals to alleviate the worries.

A common example is a patient who has an obsession about germs and cleanliness, and compensates by ritual hand washing or cleaning, or a patient who obsesses over their safety in their home, and will repeatedly check the locks on the house.

Obsessions can also be persistent and unwanted thoughts of committing violence, or thoughts that are prohibited by their religion. When the obsessions and rituals cause an interference in daily living or start to harm relationships, treatment is warranted with anti-depressant (Prozac, Zoloft, Lexapro, Paxil, Celexa) and anti-anxiety (Klonopin, Ativan, Xanax) medications, along with cognitive behavioral therapy aimed at changing thoughts, behaviors, and facing and understanding fears. Diagnosis is made after symptoms persist for six months or longer.

Patients first identify triggers that cause fear or anxiety, whether they are people, objects, or situations. As these items are identified, patients are very slowly exposed to them and are trained to slowly resist the previous negative response.

ERP patients create their list of triggers by identifying the places, people, objects, sounds, images, etc. that cause them to be afraid. The patient and therapist then go through the list to identify the trigger producing the least amount of anxiety. This trigger is used as the beginning point in the therapy. The patient is then slowly exposed to the trigger over time. Over time the patient should become more comfortable with the trigger. Eventually all of the triggers will be addressed.

Each therapist may take a slightly different approach to ERP so be sure you discuss the therapy with your therapist first.

Pros for this therapy

ERP can cause some short-term anxiety and severe discomfort. Patients may feel very uncomfortable as they are initially exposed to the negative triggers.

ERP is highly effective when administered properly. When effective, it should produce weekly therapeutic progress. 

Cons for this therapy

ERP facilitates long-term reduction in obsessive and compulsive symptoms.  While, patients will initially feel short term anxiety and discomfort, the negative feelings will decrease. In the long run these feelings are helpful for the patient in his or her fight against obsessive-compulsive behavior.

Incorrect application of techniques can lead to failure of the therapy, and inconsistency in treatment can cause regression and setbacks that are difficult to overcome. Patients who do not have a specific behavior that they want to change and address might be better suited for a different type of psychotherapy.

Psychoanalysis was perhaps the first specific school of psychotherapy, developed by Sigmund Freud and others through the early 20th century. Trained as a neurologist, Freud began focusing on problems that appeared to have no discernible organic basis, and theorized that they had psychological causes originating in childhood experiences and the unconscious mind. Techniques such as dream interpretation, free association, transference and analysis of the id, ego and superego were developed.

Behaviorism developed in the 1920s, and behavior modification as a therapy became popularized in the 1950s and 1960s. Notable contributors were Joseph Wolpe in South Africa, M.B. Shipiro and Hans Eysenck in Britain, and John B. Watson and B.F. Skinner in the United States. Behavioral therapy approaches relied on principles of operant conditioning, classical conditioning and social learning theory to bring about therapeutic change in observable symptoms. The approach became commonly used for phobias, as well as other disorders.

During the 1950s, Albert Ellis originated Rational Emotive Behavior Therapy (REBT). A few years later, psychiatrist Aaron T. Beck developed a form of psychotherapy known as cognitive therapy. Both of these generally included relatively short, structured and present-focused therapy aimed at identifying and changing a person's beliefs, appraisals and reaction-patterns, by contrast with the more long-lasting insight-based approach of psychodynamic or humanistic therapies. Cognitive and behavioral therapy approaches were combined and grouped under the heading and umbrella-term Cognitive behavioral therapy (CBT) in the 1970s. Many approaches within CBT are oriented towards active/directive collaborative empiricism and mapping, assessing and modifying clients core beliefs and dysfunctional schemas. These approaches gained widespread acceptance as a primary treatment for numerous disorders. A "third wave" of cognitive and behavioral therapies developed, including Acceptance and Commitment Therapy and Dialectical behavior therapy, which expanded the concepts to other disorders and/or added novel components and mindfulness exercises. Counseling methods developed, including solution-focused therapy and systemic. During the 1960s and 1970s Eugene Heimler, after training in the new discipline of psychiatric social work, developed Heimler method of Human Social Functioning, a methodology based on the principle that frustration is the potential to human flourishing.

ERP developed out of the Cognitive Behavior Therapy movement. It came about in the 1960s and 1970s as a result of research on OCD.  ERP has become the most prominent psychological treatment for OCD today.  

Exposure and response prevention (ERP) is an example of Exposure Therapy, which is a technique in Behavior Therapy. Behavior Therapy is an approach to psychotherapy. Psychotherapy is a general term referring to therapeutic interaction or treatment contracted between a trained professional and a client or patient; family, couple or group. The problems addressed are psychological in nature and of no specific kind or degree, but rather depend on the specialty of the practitioner. 

Psychotherapy aims to increase the individual's sense of his/her own well-being. Psychotherapists employ a range of techniques based on experiential relationship building, dialog, communication and behavior change that are designed to improve the mental health of a client or patient, or to improve group relationships (such as in a family).

ERP serves as a treatment method available from behavioral psychologists and cognitive-behavioral therapists for a variety of anxiety disorders, especially Obsessive Compulsive Disorder.

Review Date: 
February 15, 2012