How Does ERP Work?

Exposure and Response Prevention is a highly effective OCD treatment that clinicians at Reveal Counseling provide in Rhode Island, Massachusetts, and Maine. For those that commit to engaging in ERP, most clients notice symptom reduction in as little as 12-15 weeks.

ERP works through a combination of two mechanisms: habituation and inhibitory learning.

Habituation is the process through which exposure to something (again and again and again) gradually reduces the experienced fear. For example, a person who is afraid of roller coasters is asked to ride a roller coaster over and over again, by the 50th time the fear of the roller coaster has likely gone down.

Inhibitory learning is the process by which people learn new information about the experience of their fear that teaches them how to be open-minded and accepting of the fear instead. Rather than having a focus on the fears being habituated, people are taught that they are simply able to handle fear, anxiety, worry, disgust, etc and all the uncomfortable thoughts and feelings that come with it.

Habituation teaches you that the thing you are scared of isn’t as scary as you think it is. Inhibitory learning teaches you that, regardless of how scary the thing is, you can handle uncomfortable feelings and they do not have to control you.

For example: let's say someone who is new to OCD treatment experiences the obsession that their room needs to be clean in just the right way, so efforts to clean it become obsessive and distressing and the person ends up avoiding any kind of cleaning altogether because it can’t be “just right”, and it’s easier to not clean at all than to do it in a way that doesn’t feel correct. The person may feel that it is too uncomfortable to handle and their room gradually gets worse and worse.

An example exposure a therapist may do with this client is asking them to engage in a time-constrained cleaning activity, such as setting a timer for five minutes to make their bed and then sitting with the discomfort of it not being perfect. They will be asked to notice how anxiety is showing up in their mind and body and see what it is like to not respond to it, and also notice that all feelings eventually pass. This builds emotional resilience and trust in the person's capacity to handle this difficult feeling, leading to them feeling capable of doing more frequent and intense exposures.

If we can be of assistance at Reveal Counseling, please don’t hesitate to reach out. We would be happy to support you.