In this article, I discuss a therapy technique most commonly used as a treatment for obsessive-compulsive disorder but which is also effective with many other issues.


Estimated reading time: 5 minutes.

The go-to treatment for obsessive-compulsive disorder (OCD) is exposure and response prevention (ERP). This treatment consists of two steps. In the first step known as exposure, the client deliberately exposes themselves to situations which lead them to have obsessive thoughts along with strong accompanying anxiety. In the second step known as response prevention, the client is prevented from performing their usual response to the obsessive thoughts and accompanying anxiety—engaging in compulsive behaviours to avoid thinking the obsessive thoughts and experiencing the strong anxiety.

Preventing the response of engaging in compulsive behaviours forces the client to sit with the anxiety stemming from their obsessive thoughts. Doing so over a prolonged period results in the intensity of their anxiety diminishing in a lasting way rather than seeing it diminishing only temporarily by performing the compulsive behaviours. The desensitization or habituation which results from prolonged exposure and response prevention is indicative of success in addressing OCD.

Fortunately, there are many other therapy issues which can be addressed by using ERP. I will discuss how this treatment is used to address these issues in the following sections.

Phobias

People with phobias have strong anxiety in specific situations which other people typically don’t find distressing. This is often because the person has had a bad experience in that situation.

For example, a person may have a phobia about driving or being a passenger in a vehicle after having suffered a car accident. As a result of the strong anxiety and negative thoughts they experience in these situations, people with phobias often avoid these situations.

Exposure and response prevention for phobias entails repeatedly exposing the person to the phobic situation which leads them to experience strong anxiety and preventing the response of avoiding or leaving these situations. Using the example, the person would regularly expose themselves to driving situations. Repeated exposure and response prevention results in the person’s anxiety in these situations decreasing in a significant and lasting manner through habituation. This will allow them to be less likely to avoid these situations and more likely to participate in and enjoy them.

Social Anxiety

People with social anxiety issues have strong anxiety in social situations like parties and public speaking. The issue is driven by thoughts about being evaluated negatively and concerns about being unable to cope with criticism. As a result of the strong anxiety and negative thoughts they experience in these situations, people with social anxiety issues often avoid these situations.

Exposure and response prevention for social anxiety issues entails repeatedly exposing the person to the social situations which lead them to experience strong anxiety and preventing the response of avoiding or leaving these situations. Using the examples, this would involve having the person regularly attend parties, speak in front of groups or deliberately expose themselves to criticism while preventing the response of avoiding these situations.

Repeated exposure and response prevention will result in the person’s anxiety in these social situations decreasing in a significant and lasting manner through habituation. This will allow them to be less likely to avoid these situations and more likely to participate in them and experience enjoyment from them.

Post-traumatic stress disorder

People with post-traumatic stress disorder (PTSD) have strong anxiety when they are reminded of traumatic events from their pasts. They can be reminded by having memories of the traumatic events or by encountering stimuli or situations which were associated with the traumatic events. As a result of the strong anxiety and negative thoughts they experience, people with PTSD often avoid thinking about the traumatic events or encountering stimuli and situations which remind them of those events.

Unfortunately, these forms of avoidance are largely unsuccessful. Trying not to think about the traumatic events typically leads the events to come into the mind even more. Trying to avoid stimuli and situations reminding one of the traumatic events is like tiptoeing through a minefield with stimuli and situations inevitably triggering an experience of the negative thoughts and strong anxiety associated with the traumatic events.

Exposure and response prevention for PTSD entails repeatedly exposing the person to memories of the traumatic events as well as stimuli and situations which remind them of the traumatic events while preventing the response of avoiding the memories along with the stimuli and situations which are reminders of the traumatic events. Repeated exposure and response prevention results in the person’s anxiety in response to the memories, stimuli and situations decreasing in a significant and lasting manner through habituation.

Health Anxiety

People with health anxiety issues have strong anxiety in response to physical symptoms and oddities. In many instances, these have been determined through medical examinations and tests not to be indicative of serious illnesses. As a result of the strong anxiety and negative thoughts they experience, people with health anxiety issues engage in repeated reassurance-seeking behaviours from people close to them and from medical professionals.

Exposure and response prevention for health anxiety issues entails repeatedly exposing the person to the triggers which lead them to experience strong anxiety and preventing the response of reassurance-seeking behaviours. Repeated exposure and response prevention results in the person’s health anxiety decreasing in a significant and lasting manner through habituation.

Anger Management

People with anger management issues have strong anger in response to ‘triggers’ such as critical comments. The triggers lead the person to have negative thoughts and accompanying strong anger which often leads to a response involving verbal and/or behavioural aggression.

Exposure and response prevention for anger management entails repeatedly exposing the person to the triggers which lead them to experience strong anger and preventing the aggressive response which often follows. Because exposure to triggers has habitually led to aggression, the exposure and response prevention work is initially done under the guidance and supervision of a trained therapist who first determines whether the client is suitable for this type of treatment.

Exposure to triggers is typically done initially in role plays involving the client and therapist. The therapist verbalizes triggers such as critical comments while the client withholds their usual aggressive response. Repeated exposure and response prevention results in the person’s anger in response to the triggers in decreasing in a significant and lasting manner through habituation. They can then work with the therapist to develop constructive verbal and/or behavioural responses to the triggers.

A final word on exposure and response prevention

As this article illustrates, exposure and response prevention is an effective treatment for a variety of issues. Having said that, for it to be effective it must be implemented in a correct and consistent manner. Therefore, it is best done under the guidance of a skilled mental health professional.

May you benefit from exposure and response prevention if you have issues for which it is appropriate,

-Dr. Pat