The miracle drug: exposure and response prevention therapy.
One of the most debilitating mental health disorders, obsessive-compulsive disorder (OCD), was once thought to be untreatable. We now know this is not true. Exposure and response prevention therapy (ERP) has become the gold-standard treatment for OCD as well as other mental health disorders like phobias, panic, social and health anxiety, trauma, and eating disorders.
What is ERP?
Perhaps you have heard of cognitive behavioral therapy (CBT). ERP falls under the CBT umbrella and is an effective behavioral therapy. Whereas CBT focuses on our cognitions (thoughts), ERP focuses on our behaviors.
In a nutshell, ERP is the practice of strategically confronting thoughts, images, objects, sensations, urges, and situations (exposure) that provoke uncomfortable emotions like anxiety and fear. Simultaneously, one refrains from engaging in safety behaviors such as avoidance (a biggie for anxiety), assurance seeking, and other physical and mental compulsions (response prevention).
The goal of ERP is to build a tolerance for uncomfortable emotions like anxiety. It helps us get comfortable with the uncomfortable. Since our brains are neuroplastic (changeable), ERP creates and reinforces healthy brain pathways while reducing unhealthy ones. Think of our brain pathways as different roads, one is called ‘Anxiety’ Lane another is called ‘I’m Living My Best Life’ Lane. Which one do you want to take? ERP helps you repeatedly take the ‘I’m Living My Best Life’ Lane thus weakening the non-traveled ‘Anxiety’ Lane.
My personal experience with ERP
While in graduate school, I decided to try ERP but I will be honest, I was a skeptic. Years earlier, I had done CBT therapy but still had a phobia of elevators and certain bathrooms. Since I often rode elevators and used various bathrooms, I assumed “exposure” didn’t work. Any little noise on an elevator would leave me in an anxious state during and long after an elevator ride.
In therapy, I soon discovered there are right and wrong ways to engage in exposures. I was doing them the wrong way. While exposing myself to the things I feared, I simultaneously engaged in a bunch of safety behaviors, which essentially voided the exposure. I was doing the E (exposure) but not the RP (response prevention).
Some of my safety behaviors included having water and antianxiety medication on me, getting on the elevator with others, not locking bathroom doors, and even looking for escape routes.
When we engage in safety behaviors, we send a message to our brain, “you are only safe because of the safety behavior”. Unfortunately, these behaviors reinforce and feed the anxiety, making it worse. ERP teaches our brains that we are safe without them.
In the end, ERP proved me wrong. It was a life-changing experience. Not only did ERP treat my phobia, but it also treated my panic disorder and nagging anxiety that I often couldn’t explain.
In conclusion
If you think ERP might be for you, find a therapist who specializes in it. They will create a safe, non-judgmental, and supportive environment to empower you to engage in the therapy.
And remember, the first step is often the hardest.
