Exposure and Response Prevention (ERP)

What is ERP?

ERP is a type of Cognitive Behaviour Therapy (CBT) and the most effective treatment for OCD.

ERP entails exposure, that is, to face or expose yourself to the situation that triggers OCD; and practise response prevention, that is, to not perform the compulsions.

When a compulsion is performed, the relief is only temporary.

To break the cycle of OCD, you will need to not perform the physical or mental compulsions.

When the compulsion is not perform, anxiety will increase, but anxiety will eventually decrease.

As you keep on facing triggers and not performing the compulsion, anxiety will eventually become less intense. The urge to perform the compulsion will eventually decrease as well. The first time the compulsion is not performed, anxiety increases considerably (represented by the continues line in the image below), but as you continue to exposure yourself to triggers and not perform compulsions, the anxiety rises but not as high (represented by the dashed and doted lines). The anxiety continues to decrease as you practise exposure to triggers and do not perform the compulsions. In addition, you will experience the disconfirmation of the feared consequences.

Example of Exposure Hierarchy

Contamination Fear

Obsessions: I will get sick and/or die; I will make others sick, and they may die

Compulsions: Avoid touching ‘dirty’ objects/areas, avoiding going to ‘contaminated’ places; hand washing excessively

Goal: to tolerate uncertainty of being contaminated when touched objects or going out

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  1. Touch items/areas at home deemed dirty and hand wash quickly or delay hand washing, e.g., kitchen bench, doorknobs, floor, toilet sit (Anxiety Rating 3/10)

  2. Walk around train station and/or shopping centre and other public spaces (4/10)

  3. Sit on a bench at the station or/and shopping centre/other public space (5/10)

  4. Touch items at the supermarket (6/10)

  5. Push lift buttons with fingers without hand washing/hand sanitising (6/10)

  6. Touch railing at station and shopping centre and delay hand washing/hand sanitising (7/10)

  7. Open doors at shopping centre/train station and extend delay of hand washing/hand sanitising (8/10)

  8. Touch tables surfaces at the shopping centre and extend delay of hand washing/hand sanitising (8/10)

  9. Eat at the shopping centre food court without cleaning table surface (9/10)

  10. Use toilet at shopping centre/train station/other public spaces (10/10)

Note that hand washing is often carried out after using the toilet or before meals. If the person who is afraid of contamination arrives home and hand washes/sanitises, changes, clothes or clean belongings, these will need to be drop these behaviours.

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Working Together

Together, we develop an exposure hierarchy, or a list of situations, behaviours, thoughts which you are afraid of.  Then, we will decide where to start the exposure. I will encourage you to work on your fears and together we will practise the steps. We will discuss the approach to take, agree on the physical or mental compulsions to drop (response prevention) and start the work.

I will provide you with information and support to help you practise the Exposure and Response Prevention also on your own.

This process seems dauting and scary, but remember that the steps are gradual, you have a say and can decide where and when to start; I cannot force you to do anything. We will work collaboratively to help you stand up to OCD. I look forward to the opportunity to meet you and work you, to help you stand up to OCD, embrace uncertainty, and reclaim your life back.