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Exposure Response Prevention (ERP) Therapy

Exposure/Response Prevention (ERP) is used as behavioral new learning. ERP focuses on anxiety and its misinterpretation of threat and harm (fear). To illustrate in the box below: A situation, feeling, thought is experienced as anxiety provoking. A misinterpretation of severity and probability of harm gives it meaning. A behavior (avoidance, ritual or substitution) is instituted to alleviate/cope with the anxiety, thus temporarily decreasing the anxiety and preventing harm. The behavior becomes learned as a coping strategy for the anxiety provoking situation, thought or feeling. The coping strategy is used to control the environment, self, or others to cope with preventing anxiety that signifies danger. Since the coping strategy alleviates anxiety (associated with a fear), the misinterpretation continues, no new learning takes place. This becomes a trap and a vicious cycle as a belief is reinforced: the avoidance or ritual relieves anxiety and its associated fear.

Exposure is used to relearn appropriate interpretation and appropriate anxiety coping skills. There is a very specific behavioral plan and significant education that is required to prepare a patient to proceed with Exposure therapy. Understandably, if a person is afraid and anxious, they must understand the underlying concepts and agree in order to proceed (part of Cognitive work). In addition, many family members and loved ones must be educated and understand the purpose for Exposure work because they will be the ones who spend the most time with the patient. How a family member or loved one responds during these times can have a major impact on the patients ability to learn new ways of adaptive coping.

Response Prevention is the intentional non use of maladaptive coping by the patient. The patient understands that refraining from avoidance or rituals is necessary during the exposure time. By doing this; gradually and with repeated exposures, the patient experiences anxiety climb, peak, and subside. By refraining from avoidance or rituals, the patient can put in place different cognitive sets, and identify, choose, or learn more appropriate coping skills. Beliefs are challenged and the patient can learn better ways to cope.

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