Is Exposure and Response Prevention Therapy Effective for Treating Mental Health Conditions?
ERP therapy, sometimes simply referred to as exposure therapy, is at its core a type of behavioral therapy and specifically a subtype of CBT. It was originally developed in the 1970s as an alternative OCD therapy, which at the time was considered to be incurable.
Today, it is viewed as the primary treatment option for people with OCD due to its efficacy rate of 50-60% for those who complete treatment.1
What is Exposure and Response Prevention ERP Therapy?
While there are similarities between traditional cognitive-behavioral therapy (CBT) and exposure and response therapy (ERP Therapy), there are some key differences as well. Whereas CBT is the most commonly recommended form of therapy for most mental health conditions, ERP therapy is prescribed less frequently.
For many people, ERP therapy is much more intense, invasive, and uncomfortable than CBT. For ERP therapy to work, a patient must be willing to confront the items or situations that cause them anxiety.
It is important to note that this therapy is not done in a vacuum. For the majority of exercises, at least for the first few times, the therapist will typically engage in the activity with the patient to help them feel more comfortable. Most importantly, it is key for the patient to not respond the way that they have in the past.2
It helps them change the way that their brain understands and interprets the perceived danger which is, in turn, causing them to react in ways that put them in greater danger or cause more harm. By learning to interrupt them immediately triggered a reaction to the situation, the patient’s anxiety is decreased over time.
Eventually, they will be asked to approach the situation on their own in increasingly more direct ways until they become accustomed to and unafraid of it.
Integrating Biological and Psychological Approaches
By combining exposure therapy with biological psychology, a therapist can better understand the underlying reasons for a patient’s OCD, phobias, or anxiety. This understanding enables them to form a more effective treatment plan.
Through biological psychology, a therapist has a better understanding of what potential genetic or inherited triggers caused or contributed to the condition, rather than just looking for environmental ones.
This combined and integrated approach is favored by many therapists as it helps them to be flexible in treatment and allows them to tailor a therapeutic approach to each specific patient.3 In treatment for phobias and OCD therapy, in particular, this approach is essential to achieve the best results.
ERP vs. Psychotherapy
In psychotherapy treatments, a patient is encouraged to look for insight into their problems, situation, or condition. This form is traditionally known as talk therapy, and it can be very effective for certain mental health conditions such as anxiety and depression.
For more severe mental health conditions such as OCD, or as a treatment for phobias, psychotherapy is typically ineffective. In these situations where avoidance and inappropriate response behavior are key features of the condition, then ERP therapy is significantly more effective.
One of the main reasons that talk therapy is not an effective OCD therapy is that it can unintentionally force the patient to focus on their obsessions which in turn makes them worse. With ERP therapy, on the other hand, the patient is asked to confront the anxiety and compulsive behaviors that enable their OCD.4
What can ERP treat?
ERP therapy, or exposure therapy, is a form of behavioral therapy most commonly used as a treatment for OCD, particularly for severe forms of it. However, it can also be used to treat other mental health conditions where avoidance behavior is a factor. These types of disorders include phobia disorders, anxiety disorders, and certain types of PTSD.
For these conditions, exposure therapy is effective when other methods of treatment, such as cognitive-behavioral therapy, have not worked. Exposure therapy may also be more effective when combined with certain medications such as SSRIs.5
The Effect of Obsessive-Compulsive Disorder (OCD)
OCD is a mental health condition that causes a person to have intrusive and unwanted thoughts, fears, and obsessions that force them to act out repetitive behaviors in an attempt to subdue the intrusive thoughts.6
Unlike people without OCD who may experience the occasional intrusive thoughts, a person with OCD becomes obsessed with the thought or fear. It affects them in a way that disrupts their daily life as they feel that without performing certain rituals (compulsions), something bad will happen. The fear is usually irrational, but it only worsens with attempts to ignore it.
Some of the most common types of OCD obsessions are:
- Organization (everything must be in the correct place)
- Contamination (need to frequently clean and disinfect things)
- Intrusive thoughts (causing harm to oneself or another)
- Ruminations (may become stuck on a topic to the point of ignoring responsibility)
- Checking (concern of causing harm by being careless)
These obsessions begin to interfere with everyday life so that a person with OCD may feel that they have no control over their life. They may become anxious or depressed.
Addiction and obsession are two different things, although they may seem to have a strong correlation. With addiction, a person is seeking a way to escape reality by the use of alcohol, drugs, or any other substance that distorts reality. Obsession is a persistent and often unwilling preoccupation with something that a person has no control over.
How ERP Therapy Works
ERP therapy works by helping patients find their triggers and learn to overcome them. In a controlled environment, a patient will be exposed to their obsession, which will then trigger a compulsive response. The goal of ERP therapy is to learn how to ignore that response which eventually helps a patient have less anxiety about their obsession.
While the obsession may not be eliminated, by constantly exposing a patient to it and stopping the compulsive response, they will become desensitized to it and the urge will be more manageable.
When ERP therapy was first created, a method known as flooding was common. This method was a practice where a patient with OCD was placed into a situation that they feared significantly and they were told to remain in the situation until their anxiety levels reduced.
This method is used much less frequently now in favor of a more gradual desensitization approach, however, for some people flooding may still be extremely effective.
Is ERP Therapy for everyone?
ERP therapy is not the perfect fit for everyone. Although it is the primary form of OCD therapy today, it may cause obsessive behaviors to worsen in some patients. It is imperative that a patient finds a therapist that is trained in ERP therapy and that understands integrative therapy.
In addition, it is important that a patient feels comfortable with their therapist for the treatment to work. If trust is not established, then the OCD therapy will not be effective.
For other mental health conditions, ERP therapy may be effective, but it is often not the first choice of treatment options. As it involves significant trust, discomfort, and invasiveness, it is not appropriate for all patients.