What Happens In Exposure And Response Prevention (ERP) Therapy Sessions? Here’s What To Expect

Exposure And Response Prevention – commonly referred to as ERP – is the gold standard of treatment for Obsessive Compulsive Disorder (OCD).

If you (or a loved one) is entering treatment for OCD, knowing what to expect can make the process feel more approachable and less overwhelming –and get you set up for successful treatment!

Here's what you can expect from ERP sessions for treating OCD.

ERP sessions are collaborative and individually tailored

I work collaboratively with clients to determine which exposure exercises they are willing to work on. We discuss what they anticipate will happen when they do the exposure.

We talk about what bad outcome they fear, how uncomfortable they may feel, and how long they think they will be willing to resist ritualizing.

Exposure exercises are individually tailored to each client. They involve facing one’s fears without ritualizing – so we may touch contaminated objects in session that are brought from home, or are available in or near my office.

You directly confront your triggers  

We may record an exposure script that captures the very things that the person is afraid of. We may read threatening stories online and create a unique exposure comprised of the content that is most triggering.

We may write down words that are challenging and say them out loud. We may intentionally bring on physical symptoms that mimic anxiety and then do exposure work.

You may learn, or incorporate, mindfulness skills

During exposure exercises, we work together to increase anxiety tolerance by using mindfulness skills, and by adopting a paradoxical attitude of wanting the challenge.

Mindfulness skills include learning to notice and name emotions and thoughts with curiosity and compassion. Mindfulness skills can help people take steps towards exposure goals, instead of immediately jumping into doing compulsions.

Therapy sessions conclude with a thoughtful recap

After the exposure exercise, we circle back to the person’s expectations about the exposure to highlight the contrast between what they predicted would happen and what actually happened.

We finish sessions by agreeing on and often writing down what exposures will be done in between sessions, what rituals to be on the lookout for, and what strategies to use to refrain from ritualizing.

If you have OCD, chances are you've tried to confront your anxiety triggers, only to have your anxiety levels spike, forcing you to "give in" to compulsive behaviors. You may be unsure how to effectively engage in exposures, or even hesitant to try. Working with a therapist who is trained in ERP allows you to work together to optimize your treatment results – and ultimately, restore a sense of normalcy in your daily life.