Exposure Therapy (ERP)
Exposure Therapy, or Exposure and Response Prevention Therapy (ERP), is a form of Cognitive-Behavioral Therapy (CBT).
ERP is effective in treating not only phobias and fears, but many other versions of anxiety-related problems (including OCD, panic attacks, worrying, and generalized anxiety).
What is Exposure Therapy…?
Exposure Therapy is a form of Cognitive-Behavioral Therapy proven to be very effective in treating anxiety issues. It is considered the gold-standard treatment method for anxiety, panic attacks, phobias, OCD, and overthinking.
Exposure Therapy might be a good fit for you if:
- You have tried other anxiety treatment methods (such as medications or talk therapy) without lasting anxiety relief
- You want actionable, specific tools to control and manage your anxiety
- You are motivated and ready to make changes in your life
- You want to learn how your anxiety works and what to do to make it better
How does Exposure Therapy work?
Exposure and Response Prevention (ERP) works by gradually (and safely) exposing you to situations that evokes feelings of anxiety (the “Exposure” part of the equation), while also reducing what are known as avoidance/escape behaviors (the “Response Prevention” part).
During Exposure Therapy, you will first learn exactly how your anxiety works- including the things you’re doing to make it worse! You’ll then learn actionable, active tools to manage and reduce your feelings of anxiety.
Why can’t I just avoid my anxiety…?
Anxiety activates your body’s “fight or flight” system. When you feel anxious and uncomfortable, you may be tempted to run from, fight, or avoid whatever situation caused it.
This “running away” behavior is what we refer to as “escape” or “avoidance” behavior. Although running from (or avoiding) scary things might give you immediate relief, continually running away, fighting, or avoiding anxiety actually reinforces your anxiety response!
Whenever you choose to “run away” in the face of something that feels scary, you tell your brain: “yup, that thing was dangerous! Keep sending me anxiety every time I see it!” If you continue to run from a scary thing, you will continually develop more and more anxiety about that thing.
Let’s use an example to illustrate how Exposure Therapy works:
Brian is afraid of birds. Any time he is around birds, he feels intense feelings of fear course through his body. Seeing birds fly overhead, hearing bird noises, and talking about birds make Brian extremely uncomfortable. He even feels fear from the mere thought of birds.
Given his intense discomfort, Brian starts to avoid all things bird-related: anytime he sees or hears a bird he runs into his house; if someone talks about birds he abruptly ends the conversation; he stops going on walks outside entirely. He even tries to block or change his own thoughts about birds. He anxiously plans his days around the possibility of encountering birds and worries constantly; his life starts to become more and more limited.
Although Brian’s avoidance of birds has the short-term effect of controlling his anxiety, his continued avoidance of birds is actually reinforcing and increasing his fear of birds! Every time he feels fear around birds and uses avoidance or escape behavior, he gives his brain the message: yes, birds are dangerous, keep avoiding them!
Brian decides to try Exposure Therapy. Initially, he learns all about the anxiety avoidance cycle. He starts to understand which of his behaviors that are actually making his anxiety worse, and he learns tools to tolerate his anxious feelings.
He and his therapist start by talking about birds, then they move onto looking at pictures, then to watching videos of birds. All the while, Brian resists his impulse to escape or avoid the anxiety, and instead practices his anxiety tolerance skills. When this happens, his brain learns a valuable lesson— “I sent Brian a huge dose of fear, he didn’t run away, yet he survived!… maybe birds aren’t quite as dangerous as I thought?”
With continued exposure exercises, Brian’s brain starts to align with the actual danger level of birds (which is that most birds are completely safe) and delivers him less and less fear when faced with birds. Brian begins to engage with his life again, and has started to take control of his anxiety.
What if I don’t have a specific fear? Can Exposure Therapy still help?
Exposure Therapy also helps with generalized anxiety, overthinking, and excessive worry. Generalized anxiety is often tied to fears of uncertainty, lack of control, or scary outcomes. These kinds of fears can be confronted and conquered using the same Exposure Therapy principles used in phobia treatment.
ERP Research and Resources:
American Psychological Association: What Is Exposure Therapy?
