What is Exposure and Response Prevention?
Exposure and Response Prevention (E/RP) is a behavioral method that is very effective for treating a number of disorders. Though most associated with treatment for Obsessive-Compulsive Disorder, E/RP has been employed to successfully treat conditions considered within the Anxiety Spectrum Disorders including, Panic Disorder, Generalized Anxiety Disorder, Social Anxiety Disorder, and others.
E/RP involves two components: actual or imagined exposure to the anxiety invoking situation and response prevention that consists of stopping avoidance or escape behaviors that terminate the anxiety, but ultimately reinforce maladaptive behavioral patterns. For example, suppose you fear going to a social event because you believe that you will embarrass yourself and others will laugh at you. As you begin to enter the event, you experience the physiological symptoms of anxiety along with thoughts associated with fear and embarrassment. Because the symptoms cause a good deal of discomfort, you leave the event. This pattern of avoidance and escape is maladaptive because you never allow yourself the exposure necessary to successfully habituate to the anxiety invoking situation. Anxiety in and of itself may not be necessarily maladaptive; in fact, it can be quite useful in an appropriate context. Instead, it's your response to anxiety that often leads to dysfunction. In this example, avoidance and escape terminates anxiety but maintains a maladaptive pattern of behavior that interferes with an individual's ability to attain all the pleasurable or beneficial experiences associated with social contact.
The goal of E/RP is habituation and extinction of responses (emotional, cognitive, and overt behavior) that contribute to avoidance or escape. Habituation and extinction refer to behavioral processes that allow an individual to become accustomed to anxiety invoking experiences without the typical discomfort. Another example that may illustrate this process is that of a child who is initially afraid of dogs. When the child sees the dog, she may experience thoughts, emotions, and behaviors associated with fear and danger. Over time, with repeated exposure and the prevention of avoidance or escape, these thoughts, emotions, and behaviors will eventually dissipate and change over time. As you can see, habituation and extinction is a natural process and it is certain that anyone can identify similar situations in their own lives. It is not enough, however, to do just exposure or just response prevention; both must be done in order to experience habituation and extinction.
Exposure and Response Prevention (E/RP) can be either gradual or immediate. Typically, a list is generated that rank orders feared situations and both patient and psychologist decide which is the best way to proceed: either beginning from the bottom of the list or near the top. Not only is it important for the patient to have an understanding of the process, but it is equally important that the psychologist has had proper training and supervision. Without these conditions, E/RP could become a traumatic experience if not properly employed.
As mentioned earlier, E/RP can be used with a number of anxiety spectrum disorders. The use of E/RP with Obsessive-Compulsive Disorder, however, is best known. Please click here to read an excellent article by a recognized expert in the field that outlines the effectiveness of E/RP with OCD.