What is ERP?

Exposure and Response Prevention (ERP) is a cognitive behavioral therapy grounded in decades of scientific research on fear learning and is the gold-standard therapeutic treatment for OCD.

Exposures are not just about proving the worries in our brains wrong. Psychologists used to think the purpose of ERP was to unlearn fears through habituation or getting used to the fear. This was because often the more someone engages in an exposure, the less anxious they have the next time the approach a trigger. However, research has found that a decrease in anxiety does not necessarily predict willingness to engage in the next exposure. Thinking about ERP like we do when we try to learn any new skill or information adds something above and beyond just focusing on removing the fear. 

Through ERP, individuals develop new associations. So, a contaminated object can both feel scary AND to feel pleasant, be a source of pride, or even safe. Over time, this new learning will compete the fear memory and the initial feared trigger can hold multiple meanings. We can't erase what the brain has already learned, but we can add new information that adds to or changes the meaning of the first learning.  

One way to think about this is like a stream from the moat of a sandcastle. If you overfill your moat, one stream will break through the moat down to the water. Now every time you overfill the moat, the water will flow down that path making it deeper and wider. However, if you dig out a new path from your moat, over time the water will start to flow equally into these new routes. If you continued making new beds for your streams eventually the initial stream may no longer be the most used stream.