EXPOSURE AND RESPONSE PREVENTION THERAPY (ERP)

Exposure and Response Prevention is a technique used to effectively treat issues of fear and anxiety.

Exposure Therapy is an evidence-based treatment that has been shown to be an effective treatment for people suffering from fear and anxiety related to Panic Disorder, OCD, Social Anxiety Disorder, Generalized Anxiety Disorder, PTSD and phobias. Treatment involves a therapist-prescribed series of exposures to feared circumstances that generally increase in intensity. The repeated opportunities to experience these uncomfortable scenarios without engaging in avoidance or escaping allows the person to break the cycle of fear and fully engage in life. While this may sound daunting at first, over time, the exposure to the feared objects, activities or situations in a safe environment helps reduce fear and decrease avoidance. ERP is considered to be the gold standard treatment for OCD and specific phobia and is an integral part of empirically based treatment for a variety of other disorders.

Image by Mitchell Hartley
 

TYPES OF EXPOSURE THERAPY

The types of exposure exercises we do can be broken down into four broad categories:

A variety of methods and protocols have been tested and studied under the umbrella of exposure therapy. They differ primarily in the intensity of the exposures, the length of each session and the method of exposure. While we tailor therapy to the individual needs of each client, our therapists typically practice “graduated exposure” where we start clients with less stressful experiences and increase in intensity over time. This has been shown to be as effective as other methods of exposure that involve only experiencing the most intense discomfort, but tends to be better tolerated by clients.

Light and Shadow Portrait

IMAGINAL EXPOSURE

Imaginal exposure takes place, as the name suggest, in the imagination. It can be a great tool for experiencing feared events that may be too stressful to approach or impossible to recreate. In imaginal exposures, a therapist may guide a patient through a vivid narrative that invokes the feared situation, object or activity. After experiencing the discomfort through repeated exposures, people become accustomed to it, through a process called habituation.

IN VIVO EXPOSURE

In vivo exposure- or exposure happening “in real life”- allows the client to experience the feared situation, object,  or activity in real life without engaging in the avoidance behaviors that are typical when a person encounters them. For treating audition or performance anxiety, this might involve attending mock or real auditions. A person who is afraid of snakes might be instructed to look at a snake in a pet store. Clients often start out engaging in exposure exercises that invoke moderate level of anxiety before tackling those that cause the highest anxiety.

Image by Bruno Kelzer
Virtual Reality Headset

VIRTUAL REALITY EXPOSURE

Using virtual reality technology for exposure exercises may be particularly useful when the feared situation is difficult or impossible to reproduce. VR technology has been used to successfully treat the fear of flying.

INTEROCEPTIVE EXPOSURE

Interoceptive exposure involves bringing on the physiological symptoms of anxiety so that an individual becomes accustomed to them and learns that they are not threatening. During panic attacks, most individuals confuse safe (but perhaps unpleasant) physiological reactions to fear (sweating, trembling, dizziness, chest pain, etc.) with a more serious medical event. By running in place to bring on some of the same symptoms, over time, individuals learn that they are actually safe.

Image by Radvilas Seputis

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