What Is Exposure Response Prevention (ERP) Therapy? 

Clients with Obsessive Compulsive Disorder (OCD) are encouraged to let intrusive thoughts occur without having to neutralize their anxieties with compulsions in Exposure Response Prevention (ERP) therapy. The therapy is a part of Cognitive Behavioral Therapy (CBT) and has been widely used as one of the most effective treatments for OCD. In this breakthrough series, we would like to share with you a story of a young adult who had serious checking behaviors and how she overcame her fears with ERP therapy. 


How Does the Treatment Look Like? 

In this breakthrough series, we would like to mainly focus on the ERP stage of CBT. 

Before starting ERP, Emma, our 24-year-old client had a few sessions covering psychoeducation and cognitive restructuring. She learned that… 

  1. compulsive behaviors, such as repetitively checking whether she turned off the stove or locked the house door, reduce her anxieties that arise due to intrusive thoughts, such as her house setting on fire or allowing a burglar to break in and cause harm; 
  1. such compulsive behaviors only reduce her anxieties temporarily and that her compulsive behaviors may worsen over time. 

She also had to tackle many other issues (e.g. excessive responsibility, her doubt in her ability to overcome problems if they actually did happen) that people with OCD often face in treatment. Emma was more aware of how her symptoms persisted after 2 months of psychoeducation and cognitive restructuring and then she began the ERP stage of treatment. 


Exposure Response Prevention 

Emma made a list of her intrusive thoughts that are highly anxiety-provoking. The intrusive thoughts below are a few that she listed from the least to the most anxious. 

  1. Did I lock the house door? What if a burglar breaks in and takes my family’s possession? What if the burglar harms my family? 
  1. What was the bump that I just felt while driving? What if it was a living creature?  
  1. Did I unplug all the appliances that are not in use? What if I didn’t and our house sets on fire? What if the situation gets worse and I harm my neighbors as well? 

These intrusive thoughts made Emma repeatedly drive the same route to check that she did not drive over a living creature and repeatedly check that her house is locked and all appliances are unplugged so that she is 100% sure that her worst fears are not likely to happen. Her symptoms grew over time and she had many occasions when she was late for her classes or appointments. 


Emma was asked to reduce her number of checking until she felt minimal level of anxieties even when she did not check at all. She left her house after locking the door and without checking that the door was firmly locked. She did not drive the same route when she think she felt a small bump while driving. She checked whether the appliances were unplugged before leaving the house and did not go back to re-check. 

The Exposure Response Prevention stage of the therapy made her realize that the vicious cycle of the intrusive thoughts, anxieties, and compulsive behaviors would only stop if she does not respond to her intrusive thoughts with compulsive behaviors. Emma also learned that her intrusive thoughts may not go away entirely, but that she can live with the intrusive thoughts without reacting to it!