Exposure and Response Prevention (ERP) is a technique used within Cognitive Behavioural Therapy (CBT) to treat many anxiety disorders such as OCD, panic disorder and specific phobias (including emetophobia). If you’d like to read more about what ERP is and are interested in the theory behind it, I’ve written a separate blog post which you can read here.
The purpose of this post is to share with you the practical steps used in ERP and give you an insight into how we would work together using this technique to help you to overcome your fears.
The 5 key steps
- Identify triggers
First and foremost, we need to get clear on what triggers your anxiety By the time we start ERP (usually around session 4/5), we will likely already have a fairly good idea of what tends to trigger your anxiety. However, we will work together to create a list of any potential triggers including situations, thoughts, or images. - Create a hierarchy
Once we have created our list of triggers, we will then work together to create a hierarchy starting from the least anxiety provoking triggers to the most. This involves ranking the list of triggers from 0-100% in terms of how much anxiety it causes you currently when you are in those situations, think those thoughts or imagine those images. - Start small
In ERP, it’s important that we take a gradual approach. That’s why we will start with something that gets some anxiety going (around about 30-40%), but not too much that it feels too difficult to do. As we work through your hierarchy, you will gain more confidence and the really scary triggers won’t seem as scary any more! - Stay present, drop safety seeking behaviours/compulsions
For ERP to be effective, you need to expose yourself to the triggers without distraction and without using any compulsions or safety seeking behaviours. This is important as you need to allow the process of habituation to work, which you can read more about The more you embrace the feeling of discomfort and anxiety, the quicker your mind and body will learn that there is no need to react so intensely and the better you will feel. I will support you through this so that you feel confident enough to drop any unhelpful behaviours. - Repeat and progress
The key with ERP is that you repeat, repeat, repeat. Whatever exposure we do together in session, I will then ask you to repeat as often as you can for homework (ideally daily). Eventually over time and with repetition, the trigger will become “boring” and you won’t respond with intense fear any more. At that point, we will then move onto your next trigger and repeat the same process. Over time, you will gain more confidence and resilience and suddenly the really scary triggers no longer feel that scary.
If you feel able to give this a go by yourself, go for it! Make sure you’re sticking to these steps and look out for any sneaky compulsions or safety seeking behaviours that may arise. If you think you need more professional and expert guidance with your ERP journey, you can get in touch with me here to book your first session.
