According to the National Institute of Health, Anxiety Disorders affect about 40 million American adults age 18 years and older in a given year, with the onset starting in adolescence for many anxiety sufferers. Exposure Therapy (in vivo, imaginal, interoceptive, technology-augmented, Exposure and Response Prevention) is recognized as one of the most effective treatment options for specific anxiety (Phobias, Social Anxiety, OCD, PTSD, Health Anxiety, Panic). Exposure Therapy requires specialized training to learn and master and, unfortunately, is limited in its availability. At the core of Exposure Therapy, the individual will face his/her fears step by step by developing a hierarchy of anxiety-producing situations or stimuli and then begin the safe process of exposure to the various predetermined triggers on the hierarchy. The goals for Exposure Therapy are to teach the individual mastery and control over cognitive, behavioral, and physiological responses to cues and triggers that elicit the anxious reaction as well as helping the patient learn to generalize the skills they learn during an exposure so they can use them on their own, without the therapist.
Regardless of disorder or method of exposure, each course of exposure-based treatment has common elements, including: a complete initial evaluation, education on the specific anxiety disorder, education on the specific course of exposure treatment, determination for readiness for change, baseline assessment of key symptoms, reduction of rituals or safety behaviors, exposure therapy with your clinician and on your own between session, thoughtful emotional processing of each exposure, and finally, relapse prevention.
Exposure and Response Prevention (ERP)
Exposure and Response Prevention is a Cognitive Behavior Therapy intervention recognized as the “gold standard” for treating OCD, in most cases. The Exposure in ERP refers to exposing oneself to the thoughts, images, objects and situations that make you anxious and/or start your obsessions. The Response Prevention part of ERP refers to making a choice not to do a compulsive behavior once the anxiety or obsessions have been “triggered.”
For Obsessive Compulsive Disorder, Exposure therapy is coupled with response prevention, also known as ritual prevention, or just RP. RP is a component of treatment that is particularly important for people who have developed ritualized, repetitive behaviors such as compulsions. The compulsive behavior serves to “undo” or neutralize the anxiety that occurs when faced with an anxiety-provoking situation. Since compulsive behaviors serve to reduce or eliminate anxiety they are inherently rewarding. Therefore, they are easily repeated over and over and often become the primary method of coping with obsessions.
RP is built upon our knowledge of learning theories. According to this principle, when a behavior is no longer rewarded (reinforced) it becomes extinct. This means the behavior gradually fades away. For instance, washing hands after contact with a doorknob serves to “undo,” or negate the anxiety that occurs after touching a doorknob. Response prevention eliminates the rewarding effect of hand washing. As such, compulsive hand washing will gradually become extinct as will ritualistic reassurance seeking, counting, checking, ordering and arranging.