Exposure and Response Prevention (ERP)

We specialize in the administration of  Exposure and Response Prevention (ERP).  ERP has strong research support and has been documented to be  effective through research for obsessive-compulsive disorder (OCD). It has  also demonstrated its efficacy and effectiveness in the administration of ERP  through telehealth practices. We have provided summaries of ERP treatment below and include research articles notating their efficacy and effectiveness broadly along with the administration of these services through telehealth practice. 

Exposure and Response Prevention (ERP) is a type of cognitive-behavioral therapy (CBT) specifically designed to treat obsessive-compulsive disorder (OCD) and other anxiety disorders. ERP focuses on helping individuals face their fears and reduce their compulsive behaviors through exposures.

ERP is based on the principle that avoidance and ritualistic behaviors reinforce anxiety/distress, while confronting fears and refraining from compulsions can lead to significant symptom relief and long-term improvement.

Exposure: This involves gradually and systematically confronting feared situations, objects, or thoughts that trigger anxiety, distress, or obsessive thoughts. The exposures are planned and structured to start with less distress-provoking scenarios and progressively move to more challenging ones.

Response Prevention: During exposure, individuals are encouraged to refrain from engaging in their usual compulsive behaviors or mental rituals that they typically use to reduce anxiety or discomfort. This helps to break the cycle of obsession and compulsion.

Therapeutic Relationship: We believe the therapeutic relationship is essential to ERP treatment as providers engage collaboratively in all exposures with clients. ERP treatment is implemented as a "team" approach where client's and therapist work together to manage the client's obsessions and compulsions together in the moment by doing the same behaviors. 

Assessment: The process begins with identifying the specific obsessions (intrusive thoughts) and compulsions (ritualistic behaviors) the individual experiences.  The therapist and client will work together to complete the Yale-Brown Obsessive Compulsive Scale (YBOCS) to assess level of severity and monitor treatment progress. 

Exposure Exercises: The therapist and client collaborate to create a hierarchy of feared situations, ranked from least to most anxiety-provoking. The client systematically faces these fears according to the hierarchy, starting with less intense exposures. This gradual approach helps to build tolerance and reduce overall anxiety/distress.

Response Prevention: While facing these fears, the client works to resist performing their usual compulsions or rituals. This helps to reduce anxiety/distress in the long term through habituation and allows for the learning of tolerance for discomfort and the long-term implementation of more adaptive coping mechanisms. 

Cognitive Restructuring: Although not the main focus of ERP, cognitive restructuring may be integrated to help clients challenge and modify irrational beliefs related to their obsessions and compulsions. This often focuses on staying in an ambiguous position and learning to tolerate  uncertainty. 

Reduce Anxiety/distress: By repeatedly facing feared situations without performing compulsive behaviors, clients learn that their anxiety/distress diminishes over time through a process called habituation.

Break the Cycle: ERP aims to disrupt the cycle of obsession and compulsion, thereby reducing the overall intensity and frequency of OCD symptoms.

Improve Functioning: Ultimately, ERP helps clients regain the ability to manage their obsessions and compulsions, which reduces  the impact of OCD on  daily functioning and improves  over all   quality of life.

•  Farrell, L. J., Nabinger de Diaz, N. A., Mathieu, S., McKenzie, M. L., Miyamoto, T., Donovan, C. L., ... & Ollendick, T. (2022). FAST CBT for pediatric OCD: A multiple-baseline controlled pilot trial of parent training in exposure and response prevention delivered via telehealth. Frontiers in Psychology, 13, 1009735.
• Fletcher, T. L., Boykin, D. M., Helm, A., Dawson, D. B., Ecker, A. H., Freshour, J., ... & Hundt, N. E. (2022). A pilot open trial of video telehealth-delivered exposure and response prevention for obsessive-compulsive disorder in rural Veterans. Military Psychology, 34(1), 83-90.
• Franklin, M. E., Engelmann, J. M., Bulkes, N. Z., Horvath, G., Piacsek, K., Osterlund, E., ... & Riemann, B. C. (2024). Intensive cognitive-behavioral therapy telehealth for pediatric obsessive-compulsive disorder during the covid-19 pandemic: Comparison with a matched sample treated in person. JAACAP Open, 2(1), 26-35.    
• Gittins Stone, D. I., Elkins, R. M., Gardner, M., Boger, K., & Sperling, J. (2023). Examining the effectiveness of an intensive telemental health treatment for pediatric anxiety and OCD during the COVID-19 pandemic and pediatric mental health crisis. Child Psychiatry & Human Development, 1-15.
• Kathiravan, S., & Chakrabarti, S. (2023). Development of a protocol for videoconferencing-based exposure and response prevention treatment of obsessive-compulsive disorder during the COVID-19 pandemic. World Journal of Psychiatry, 13(2), 60.
• Krabasi, Z., Eslami, P., Sabahi, A., & Zahmatkeshan, M. (2024). Investigating the effectiveness of using a telemental health approach to manage obsessive-compulsive disorder: a systematic review. Middle East Current Psychiatry, 31(1), 30.
• Krzyzaniak, N., Greenwood, H., Scott, A. M., Peiris, R., Cardona, M., Clark, J., & Glasziou, P. (2024). The effectiveness of telehealth versus face-to face interventions for anxiety disorders: A systematic review and meta-analysis. Journal of Telemedicine and Telecare, 30(2), 250-261.
• Lisi, D. M., Hawley, L. L., McCabe, R. E., Rowa, K., Cameron, D. H., Richter, M. A., & Rector, N. A. (2024). Online versus in‐person delivery of cognitive behaviour therapy for obsessive compulsive disorder: An examination of effectiveness. Clinical Psychology & Psychotherapy, 31(1), e2908.
• Murphy, C. E., Rhode, A., Kreyling, J., Appel, S., Heintz, J., Osborn, K., ... & Feusner, J. D. (2023). A targeted strategic peer support intervention to increase adherence to video teletherapy exposure and response prevention treatment for obsessive-compulsive disorder: a retrospective observational analysis. Frontiers in Human Neuroscience, 17, 1251194.
• Voderholzer, U., Meule, A., Koch, S., Pfeuffer, S., Netter, A. L., Lehr, D., & Zisler, E. M. (2024). Effectiveness of one videoconference-based exposure and response prevention session at home in adjunction to inpatient treatment in persons with obsessive-compulsive disorder: Nonrandomized study. JMIR Mental Health, 11, e52790.