Exposure and Response Prevention Therapy (ERP)

“Do the thing you fear, and the death of fear is certain.”

– Ralph Waldo Emerson

Exposure-based  therapy is a well-researched and highly effective method to treat persons with anxiety disorders. Normally, when an individual experiences a high degree of anxiety and distress, they seek to escape from the situation immediately and then avoid that situation again in the future. This natural fear response works well when the fear is accompanied by real danger, but in the case of anxiety disorders, fear and avoidance become “teammates.” Fear and avoidance work together because this avoidance of the feared situation prevents the person from experiencing the natural process of corrective feedback that would inform the person that while the fear is real, the danger is not.

Exposure therapy seeks to harness this natural process of corrective feedback by encouraging a person to choose not to avoid or escape from their anxiety, but rather to intentionally allow the anxiety to remain, knowing that the anxiety is temporary and harmless. When a person remains in the presence of a feared situation or object, a natural process known as “habituation” occurs. Habituation is the phenomenon that occurs when an individual enters cool water in a pool or at the beach and “gets used to it.” To put it simply, we don’t defeat anxiety by avoiding it. We defeat it by outlasting it.

During exposure therapy a client and psychologist create a hierarchy of feared situations, and then, like climbing a ladder, they decide together how to begin and how to proceed up the hierarchy over time. The client is always in control of the process and is an active member of their own treatment.  This process produces two highly beneficial outcomes. Specifically, the person learns that their anxiety was out of proportion to the danger, and perhaps more importantly, they learn that the can cope with anxiety effectively without using avoidance.