Exposure and response prevention (ERP)
Exposure and response prevention (ERP) is a specialized form of cognitive behavioral therapy (CBT), developed specifically as an OCD treatment. While CBT looks at unhelpful thoughts and behaviors more broadly, ERP zeroes in on the cycle of obsessions and compulsions. It helps people gradually face situations or thoughts that make them anxious, while learning to resist the rituals or habits they typically turn to for relief. With practice, this process helps people better tolerate distress and retrain how the brain responds to fear and anxiety.
What are the origins of exposure and response prevention (ERP)?
Exposure and response prevention (ERP) therapy was first developed in the 1960’s, with British psychologist Victor Meyer credited for laying the foundation through his early research in 1966. His work marked the start of a more structured approach to the treatment of obsessive-compulsive disorder (OCD) by gradually helping people face their fears and learn to resist compulsive behaviors.
ERP was further developed by prominent researchers such as Dr. Edna Foa, who helped expand its use and built a strong base of research to support it. Much of this work took place in academic settings, including the University of Pennsylvania, where Dr. Foa made major contributions to how ERP is understood and used in clinical practice.
When is exposure and response prevention (ERP) used?
Although ERP is best known for treating obsessive-compulsive disorder (OCD), it’s also used to help people with other mental health concerns where fear, avoidance, or rituals are part of the problem. This includes conditions such as social anxiety disorder, generalized anxiety disorder (GAD), panic disorder, health anxiety, and specific phobias.
ERP can also play a role in treating body dysmorphic disorder (BDD) and some eating disorders, especially when routines or avoidance are negatively impacting recovery. While it’s not always the first-line treatment for these conditions, ERP can be an important part of a treatment plan when anxiety and avoidance are key concerns.
ERP is most commonly done one-on-one with a psychotherapist, but it can also be adapted for group or family therapy settings. In individual sessions, a person works closely with a therapist to tackle their specific fears and compulsions.
Group ERP can be a good option for people who find it helpful to connect with others going through similar challenges. Family-based ERP can be useful when loved ones are directly affected or involved — helping them learn how to support the person in ways that don’t accidentally reinforce unhelpful behavior. This flexibility makes ERP a valuable treatment option for different people, depending on their needs and support systems.
How does exposure and response prevention (ERP) work?
Facing fears without falling back on unhelpful habits is at the heart of how exposure and response prevention (ERP) therapy works. ERP helps people face the intrusive thoughts, situations, or feelings that provoke anxiety without turning to compulsions for relief. The exposure therapy aspect involves gradually and safely facing the stimuli that cause fear, rather than avoiding them. With a therapist’s support, individuals take small, manageable steps toward their triggers, which helps reduce anxiety over time.
The response prevention therapy focuses on resisting compulsive behaviors like checking (such as to make sure the stove is off), hand washing, or seeking reassurance. These behaviors may feel helpful in the moment but actually keep anxiety going in the long run.
Together, exposure and response prevention (ERP) helps the brain learn that feared outcomes are usually not as dangerous or likely as they seem. This process leads to habituation, meaning anxiety naturally fades with repeated exposure, and supports inhibitory learning, where the brain builds new, healthier associations. The goal isn’t to eliminate distressing thoughts, but to change how people respond to them.
For example, someone who fears contamination or germs might worry that touching a public doorknob will make them seriously ill. They may engage in excessive hand washing or avoid public spaces altogether.
In exposure and response therapy, they would work with their mental health provider to create a gradual exposure plan — maybe starting with touching a doorknob and washing their hands only once, then eventually using a public restroom without washing their hands right away. Practicing these steps over time helps ease anxiety and reduce the urge to engage in compulsions, leading to more confidence and long-term relief.
What is exposure and response prevention (ERP) like?
Exposure and response prevention (ERP) therapy begins with a collaborative assessment and planning phase. In the first few sessions, the therapist asks questions to learn more about the person’s symptoms — like what triggers their obsessive thoughts, what habits they use to feel less anxious, and what outcomes they are afraid of.
The therapist also provides psychoeducation on OCD (or applicable mental health conditions) and explains how ERP can help. Together, the therapist and client identify both external triggers (such as people, places, or objects) and internal ones (like thoughts or physical sensations), explore how obsessions and compulsions are connected, and build a “fear hierarchy” — a list of situations that cause anxiety, ranked from least to most stressful. These steps help set the stage for interventions that match the person’s unique fears and habits.
As treatment progresses, the focus shifts to slowly facing those feared situations without giving into compulsion. This might include in vivo exposure, where someone directly faces real-life triggers (like touching a doorknob), or imaginal exposure, where they picture upsetting thoughts or situations that are harder to recreate in real life.
Starting with less intense exposures — like briefly touching a feared object or thinking a stressful thought — the person practices sitting with the discomfort without doing their usual rituals. After each exposure, the therapist and client discuss what happened, what they learned, and whether the feared outcome came true. The “post-exposure processing” helps strengthen progress and deepen the client’s understanding of the OCD pattern.
ERP also includes practice between sessions, where clients continue exposures on their own and work to cut back on compulsions in everyday life. As they get more used to the discomfort, they move up the fear hierarchy to tackle more difficult triggers. Toward the end of therapy, the focus shifts to relapse prevention, which helps people develop the tools to manage future symptoms and feel more confident managing challenges on their own.
How long does exposure and response prevention (ERP) take?
The amount of time exposure and response prevention (ERP) therapy takes can vary, but many people start noticing real progress within 12 to 20 sessions. Most sessions last around 50 minutes and are held once a week. In some cases — particularly when symptoms are more severe or someone wants to move more quickly — ERP sessions might be longer or happen more frequently. Research shows that both the typical weekly approach and more frequent sessions can be effective, depending on what works best for each person.
ERP is designed to be flexible and can be adjusted based on the client’s schedule and needs. While consistency tends to support the best outcomes, therapy doesn’t have to be completed all at once. Some people complete ERP therapy in just a few months, while others take more time, especially if they’re dealing with more complex symptoms or using ERP alongside other treatments.
Is exposure and response prevention (ERP) effective?
Exposure and response prevention (ERP) is an effective treatment for obsessive-compulsive disorder (OCD), backed by decades of clinical research. A meta-analysis conducted in 2004 found that about two-thirds of people who did ERP experienced improvements in their symptoms, and around one-third were considered recovered by the end of treatment. ERP has also been shown to outperform other therapeutic approaches in treating OCD symptoms.
In a more recent randomized controlled trial comparing ERP to stress management training (SMT), ERP showed superior outcomes. The study found that ERP led to greater reductions in OCD symptom severity compared to SMT, both immediately after treatment and at follow-up. This shows that while general stress relief can support overall mental health, ERP is especially effective because it focuses on breaking the cycle of avoidance and compulsions that are at the core of OCD. Taken together, this research highlights that ERP is a research-backed approach that offers meaningful, long-lasting benefits for people living with OCD.
How to find an exposure and response prevention (ERP) therapist
If you think exposure and response prevention (ERP) might be right for you, it’s important to speak with a licensed and experienced clinician. There are many types of mental health care providers who practice exposure and response prevention (ERP), including licensed marriage and family therapists (LMFTs), licensed clinical social workers (LCSWs), psychologists, psychiatrists, psychiatric nurses, licensed professional counselors (LPCs), licensed mental health counselors (LMHCs) and more.
On top of finding a therapist who is skilled in exposure and response prevention (ERP), you want to make sure they meet your other needs. For example, if you struggle with an anxiety disorder, you’ll want to find an exposure and response prevention (ERP) therapist who also specializes in treating anxiety. In addition, finding a therapist who accepts your insurance can make therapy much more affordable.
You can find a therapist who accepts your insurance and specializes in exposure and response prevention (ERP) by using Grow Therapy. After filtering for your location, insurance, and needs, you can then select “Exposure Response Prevention (ERP)” from the “Treatment methods” drop-down.