Exposure and response prevention

Exposure and response prevention (ERP) is a treatment method available from behavioral psychologists and cognitive-behavioral therapists for a variety of anxiety disorders, especially Obsessive Compulsive Disorder. It is an example of an Exposure Therapy, with the addition of Response Prevention.

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The method is predicated on the idea that a therapeutic effect is achieved as subjects confront their fears and discontinue their escape response. An example would be of a person who repeatedly checks light switches to make sure they're turned off. They would carry out a program of exposure to their feared stimulus (leaving lights switched on) while refusing to engage in any safety behaviors. It differs from Exposure Therapy for phobia in that the resolution to refrain from the avoidance response is to be maintained at all times and not just during specific practice sessions. Thus, not only does the subject experience habituation to the feared stimulus, they also practise a fear-incompatible behavioral response to the stimulus.

Recent results (Lovell et al, see below) indicate that ERP can be carried out effectively with minimal face-to-face contact between the therapist and the subject.

Please refer to the Obsessive Compulsive Disorder article for elaboration on ERP and its effectiveness.

Recommended Reading

• Marks I (1981) Cure and Care of Neuroses John Wiley & Sons Inc 0-471-08808-0
• Marks I. (1997) Behaviour therapy for obsessive-compulsive disorder: a decade of progress. Can J Psychiatry. Dec;42(10):1021-7.
• Lovell K, Cox D, Haddock G, Jones C, Raines D, Garvey R, Roberts C, Hadley S. (2006) Telephone administered cognitive behaviour therapy for treatment of obsessive compulsive disorder: randomised controlled non-inferiority trial. BMJ. Oct 28;333(7574):883