Exposure and response prevention (ERP) is a form of therapy used to treat people with obsessive-compulsive disorder (OCD). Research shows that it may effectively reduce symptoms and improve quality of life.

ERP is a form of cognitive behavioral therapy that mental health professionals tailor to address symptoms like phobias, obsessions, and compulsions.

Formal OCD symptoms include obsessions, compulsions, or both. Obsessions are intrusive, upsetting, and persistent thoughts or images that you can’t control or stop at will. Compulsions are repetitive behaviors that follow obsessions in an effort to reduce the distress these cause.

For example, if you have contamination OCD, you may have obsessions around the fear of germs and toxins. Whenever those thoughts or images arise, you may feel compelled to wash your hands, even if you just did a few minutes earlier.

ERP is a structured form of therapy that involves mental health professionals gradually exposing you to triggering thoughts, images, or situations (exposure) and guiding you to avoid engaging in typical compulsive responses (response prevention).

While engaging in compulsions can sometimes bring temporary relief from obsessions, it may also reinforce the idea that you need to fear your obsessions and carry out your compulsions. This experience is commonly known as the “cycle of OCD.”

ERP can help break this cycle and reduce your distress levels by helping you face your OCD triggers without carrying out your compulsions.

Strategies and tools used in ERP

An ERP therapist may use many strategies and tools, including:

  • Psychoeducation: Therapists usually start by explaining the cycle of OCD and how ERP aims to disrupt this cycle.
  • Practicing exposures: Exposing you to those things you fear is a critical component of ERP. Exposure typically brings out your OCD-related fears so you and the therapist can address them in a controlled and gradual manner. For example, if you have contamination fears, a therapist may ask you to touch a doorknob without washing your hands immediately after.
  • Exposure scripts: When direct exposure is too distressing, therapists may use exposure scripts, which are detailed narratives of feared situations. These scripts may help you face your fears without actually experiencing exposure to them.
  • Response prevention: Response prevention involves strategies designed to resist the urge to perform compulsive behaviors. For instance, if you have a compulsion to check locks repeatedly, ERP can help encourage you to leave the locks unchecked.
  • Delaying the ritual: ERP often starts with delaying the compulsion, gradually increasing the time between the obsessive thought and the compulsive behavior. You may also work on engaging in your ritual differently, which may help weaken the association between obsession and compulsion.

A therapist may also refer to habituation and inhibitory learning.

Habituation is a process in which repeated exposure to a feared stimulus gradually reduces the distress it causes. Over time, you may become desensitized (not reactive) to the stressor, diminishing the compulsive response.

Inhibitory learning is a newer concept in ERP that focuses on creating new, nonfearful associations with the stressor. Rather than simply reducing anxiety through repeated exposure, inhibitory learning can teach your brain that the feared outcome is unlikely to occur, thereby inhibiting the old, fearful response.

ERP is usually suitable for people of all ages with OCD. It may be an effective therapy for children, adolescents, and adults.

ERP might be particularly beneficial for those whose OCD symptoms interfere significantly with daily activities and for symptoms that don’t respond to other forms of treatment.

In addition to treating OCD, ERP can also be effective in managing anxiety disorders, such as phobias and panic disorder. It can help you develop skills to handle distressing thoughts and emotions more effectively, making it a valuable tool for various mental health challenges.

Yes — ERP is one of the most well-researched and demonstrated effective treatments for OCD. Some experts consider ERP a first-line treatment for OCD, which means it’s often the first treatment that mental health professionals suggest for the condition.

A 2019 research review showed that between 50% and 60% of people may experience an improvement in OCD symptoms after undergoing ERP.

A 2021 review, which involved 24 randomized controlled studies, found that ERP might be more effective than other forms of OCD treatment. This review and a study from 2020 showed that participating in EPR therapy can help reduce and manage obsessions and compulsions.

ERP isn’t the only therapy for OCD. Other options include:

A 2022 review suggested that ERP can be more effective when combined with medications.

Depending on your symptom severity, a care team may suggest a combination of therapies.

Many mental health professionals consider ERP an effective and safe treatment for OCD. They may use ERP to break the cycle of obsessions and compulsions by gradually exposing you to stressors and helping you resist compulsions.

Backed by substantial research, ERP may help manage OCD symptoms and improve overall quality of life.