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While the impulse to avoid or escape from things that we associate with danger or aversion is usually beneficial, an excessive tendency to avoid particular experiences and situations often provides only temporary relief and exacerbates problems of anxiety, disgust, and other negative emotions over time. The opposite is also true: our ability to willingly and mindfully endure difficult experiences without succumbing to our urges to avoid, control, or neutralize them (e.g., through superstitious habits, compulsive rituals, etc.) usually leads to the desired outcome (e.g., increased coping, emotional resilience, and the ability to tolerate adversity or distress, and decreased worry, anxiety or obsessional thinking).


Exposure and Response Prevention (ERP) is a therapeutic approach whereby a person is guided through a process of repeated exposures to feared stimuli over time and across situations while being taught to deliberately refrain from engaging in escape or avoidance behavior.  The "feared stimuli" may be objects, people, or situations (as in the case of OCD, agoraphobia, social phobia, etc.) or bodily sensations associated with fear (as in the case of panic disorder). This occurs in a systematic and safe manner, at a pace with which the patient is agreeable. Exposure exercises can be conducted "imaginally” (using guided imagery, etc.) and "in vivo" (in real-world situations, such as one's home, workplace, school, or community), and are practiced regularly by the patient during and between sessions.


In many instances, feared situations are arranged in a hierarchy (from least to most anxiety-provoking for the person) and the patient is not exposed to the more fearful stimuli until they have sufficiently acclimated (e.g., increased their emotional tolerance, reduced their anxious response) to their own lower-level fears. This is analogous to an “inoculation” model of treatment, where the patient is made heartier to threats by gradually receiving “booster shots” of anxiety in safe and metered doses. While this approach is often preferred by patients because of its gradual nature, studies have shown that therapeutic gains can often be enhanced and maximized when a patient is willing to undertake exposure exercises "out of sequence" (e.g., working through a more difficult task in the hierarchy prior to a seemingly easier one, etc.).

If you would like to find out more about Exposure and Response Prevention or have any questions, feel free to call me at 631-444-5354 or send me a message

Exposure and Response Prevention (ERP)


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