Exposure and Response Prevention
Authors: Jennifer Smith, MA, LPC – Exposure Therapist & Kristin Kohn, LCSW – Exposure Therapist
Everyone experiences anxiety. Though anxiety has a bad reputation, its purpose is to help us in times of stress and danger, and typically centers on uncertainty related to the future. It’s normal to be afraid of the unknown. Learning to accept uncertainty is one of the most challenging things to do in life. Everybody has worries. Everybody has intrusive thoughts. The only difference between someone with a clinical diagnosis of anxiety and someone who simply experiences anxiety is how they manage their reaction to the anxiety trigger.
Anxiety can feel very isolating, paralyzing, and can negatively impair us in ways we never expected. Naturally, our minds and bodies generate ways to help us feel protected from the paralyzing fear, even if it’s only for a short period of time. Unfortunately, as we repeatedly engage in avoidance, reassurance-seeking, distraction, and safety behaviors that help us feel protected, we forget that we can handle feeling uncomfortable, and often avoid anxiety-provoking triggers. Ultimately, this increases our anxiety in the long-term. Thereby, experts have determined through evidenced-based research that Cognitive-Behavioral Therapy (CBT) and Exposure and Response Prevention (ERP; a.k.a. exposure therapy) are the most effective treatment modalities in relieving symptoms of anxiety, obsessive-compulsive, and other related disorders.
So, what is exposure therapy and how will it help in overcoming anxiety? Essentially, exposure therapy is a process where you and your therapist work together to confront anxiety-provoking triggers in a gradual and systematic manner. By doing this, we reduce avoidance of these triggers and learn the following:
- What we are fearful of is unlikely to occur.
- If what we are fearful of occurs, we are able to cope with it better than expected.
- Our anxiety may decrease more quickly than expected and if it does not, we are capable of tolerating feeling uncomfortable. In short, we will survive anxiety provoking thoughts and situations.
- By reducing avoidance, distraction, and reassurance seeking, we are able to cope with our anxiety triggers better than we anticipated.
In-vivo exposures are preferable and most commonly used. These exposures are done live in person, e.g. talking to peers or adults for someone with social anxiety, touching contaminated items for someone with OCD. Imaginal exposures are used when the fear that we want to confront is unable to be directly experienced. For instance, your exposure therapist will not have a dog attack someone with an animal phobia. However, if this is a fear, then imaginal exposure can be used to confront this fear, e.g. strategically and repeatedly thinking about a worst case scenario. Finally, interoceptive exposures are used to help us invoke the physical symptoms that we are fearful of, e.g. pounding heart, dizziness. In treatment, your therapist will determine what types of exposures will be most beneficial for you. At Compass, our Complex Anxiety & OCD track utilizes exposure therapy to treat panic disorder, agoraphobia, social anxiety, specific phobias, generalized anxiety, and OCD.
When we struggle with debilitating anxiety, it seems like the scariest thing that a therapist could ask of us is to confront the things that make us the most anxious. However, exposure therapy is designed to be a collaborative process, during which your therapist acts as your teammate, meaning that you will never be forced to do something that you’re not willing to do. Your therapist will encourage and challenge you to step out of your comfort zone. Suffering from an anxiety disorder can often feel like anxiety is controlling your life. By engaging in exposure therapy, confronting the anxiety, and practicing coping skills, we are able to take back control from the anxiety and lead a more healthy, fulfilling life.
Exposure therapy is not a cure for anxiety and OCD symptoms, but rather helps you learn to manage your symptoms. You may always have intrusive thoughts or worries, and through exposure treatment, that loud worry or thought becomes a whisper. We learn to act on behalf of our personal values (e.g., independence, productivity) instead of our anxiety-driven values (e.g., certainty, control).
To motivate ourselves and embark on a journey in working on the seemingly impossible, it helps to remind ourselves of what anxiety and OCD has taken away from us. Has it isolated me more? Is it hard for me to pay attention and do well in work or school? Have I been more hesitant to see people or do things that uplift me? Have I found myself feeling insecure or sad because of anxiety? With a desire to change, the help of your treatment team, and willingness to engage in exposure therapy, our goal is to help you feel a relief in your symptoms and learn to manage those scary thoughts and worries. You have the power to prove to yourself that you can face your fears and get your life back.