Beyond Habituation: How ERP Creates Lasting Change in OCD Treatment
What is ERP?
Exposure and Response Prevention (ERP) is a highly effective form of Cognitive Behavioral Therapy grounded in decades of scientific research on fear learning and is the gold-standard therapeutic treatment for Obsessive-Compulsive Disorder (OCD).
ERP helps individuals rewire their response to uncomfortable or intrusive thoughts and feelings and break free from OCD’s cycle.
Beyond Habituation: The Power of Inhibitory Learning
Exposures are not just about proving the worries in our brains wrong. Psychologists used to think the purpose of ERP was to unlearn fears through habituation or getting used to the fear. This was because often the more someone engages in an exposure, the less anxious they feel the next time they approach a trigger.
However, research has found that a decrease in anxiety does not necessarily predict willingness to engage in the next exposure. Inhibitory Learning Theory suggests that rather than focus on getting rid of that initial fear reaction to the trigger, we build new associations that compete with the old fear response.
ERP as a Learning Process, Not Just Fear Removal
Through ERP, people with OCD work to develop and learn many new associations. So, a contaminated object can both feel scary AND to feel pleasant, be a source of pride, or even safe. Over time, this new learning will compete the fear memory and the initial feared trigger can hold multiple meanings. We can't erase what the brain has learned. However, we can add new information. This new information can change or add to the meaning of what was learned before.
One way to think about this is like a stream from the moat of a sandcastle. If you overfill your moat, one stream will break through the moat down to the water. Now every time you overfill the moat, the water will flow down that path making it deeper and wider. However, if you dig out a new path from your moat, over time the water will start flowing equally into these new routes.If you continued making new beds for your streams eventually the initial stream may no longer be the most used stream.
How ERP Works in Practice
Psychoeducation: Understanding OCD symptoms, which ones are impacting your lives, how the cycle is being maintained and how exposure and response prevention work.
Creating an exposure menu: Create a list of exposures that feel both appropriately challenging and meaningful for the individual to work on.
In-session exposures: Practicing engaging in exposures and response prevention in session. Noticing thoughts and feelings as they come up during ERPs.
Homework and relapse prevention: Practicing exposures outside therapy and building strategies to sustain progress.
Who Benefits from ERP
ERP is adaptable and effective across all OCD subtypes—contamination, harm, taboo thoughts, checking compulsion, mental rituals and is beneficial for adults and children alike.
If you're seeking help with OCD, consider reaching out to an OCD and anxiety specialist trained in ERP. This approach isn't just about managing symptoms—it’s about regaining control, building resilience, and fostering meaningful change.