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Exposure and Response Prevention Therapy (ERP)

What is Exposure and Response Prevention Therapy?

Exposure therapy is a method in behavior therapy purposed for treating anxiety disorders.  This involves the exposure of the man or woman to the feared object or circumstance in the absence of danger as an approach of overcoming their anxiety.  Exposure and Response Therapy (ERP) was essentially designed to desensitize one to their fears and distresses. As the commonly co-occur, ERP has proven to be a useful tool in treating eating disorders and anxiety together.

Prior to beginning ERP treatment, patients detail a hierarchy of situations that trigger obsessive fears.  Treatment would begin with exposure to circumstances that create mild to moderate anxiety.  As the individual adjusts to various situations, they are gradually able to work up to predicaments that influence increased levels of anxiety or fear.  The time period of progression in treatment is dependent of the patient’s capacity to withstand anxiety and to resist engaging in compulsive behaviors.  Exposure tasks are generally executed primarily with a professional therapist assisting.  Sessions can usually be expected to last between 45 minutes to three hours.  Participants are directed to practice additional exposure tasks between sessions for up to two to three hours per day.  In specific instances, direct exposure to the feared object or circumstance is practiced in “imagined” exposure, which involves exposing an individual to instances or situations that trigger obsessions by imagining various scenarios.  The primary goal during exposure sessions is for the individual to remain connected with the trigger without using ritualistic behaviors.  To record progress during exposure trials with a therapist, patients are guided to rate their anxiety levels.  Typically, an ERP treatment runs over a course of 14-16 weeks.

Types of Exposure Response Therapy

Types of exposure therapy are as follows:

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    • Exposure therapy Post Traumatic Stress Disorder (PTSD): The use of exposure therapy targeted at healing from events that may have caused PTSD.
    • Gradual Exposure Therapy: Involving the slow increase of exposure to stimuli during therapy
    • Prolonged Exposure Therapy: Involving extended periods of sustained exposure to stimuli during treatment
    • Exposure Therapy Social Anxiety: Targeting anxiety created by social events or activities

    Components of Exposure Response Prevention Therapy

    Exposure Response Prevention Therapy may include flooding or graduated techniques.  With flooding techniques, patients are generally exposed to a distressing situation, object, or thought for as much as two hours at a time.  Contrarily, graduated techniques exposure patients to distressing stimuli in shorter time frames, giving them greater control over the length and extend of the exposure.

    Uses of Exposure Response Prevention Therapy

    Exposure Response Prevention Therapy can be an effective method in helping individuals who are dealing with various degrees of anxiety or fear.  In relation to those suffering from eating disorders, particularly bulimia nervosa or anorexia nervosa with the purging sub-type, Exposure Response Prevention Therapy can be helpful in assisting individuals overcome fears of consuming forbidden foods.  Use of this method for this patient population has demonstrated effectiveness in decreasing urges to binge/vomit, as well as reduce anxiety levels, guilt, depression, tension, as well as feelings of lack of control.  In addition to a therapy method for some forms of eating disorders, such as bulimia nervosa, exposure response prevention therapy has also been utilized to treat a variety of anxiety disorders, especially obsessive-compulsive disorder, and an array of phobias. Use our directory to locate treatment centers for eating disorders.

    Last Reviewed By: Jacquelyn Ekern, MS, LPC on April 25, 2012

    Page last updated: June 12, 2012
    Published on, Help & Information For Eating Disorders

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