Exposure and Response Prevention (ERP) can sometimes be referred to as exposure therapy. This is misleading. As it’s way more than that. ERP works because our brain learns something new. How? It learns through our behaviour change i.e. changing from doing compulsions which tells our brain that in fact these thoughts and feelings are dangerous so our brain learns to give us more of them, whereas, not doing compulsions and our brain then learns that if we are not reacting to the perceived danger then there must be no danger, and our brain calms down (this can take time but that’s the process).

So doing exposures and continuing to do compulsions is just torture. The brain is only learning that the person is brave to face the fear (which is great) but it’s also learning that the brain still needs to be afraid. The person will get far less pay off from this approach and ERP will feel dramatically harder, versus someone who does exposures then reduces and then stops compulsions.

The key point to remember about ERP, the primary reason therapists ask clients/patients to do an exposure is so they can respond differently to it. So that their brain can learn.

Respond differently, stop compulsions, get the pay off (reward) from the tough exposure.

Hope that helps.

Illustration by https://namiralph.com/

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