Exposure Therapy

Yes. This is hard work. Yes. You can expect to be miserable at times. Yes. You have to work at it every day. These are words I reiterate regularly during my week. These are spoken words in the context of explaining to my clients what exposure therapy is all about. Exposure Therapy Response Prevention (ERP) is a type of Cognitive-Behavioral Therapy (CBT). It’s a subset rooted in learning theory and used to target a clients behaviors and thoughts that maintain obsessions, irrational fears, avoidance, and safety behaviors. In a nutshell, ERP is learning to face ones fears. But it’s so much more than that. More than facing ones fears, it’s helping clients build confidence in themselves. It’s providing tangible evidence that anxiety is just a feeling, and nothing more. Most importantly, it provides actual data that feeling scared, anxious, and terrified is just uncomfortable; not dangerous. The process of ERP is recalibrating ones brain-and body to experience distress and discomfort without fleeing, or incorporating some type of safety behavior (i.e., “coping”) to manage the distress. ERP is simplistic. It’s easy to explain and easier to implement. There are no fancy chants, finger waving, breathing strategies, or finding your happy place. Its not sexy, but raw. It’s also underutilized greatly. This is bad news for those suffering with anxiety disorders. Anxiety disorders are the number one reason individuals seek services for mental health, yet experienced clinicians rarely use ERP. Logistically, using ERP as a tool to fight anxiety takes some consideration. A clinician must be prepared to get out of the office. Although many fears, obsessive thoughts, and distressing memories can be activated in the office, most reside elsewhere. A client suffering from harming OCD requires a clinician who will drive with them. A client with Panic Disorder needs a clinician by their side to climb a flight of stairs.  A client with contamination OCD will benefit from their clinician sharing the experience of touching every garbage can in a three-block area and enjoying finger food together. A teenager with social anxiety is unable to challenge fears of interacting with strangers or engaging in small talk while sitting on a therapy couch. This has to happen in real time, with real people, to build real confidence. Exposure Therapy works. It works because clients commit to working hard, to being miserable on purpose in order to overcome their fears. Individuals with anxiety are miserable. At least when engaged in ERP their misery has a purpose. They evoke feelings of fear, danger, and distress on purpose and wait. There is no better example of courage