ERP Therapy in London and Online

What is Exposure and Response Prevention (ERP)?

We would live free of distress and anxiety in an ideal world. Unfortunately, we face challenges resulting in chronic stress and mental difficulties. Sometimes, our brain deals with distress by engaging in intrusive thoughts that encourage repetitive behaviours. Exposure and Response Prevention is often a behavioural component of CBT therapy, the most popular treatment for anxiety-based issues.

ERP aims to help OCD sufferers and others struggling with anxiety break the association between a feeling of distress and distress-producing situations and thoughts and the association between carrying out ritualistic behaviour and distress reduction. For example, you might worry about setting your house on fire and repeatedly check if the stove is turned off to reduce the feeling of anxiety.

How Effective is ERP?

ERP is considered the most effective treatment for OCD. One estimate says that 80% of patients respond well to treatment and experience decreased symptoms. [1] Exposure therapy has also been effective in treating other anxiety disorders such as post-traumatic stress disorder (PTSD), social anxiety disorder (SAD) and specific phobias. [2]

How Long Does ERP Therapy Take?

When Should I Consider ERP therapy?

Do you feel at the mercy of your thoughts or images? Does it feel like you aren’t in control anymore? Are you terrified of how much time you waste fighting or trying to escape thoughts? Do you want a change from feeling often anxious? Is your everyday life affected? One of the warning signs is being late because of compulsions or avoiding going places due to distressing thoughts.

If you notice your sleep is disturbed, you feel exhausted, experience unexplained pains and an overall deterioration of your health, it’s probably time to seek professional help. Don’t suffer in silence. You’re capable of living a happy and fulfilling life free of the impact of obsessions and compulsions. At Therapy Central in Central London, we offer a safe space where you can receive support and tools to achieve your goals.

Does ERP Therapy Work?

Yes, previous findings have shown that Exposure and Response-Prevention therapy effectively improves OCD symptoms. [3] Besides reducing obsessions and compulsions, studies also noted a reduction in depressive symptoms. [4] Additionally, ERP’s effectiveness in treating other anxiety-based disorders is well-documented. For example, a previous study that looked at the efficacy of ERP paired with CBT therapy found that it lessened symptoms of social anxiety. [5] 

At Therapy Central, our therapists draw upon therapy approaches shown to treat OCD symptoms effectively, the most popular being ERP. After the initial assessment, you will choose the approach that will be the most helpful to your specific circumstances with your therapist.

What’s the Difference Between CBT and ERP?

CBT is a treatment that draws upon techniques from cognitive and behavioural therapies and might include exposure therapy. At the same time, ERP is a form of behavioural therapy. Since CBT aims to challenge our thoughts, it also implies we are responsible for what we think. ERP takes a different approach and aims to give less importance to your thoughts and trying to change them. However, ERP is an intervention commonly used in CBT therapy, so these approaches are often combined. 

Additionally, ERP requires you to commit to avoiding compulsions. You could say that ERP is an advanced exposure therapy dedicated to patients struggling with OCD. 

The focus of CBT therapy is ultimately to encourage patients to face their fears. In the case of ERP for OCD, the client can expect to engage in a stressful activity while resisting the urge to use repetitive behaviours to cope with their distress. But don’t worry, it’s not as scary as it seems. Your therapist will help you prepare an exposure hierarchy, and you’ll start from the least distressing item on the list. It’s about starting with taking smaller risks while building your confidence to move to more high-stakes situations.

How is ERP Different from Traditional Psychotherapy?

Traditional psychotherapy refers to talking therapies. Talking therapy gives you a chance to talk about your problems which, by itself, can decrease emotional distress. One example is psychodynamic therapy, which focuses on unresolved conflicts. In other words, it explores the relationship between your past and present difficulties.

However, in the case of OCD and other anxiety-related disorders, ERP and CBT can prove more effective. This is due to using a more practical approach; they focus on breaking patterns of behaviours and thus reducing anxiety.

How does ERP Therapy Help with OCD?

But how does ERP therapy exactly help with OCD? Let’s dive into the topic a bit deeper. As mentioned before, ERP therapy aims to break the cycle of experiencing intrusive thoughts and engaging in repetitive behaviours to reduce anxiety. This association is otherwise known as a vicious cycle of OCD. 

The Vicious Cycle of OCD

While every person with OCD is different, the sufferers typically struggle with unwanted thoughts, images or impulses that leave them distressed. For example, you might have thoughts of committing something illegal. Another feature of OCD is experiencing compulsions which are repetitive behaviours such as obsessively checking if the cables are plugged in or touching particular objects a set number of times. When a person experiences unwanted thoughts that cause anxiety, they might repeat a behaviour that reduces the anxiety. As time passes, a person becomes dependent on compulsions to cope with distress. Unfortunately, the relief is short-lived and repeating the same pattern of behaviour only reinforces the association between obsessions and compulsions.

ERP’s goals that aim to break the cycle:

• Exposure – the goal is to help you get used to the sensation of anxiety without needing to engage in behaviours that can provide immediate relief. No matter how distressing your thoughts are, you can accept how they make you feel without losing control. A therapist will guide you through confronting objects or situations that trigger your anxiety.
• Prevention – the second goal is to help you see the bigger picture. If you frequently engage in compulsions and still experience intense anxiety, it means they aren’t a long-term solution. Even worse, compulsions actually increase the obsessions as they’re a reaction to anxiety and make you pay more attention to unwanted thoughts as a result. A therapist will help you become more aware of the mechanisms between compulsions and obsessions and explain why this cycle isn’t a good long-term anxiety reducer.

Does ERP Therapy Help with Anxiety?

Even though ERP is typically used to treat patients with OCD, its techniques can be applied to patients suffering from other anxiety issues. The exposure part of ERP requires the client to face their fears directly. For example, a specific phobia, such as a fear of spiders or attending a social event and going on public transport. While someone with anxiety doesn’t usually experience compulsions, they might still engage in avoidance which is the pattern exposure prevention aims to break. 

What are the Benefits of ERP Therapy?

Picture this. You’re out for a walk, completely relaxed. The only thought that enters your mind is being in the present and enjoying nature. Even if distressing images appear, you can let them go —no more intense worrying whether you turned off the iron—no more distress. You’re at peace.

ERP therapy aims to improve your quality of life. Here are some of the benefits you can expect:

• Awareness of harmful thoughts and anxiety-inducing behaviours
• A better understanding of your condition
• Reduced anxiety
• Less time spent on intrusive thoughts and behaviours = more time to do the things you enjoy
• Reduction in symptoms of OCD-related issues such as depression or insomnia 

As a result, more general benefits will be:

• No more being late for work or an appointment
• Increased life satisfaction
• Greater enjoyment of the present moment
• Greater kindness and compassion towards yourself
• Greater sense of confidence

Things I Wish I Knew Before Starting ERP Therapy

If you’re considering ERP therapy, you aren’t alone. While taking the first step can make you feel unsettled, your health should be prioritised. Below is a list of tips that can help you feel more prepared for what’s to come.

1. Therapy takes hard work and time

Breaking the old patterns doesn’t happen overnight. If you want to see positive results, you must stick to the treatment plan and put in the work. Many people think that attending therapy sessions is enough to make progress. Still, while a therapist is there to guide you, you are the person doing the work. You’re the only one who can make a change, and if you get to that point, you likely have the capability to do so. Take a deep breath and focus on what you want to get out of the therapy. Do your homework and make therapy your priority. After all, if you wanted to learn guitar, you would not expect to exercise only during your lessons, would you?

2. Even if you do your best, it’s not easy

Sometimes despite your best efforts, you don’t see the results straight away, or the results aren’t as good as expected. For example, you might respond well to the exposure but struggle not to give in to compulsions. It’s frustrating when things aren’t going as you hoped but remember to be kind to yourself. Everyone’s journey is different. Progress will eventually happen if you desire to improve your situation and commit to the work.

3. Things might get worse before they get better

You might be progressing very slowly and feel discouraged. By making you face your anxiety triggers while asking you to refrain from compulsions, the exposure work might make you feel even worse than before you started. This is normal, and it’s part of the process. The key is to trust yourself and your therapist and stick to the treatment plan.

Tips for Handling ERP Therapy as a Client

Here are some tips that can make treatment more effective:

1. Practice what you learned in therapy as often as possible

ERP requires commitment. While working on the cycle of obsessions and compulsions can be incredibly triggering, doing the work only during the therapy sessions isn’t enough. If you fight against your urges in therapy but always give in to them at home, the treatment won’t be effective. You have to immerse yourself in it completely. Working as a team with your therapist, devising a plan that works for you, and then practising outside therapy sessions will be the key.

2. Communicate Honestly with Your Therapist

If you have any concerns or doubts about how therapy is going, share them with your therapist. Chances are you’re progressing but might not see it just yet. Alternatively, your therapist might be able to adjust the treatment plan if the current approach isn’t working.

3. Don’t forget self-care

The treatment can be overwhelming. You might start doubting yourself and even think of quitting when you don’t progress as fast as you had hoped. That’s why you must take extra care of your mental wellbeing. Besides being honest with your therapist about how you feel, to engage in self-care, make sure you do a relaxing activity every day and try positive self-talk. You can choose statements that make you feel empowered and repeat them to yourself every day. Try, for example:

“I am capable of managing my anxiety and tolerate uncertainty” or “I am proud of my commitment to therapy”.

Tips to Help Someone Going through ERP Therapy

What if you want to support a loved one currently undergoing ERP therapy? 

1. Refrain from Asking How the Treatment is Going

While you might mean well and ask about the therapy because you care, it might put the person under pressure. On top of dealing with their difficulties, they might start worrying about fulfilling your expectations. Instead of asking a direct question, you can offer them support; ‘I’m here if you want to talk.’ Remember to give them the space they need.

2. Don’t Offer to do the Distressing Tasks for Them

Avoidance is the opposite goal of therapy. While it might be challenging to see them under a lot of stress, try not to offer them excessive support. You might risk colluding with their difficulties. On the other hand, you can gently try to discourage them from engaging in compulsions. In any case, ask them if and how you might be able to help them. 

3. Remember to Take Care of Yourself

Supporting a loved one struggling with OCD can be challenging. Before you can help them, you must take care of yourself. Try to add self-care to your routine and spend time with other people from your social circle. The best ally is a strong ally.