Exposure and Response Prevention (ERP)
Exposure and Response Prevention (ERP) is considered the gold-standard treatment for OCD, and it is an approach I use often with clients who are ready for it. It also works well for phobias, social anxiety, and other anxiety that has started to shape what you avoid.
I offer ERP in person in Barre, Vermont, and via telehealth throughout Vermont and Maryland. It works either way, exposure work translates to video better than most people expect, and some exposures are easier to practice in your own environment than in an office.
How I Approach ERP
We start with a good amount of psychoeducation, understanding what is happening in anxiety and OCD, and why ERP works when talking alone often does not. Talking things through can feel helpful in the moment, but it does little to help your amygdala, the brain’s alarm system, learn that something is actually safe.
ERP works by gradually facing the things that trigger anxiety, built around an exposure hierarchy we create together. You are not thrown into the deep end. We start where you can actually start, and we build from there.
When ERP Helps
ERP is best known for OCD, and that is where the research is strongest. But the same approach applies whenever anxiety has led to avoidance, when the thing you are afraid of has quietly started deciding where you go, what you say yes to, or what you organize your day around.
That might look like OCD. It might also look like a specific phobia, social anxiety that keeps you out of rooms you want to be in, or a fear that has grown larger the longer it has gone unchallenged.
My Approach to Exposures
I will never ask you to do an exposure I am not willing to do myself, or that you are not willing to try. In fact, I often do my own exposures alongside my clients, so you are not facing it alone.
Common Questions
Is ERP only for OCD?
No. It is considered the gold-standard treatment for OCD and that is where it is best known, but I also use it for phobias, social anxiety, and other anxiety that has started driving avoidance. If you are not sure whether it fits what you are dealing with, that is a good thing to ask about.
What if I have tried exposure work before and it did not help?
That happens more often than you might think. Willingness is a bigger part of the process than most people realize, and exposure work without it does not tend to go anywhere.
With kids especially, a parent can end up unintentionally making their child do exposure work, sometimes without the support that needs to sit alongside it. Take riding the bus. It matters that the child is willing, that they actually want to work on the anxiety, and that their feelings are being validated at the same time as they are being encouraged that they can handle it. All of that together is what makes it work.
How long before I notice a difference?
Sometimes almost immediately, depending on the exposure and on your own willingness. I have worked with clients who understood the concepts, grabbed the bull by the horns, and ended up having genuine fun with it. Those are the ones who notice a difference quickly.
For others it takes longer. If the fear is too big to approach yet, or you are not fully in touch with what you are feeling, we may need to do some other work first before ERP is the right tool.