Exposure and response prevention (ERP): How to face your fears

The best way of overcoming your fears is to confront them. Exposure therapy is a proven psychological treatment for all forms of anxiety, but how exactly does it work?


Cutting out avoidant behaviours is crucial because often a person will know on an intellectual level that their particular fears are unfounded or unrealistic; on an emotional level, however, you will remain anxious until you change your risk-averse behaviours and expose yourself to feared situations.


Exposure is the opposite to avoidance. The more you avoid, the weaker you feel. In contrast, exposure makes you feel more competent, more confident, more open to life’s challenges and opportunities.


That said, exposure therapy is often misunderstood. First of all, let’s start by giving it its proper name – exposure and response prevention, or ERP.


An exposure is when you voluntarily expose yourself to something you fear. Response or ritual prevention (RP) means you don’t resort to rituals or safety behaviours when doing an exposure; you sit with the anxiety and allow it to come down on its own.



ERP is often associated with phobias and obsessive-compulsive disorder (OCD). For example, say you’re afraid of flying and you expose themselves to your fear by getting on an airplane and flying.


However, let’s say that before the flight, you get some Xanax tablets, drink a bottle of wine and spend the flight feverishly praying and reciting mantras.


Will you get over your flight phobia? Of course not. Your safety behaviours (taking tablets, drinking, praying and reciting mantras) make sure of that. You will come away thinking, I was so anxious, that was awful, I'd never have survived the flight if I hadn't taken steps to calm myself down.


Thus, the exposure is getting on the plane, but that is only the first step. The really important part is the response prevention, which in this case would mean no Xanax, no wine, no praying, no mantras.


The purpose of ERP is to demonstrate to the brain that the alarm signal it is sending – that jolt of anxiety when you think about flying – is unnecessary. We want to retrain the brain to stop sending false alarms. If you're behaving in a terrified manner during an exposure, you're telling the brain the alarm signal it is sending is relevant, not irrelevant. Thus, the brain (more specifically, the amygdala, a part of the brain associated with anxiety) will continue to send those false alarms and your fears will persist.


Similarly, let’s say you have OCD and you have fears about contamination. A typical exposure exercise might consist of shaking someone’s hand, or touching a door knob without wearing gloves, and so on. In this case, the response prevention would be not washing your hands afterwards. If you don’t do the RP – that is, if you furiously wash your hands after coming into contact with the feared object – then you undo the exposure.


Another example. Let’s say you are socially anxious and the thought of attending social events fills you with dread. In this case, exposure exercises might include going to a party or a busy social event. The response prevention would be not conducting the safety behaviours you typically resort to in such situations – for example, scrolling through your phone for extended periods, standing in the corner so you can quickly make your exit should you wish to, rehearsing conversations, and so on.


Are safety behaviours always a no-no? Some researchers argue safety behaviours may be defensible in certain cases – for example, when someone says they are too scared to confront their fear unless they can utilise one or two of their familiar safety behaviours.


Still, I always encourage people to be very aware of the counter-productive nature of safety behaviours. At the very least, aim to cut back drastically on them and aim to phase them out sooner rather than later.


ERP is an incredibly powerful approach. It’s also one that can be used in all areas of your life, whether or not you suffer from anxiety.


My last column explored how worriers often get anxious at the thought of relaxing or of being “too happy”. In my next column, I’ll explore some emotional exposures that will help you to drop that guard.