Coastal Center for Anxiety Treatment

Name card of Dr. Eric goodman.

ERP Therapy for Anxiety and OCD

In order to overcome a fear, one must face it. The main strategy for this is called Exposure with Response Prevention (ERP). Designing optimal exposures require planning. If an exposure is too easy, then treatment may take a very long time. If exposures are too difficult, you are more likely to avoid it all together or quit an exposure prematurely. Below are factors to consider when designing an optimal exposure activity.


Who is going to take part in your exposure? Who will be the targeted people?

Depending upon the nature of your fear, you may find that having certain “comfort” people accompany you may decrease your anxiety level. This may be ok early-on, but as your confidence builds, the nature of your fear might be better addressed going solo. “Targeting” certain types of people (gender, level of attractiveness or education, and so on) may make your exposure more or less challenging. It is okay to initially start with challenging, but easier people, and then progressing to more difficult targets.


What specifically will you do for your exposure?

Varying what you do, even a little bit, may make your exposure more or less challenging. It is ok to start with low to moderate exposure goals before progressing to more challenging ones. If you are socially phobic, for example, you could start out by just being in the presence of other people, then move on to eye-contact in passing, then to brief small talk, and so on.


What day or days of the week and time or times of the day will you do the exposure/s?

Some exposures may fit in best before or after school or work. Some exposures may be made more challenging in the daytime or nighttime depending upon the nature of the fear. Working your way up to the most difficult times of the day or week may enhance the exposure challenge.


Where will the exposure take place?

Will your exposure be made easier or harder if it is done at home or in public? It is ok to start with challenging but easier places and then progress to more difficult locations. Sometimes going out of town, among people you will never see again, is easier than in places where you may bump into people you know. The opposite can be true as well, depending upon the nature of the fear. In order for you to “generalize” your exposures to your everyday life, you will probably need to face your fear in a number of situations.


Ask yourself two questions.

(1)    What might I learn as a result of the exposure that might be helpful in the future?

Successful exposures tend to lead to the realization that the situation was not as dangerous as previously believed and that even if a negative outcome results, it tends to not be as bad as feared and you can cope adequately. Over time, successful outcomes tend to lead to “habituation” or a lessening of anxiety in those situations.

(2)    What do you stand to gain if you successfully face your fears?

Make a list of all the things that you will gain if face your fear. What are you losing out to the anxiety and how will your life be better if the anxiety no longer calls the shots? Read this frequently in order to bolster your motivation.


ERP involves going towards the feared situation either in your imagination or in the “real world” without engaging in avoidance or “safety” behaviors.

Plan B

If you design an exposure that turns out to be significantly more anxiety-provoking than anticipated, or you find that you just can’t get yourself to follow-through, have a back-up exposure planned that is less challenging (though certainly not overly easy—where would the growth be in that?).

Feared Outcome

Before an exposure, write down, specifically, what you (or Anxiety) fears will happen. What is the catastrophic outcome that is anticipated?

Actual Outcome

Record what actually happened and keep those results handy so that you can see the proof that ERP is working for you!

Follow the steps above to design optimal ERP activities.