Exposure and Response Prevention (ERP)
Exposure and Response Prevention, commonly referred to as ERP, is the #1 recommended treatment for obsessive-compulsive disorder, generalized anxiety disorder, panic disorder, and phobias. When people are fearful of something, they tend to avoid those feared situations, activities, or objects. Although this avoidance seems to help reduce anxiety in the short term, over the long term it can make the fear become even worse. ERP works by interrupting the link between anxious thoughts, images, or impulses and the maladaptive responses done to relieve the distress they cause, including avoidance behaviors. For OCD specifically, ERP uses systematic, gradual exposure to situations which cue obsessions while refraining from compulsive behaviors. Each time an individual completes an exercise it becomes easier, and the anxiety or distress gradually subsides. Clients are then able to move on to more difficult exposure exercises, developing mastery over their fears as they progress.
Exposure therapy goals might include:
A major benefit of the ERP protocol is that it is intended to be a short-term treatment model of 16-20 total sessions. The frequency and duration of treatment may be adjusted based upon the severity and subtype of OCD as well as the individual client's ability to consistent complete treatment homework assignments.
Exposure therapy goals might include:
- Individual and family education
- Identifying anxiety triggers and responses
- Understanding feelings, urges, and behaviors
- In vivo and imaginal exposures to develop tolerance to fears or discomfort
- Learning to break the cycle of fear and endless rituals
- Reducing avoidance behaviors
- Identifying and reducing rumination
- Replacing exaggerated, fearful thinking with more realistic thinking and self-talk
- Coping tools and problem-solving strategies
- Relapse prevention strategies
A major benefit of the ERP protocol is that it is intended to be a short-term treatment model of 16-20 total sessions. The frequency and duration of treatment may be adjusted based upon the severity and subtype of OCD as well as the individual client's ability to consistent complete treatment homework assignments.
Supportive Parenting for Anxious Childhood Emotions (SPACE)
SPACE (Supportive Parenting for Anxious Childhood Emotions) was developed by Dr. Eli Lebowitz at the Yale Child Study Center and has been shown to be as effective as child-based CBT in reducing anxiety symptoms in children and adolescents.
The basic approach of SPACE is to help parents learn how to increase support for and reduce accommodation of their anxious children. SPACE is ideal for:
Parents can participate in single-family SPACE training or in a group format with a small number of other parents. All participating parents will complete a 15-minute consultation prior to enrollment to determine suitability for the program.
The basic approach of SPACE is to help parents learn how to increase support for and reduce accommodation of their anxious children. SPACE is ideal for:
- Parents of children ages 6-18 with separation anxiety, social anxiety, generalized anxiety, phobias, or OCD.
- Parents of children who have had trouble engaging with or fully achieving the goals of individual therapy.
- Parents whose own anxiety or accommodation has been a barrier to treatment progress.
- Parents with discordant communication styles, eg, demanding vs. protective.
Parents can participate in single-family SPACE training or in a group format with a small number of other parents. All participating parents will complete a 15-minute consultation prior to enrollment to determine suitability for the program.
Prolonged Exposure (PE)
Prolonged exposure is an evidence-based type of cognitive behavioral therapy that guides individuals in gradually approaching trauma-related memories, feelings and situations. Most people understandably want to avoid anything that reminds them of the trauma they experienced, but in doing so actually reinforce their fear.
By facing the memories and situations in a controlled way, you will learn that trauma-related memories and reminders are not dangerous and do not need to be avoided. This treatment is strongly recommended by the American Psychological Association for the treatment of PTSD.
Prolonged exposure is ideally provided through weekly sessions over a period of about three months. The original intervention protocol is recommended as 90 minutes in length are usually needed in order for the individual to engage in exposure and sufficiently process the experience.
Treatment begins with an overview of treatment and understanding the patient’s past experiences. Sessions include psychoeducation and typically teach breathing techniques to manage elevated anxiety. Generally, after the assessment and initial session, exposure begins. As this is very anxiety-provoking for most patients, the therapist works hard to ensure that the therapy relationship is perceived to be a safe space for encountering very scary stimuli. Both imaginal and in vivo exposure are used in treatment at a mutually agreed upon pace.
Imaginal exposure occurs in session with the patient describing, with guidance, the trauma event in detail in the present tense. We will discuss and process the emotions raised by the imaginal exposure in session. The patient is recorded while describing the event so that she or he can listen to the recording between sessions, further process the emotions and practice the breathing techniques.
In vivo exposure, that is confronting feared stimuli outside of therapy, is typically assigned as homework. The therapist and patient together identify a range of possible stimuli and situations connected to the traumatic fear, such as specific places or people. They agree on which stimuli to confront as part of in vivo exposure and devise a plan to do so between sessions. The patient is encouraged to challenge him or herself but to do so in a graduated fashion so as to experience some success in confronting feared stimuli and coping with the associated emotion.
By facing the memories and situations in a controlled way, you will learn that trauma-related memories and reminders are not dangerous and do not need to be avoided. This treatment is strongly recommended by the American Psychological Association for the treatment of PTSD.
Prolonged exposure is ideally provided through weekly sessions over a period of about three months. The original intervention protocol is recommended as 90 minutes in length are usually needed in order for the individual to engage in exposure and sufficiently process the experience.
Treatment begins with an overview of treatment and understanding the patient’s past experiences. Sessions include psychoeducation and typically teach breathing techniques to manage elevated anxiety. Generally, after the assessment and initial session, exposure begins. As this is very anxiety-provoking for most patients, the therapist works hard to ensure that the therapy relationship is perceived to be a safe space for encountering very scary stimuli. Both imaginal and in vivo exposure are used in treatment at a mutually agreed upon pace.
Imaginal exposure occurs in session with the patient describing, with guidance, the trauma event in detail in the present tense. We will discuss and process the emotions raised by the imaginal exposure in session. The patient is recorded while describing the event so that she or he can listen to the recording between sessions, further process the emotions and practice the breathing techniques.
In vivo exposure, that is confronting feared stimuli outside of therapy, is typically assigned as homework. The therapist and patient together identify a range of possible stimuli and situations connected to the traumatic fear, such as specific places or people. They agree on which stimuli to confront as part of in vivo exposure and devise a plan to do so between sessions. The patient is encouraged to challenge him or herself but to do so in a graduated fashion so as to experience some success in confronting feared stimuli and coping with the associated emotion.
Cognitive Behavioral Therapy (CBT)
ERP, PE, and HRT are all types of Cognitive Behavioral Therapy. The CBT model is based on the premise that our thoughts, feelings, and behaviors are all connected and influence one another. Cognitive interventions include identifying unhelpful and distorted thinking, testing and modifying beliefs, and developing skills to distance from one’s thoughts. The premise is that the core beliefs and stories that we have developed about ourselves in childhood continue to impact our current behaviors. These stories are like lenses that distort our perceptions and experiences with others and can lead to self-fulfilling prophecies in relationships. Cognitive interventions help individuals understand how their conditioning from early childhood is impacting their current relationships and influencing their behaviors. The goal is to help individuals recognize the connection between thoughts, feelings, and behaviors to create behavioral flexibility.
CBT helps individuals take incremental, constructive steps towards replacing automatic and learned behaviors with positive new ones. In this type of therapy the patient is actively involved in his or her own recovery, has a sense of control, and learns skills that are useful throughout life. Through identifying distorted or negative thinking processes that influence behaviors, the therapist and client work together to replace old behaviors with alternative behaviors that are more effective, positive, and based on values. The goal is to develop skills to cope with your internal experiences so that they don’t stop you from taking actions towards creating the life that you want. CBT typically involves reading about the problem, keeping records between appointments, and completing homework assignments in which the treatment procedures are practiced. Patients learn skills during therapy sessions, but they must practice repeatedly to see improvement.
CBT helps individuals take incremental, constructive steps towards replacing automatic and learned behaviors with positive new ones. In this type of therapy the patient is actively involved in his or her own recovery, has a sense of control, and learns skills that are useful throughout life. Through identifying distorted or negative thinking processes that influence behaviors, the therapist and client work together to replace old behaviors with alternative behaviors that are more effective, positive, and based on values. The goal is to develop skills to cope with your internal experiences so that they don’t stop you from taking actions towards creating the life that you want. CBT typically involves reading about the problem, keeping records between appointments, and completing homework assignments in which the treatment procedures are practiced. Patients learn skills during therapy sessions, but they must practice repeatedly to see improvement.
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Indy Counseling Professionals
5660 Caito Dr. Suite 126 Indianapolis, IN 46226 |