Exposure Response Prevention (ERP)

In ERP, clients are gently and repeatedly exposed to anxiety-provoking situations, allowing them to experience discomfort without engaging in compulsions. Over time, this helps the brain learn that anxiety naturally decreases on its own. Clients begin to see that:

• Anxiety lessens even without performing compulsions.
• Feared outcomes are usually far less likely than OCD predicts.
• Distress and uncertainty can be tolerated.
• Avoidance and rituals only make anxiety stronger over time.

For example, a teen with contamination fears might start by touching a doorknob without immediately washing their hands. With practice, the anxiety fades, and the urge to wash becomes less powerful.

Through repeated and consistent practice, feared situations lose their intensity, and the compulsion to perform rituals weakens—allowing individuals to regain control and confidence in their daily lives.

In our Intensive Outpatient Program (IOP), ERP is integrated into daily treatment through structured exposures, skills building, and ongoing support.

Speak with our team to learn how ERP is integrated into our treatment programs.

Reduces OCD and Anxiety Symptoms:
Studies show ERP significantly decreases the intensity and frequency of obsessions and compulsions, with improvements that often continue well beyond treatment.

Breaks the Cycle of Avoidance:
Clients learn to face, rather than avoid, feared situations—regaining confidence in school, friendships, and daily activities that anxiety once limited.

Builds Distress Tolerance:
With consistent practice, clients discover they can handle anxiety and uncertainty without needing to escape or neutralize their fears.

Decreases Reliance on Compulsions: As clients see that feared outcomes don’t occur and anxiety naturally fades, the urge to perform rituals becomes less powerful.

Improves Daily Functioning:
Reducing time spent on rituals and avoidance allows clients to stay engaged in school, connect with peers, and participate more fully in everyday life.

Provides Long-Term Results:
ERP builds lifelong coping skills that help clients manage future anxiety or OCD flare-ups with greater confidence and independence.

At Anxiety Institute, 96% of clients report reduced anxiety or depression after treatment. Our specialized ERP program, supported by family involvement and intensive guidance, creates an environment where lasting progress is both achievable and expected. 

Core Components of ERP include:

Exposure:
Gradually and systematically facing the thoughts, images, objects, or situations that trigger anxiety or distress. For example, someone afraid of germs might touch a public surface without using a disinfecting wipe.

Response Prevention:
Resisting the urge to perform compulsions—such as washing, checking, or seeking reassurance—that temporarily ease anxiety but reinforce the OCD cycle.

Habituation:
Learning through repeated practice that anxiety naturally decreases on its own, without needing to engage in compulsions. Over time, the feared situation feels less threatening, and confidence grows.

Individual Exposure Therapy:
One-on-one sessions where clients work closely with their therapist to build a personalized exposure plan—starting with manageable challenges and gradually working up to more difficult fears. Therapists guide each step, helping clients face anxiety and resist compulsions.

In Vivo (Real-Life) Exposures: In our in-person model, clinicians lead exposures in real-world settings such as schools, grocery stores, or public spaces where anxiety often appears. This practical approach ensures progress carries over into daily life.

Imaginal Exposures:
When fears can’t be safely or easily recreated in real life—like worries about harm or unlikely catastrophes—clients use vivid imaginal scripts to face those fears in a controlled way, learning to sit with distressing thoughts without engaging in rituals.

Group Exposure Practice:
Clients take part in group-based exposures where they encourage each other through difficult challenges, normalize anxiety, and celebrate progress together. This shared experience builds connection, motivation, and confidence.

Response Prevention Coaching:
Throughout treatment, clinicians help clients identify subtle compulsions and avoidance behaviors, offering tools to resist urges with self-compassion and awareness. Parents also learn how to reduce accommodation and support response prevention at home.

Take-Home Exposure Assignments:
Between sessions, clients complete independent exposure exercises that reinforce learning and build confidence in managing anxiety without direct therapist support.

Parent Support and Coaching:
Parents are taught ERP principles and strategies to stop accommodating OCD through the SPACE (Supportive Parenting for Anxious Childhood Emotions) program. This family-focused approach strengthens recovery and promotes lasting change.

ERP at Anxiety Institute May Be Right for Your Child If:

• OCD or anxiety is significantly interfering with school, relationships, or daily activities
• Your child is spending excessive time on rituals, seeking reassurance, or avoiding feared situations
• Previous therapy has not provided sufficient relief from OCD symptoms
• Your family is ready to actively participate in supporting recovery and reducing accommodation

Our Treatment Options:

We offer ERP through both our Intensive Outpatient Program (IOP) for ages 12 to 25 and Outpatient Therapy for clients as young as eight. Our IOP provides 10 hours of targeted individual and group therapy weekly, including daily exposure practice, for those needing intensive support. Our outpatient services offer flexible, individualized ERP treatment, including in-person and virtual one-on-one therapy.

We work with bright, high-functioning young people to help them face their fears and take back control from OCD and anxiety. Our treatment is delivered in a supportive, collaborative environment that respects each client’s pace while maintaining the structure and accountability essential for successful ERP.

Take the next step, contact us to see if ERP at Anxiety Institute is right for your child.

Our locations:

• Greenwich, CT
• Madison, NJ
• McLean, VA

Our in-person model is especially effective for ERP, allowing therapists to guide clients through real-world exposures in the settings where anxiety occurs. This might include practicing in a public restroom, touching surfaces that feel “contaminated,” or facing uncertainty in social situations—all with professional support and coaching.

When appropriate, we also offer telehealth options for outpatient ERP therapy. However, in-person treatment is often preferred for more intensive exposure work.

International OCD Foundation – What is ERP?

American Psychological Association – Exposure Therapy

National Institute of Mental Health – OCD Treatment