Exposure and Response Prevention (E/RP) Therapy

Exposure and Response Prevention typically requires 12-20 weekly sessions, though this can vary significantly based on symptom severity, the complexity of your fear hierarchy, and your pace of progress. Some clients with milder symptoms may see significant improvement in 8-12 sessions, while those with more severe or complex OCD may benefit from longer treatment. At Coast Psychology, we customize treatment length to ensure you achieve lasting results.

While E/RP is considered a specialized form of Cognitive Behavioral Therapy, it differs in several key ways:

• E/RP focuses more intensively on behavioral change through exposure exercises

• Standard CBT typically emphasizes cognitive restructuring (changing thoughts)

• E/RP sessions are often longer (60-90 minutes) to allow for exposure practice

• E/RP specifically targets anxiety disorders and OCD, while CBT addresses a broader range of conditions

• E/RP includes a stronger emphasis on preventing safety behaviors and compulsions

For many anxiety disorders, particularly OCD, E/RP has shown superior effectiveness compared to standard CBT approaches.

E/RP does involve facing situations that create anxiety, which can be challenging. However, our approach is:

• Gradual – starting with moderately difficult exposures, not your worst fears

• Collaborative – you're always in control of the pace and intensity

• Supportive – your therapist provides guidance and encouragement throughout

• Structured – the discomfort has a purpose and leads to meaningful improvement

Many clients find that while E/RP is challenging, the freedom from anxiety and OCD they gain makes the temporary discomfort worthwhile. Most also discover that their fears about doing exposures are worse than the actual experience.

Yes, E/RP is highly effective for children and adolescents with OCD and anxiety disorders. Our child specialists adapt exposure techniques to be age-appropriate and engaging, often incorporating play, games, and rewards. Parents are typically involved as "coaches" who learn to support their child's exposures between sessions. Research shows that children often respond very well to E/RP, with many experiencing significant symptom reduction in fewer sessions than adults.lone. At Coast Psychology, we collaborate with psychiatrists when medication might be beneficial alongside therapy.

Yes, Exposure and Response Prevention therapy can be effectively delivered through telehealth for many clients. Coast Psychology offers secure, HIPAA-compliant virtual E/RP for clients throughout New York State. Virtual sessions allow for:

• Real-time guidance during home-based exposures

• Access to naturally occurring triggers in your environment

• Parent coaching for children's exposures

• Convenience for those with travel limitations or busy schedules

For some exposure exercises, in-person sessions may be preferable, but our therapists are skilled at adapting E/RP techniques for the telehealth format.

A common misconception about E/RP is that it throws you into your worst fears immediately. In reality, effective E/RP:

• Begins with moderately challenging exposures (typically items rated 4-5 on a 10-point anxiety scale)

• Progresses at your pace, with your consent at each step

• Builds on successes to gradually work toward more challenging situations

• Provides skills and support to manage the anxiety that arises

While effective E/RP does involve experiencing some anxiety, successful treatment doesn't require overwhelming terror. The goal is to face situations that are challenging enough to learn from but manageable enough to tolerate.

To prepare for starting E/RP therapy:

• Consider keeping a brief log of anxiety triggers, avoidance behaviors, or compulsions

• Think about how your symptoms impact your daily life and what activities you'd like to reclaim

• Prepare to discuss your anxiety history, including when symptoms began and what treatments you've tried

• Come with questions about the E/RP process

• Be open to learning a new approach to managing anxiety

Remember that your first session will focus primarily on assessment and education—exposure exercises typically begin in session 2 or 3 after you and your therapist have developed a clear treatment plan.

To maximize your E/RP therapy experience:

• Commit to between-session exposure practice

• Be honest about avoidance and compulsive behaviors

• Track your anxiety levels during exposures

• Stay in the exposure until anxiety naturally decreases

• Resist seeking reassurance or performing subtle rituals

• Celebrate progress, even small victories

• Approach the process with patience and determination

Remember that E/RP is a skill-building process—the more consistently you practice, the more quickly you'll see results.