The answer is, it might. But it is not the Exposure and Response Prevention (ERP) itself, rather is a result of unfavorable conditions or inappropriate applications.
Briefly, ERP methodically exposes individuals to anxiety-provoking stimuli while preventing safety behaviors. ERP helps to retrain the brain and reduce distress with repetitive practice.
I would say that most people have a least some reservations about trying the treatment called exposure and response prevention (ERP). There is evidence that as many as one in five will refuse to do it.[1] I have seen other articles suggesting even higher refusal rates. If you search on the topic, you can find professionals and clients who object to it.
I get it. I have treated hundreds of people and I have never met anyone who was excited about it. However, exposure and Response Prevention (ERP) is widely regarded as the most effective treatment for OCD, emetophobia and other anxiety-related conditions. If it is done correctly with favorable conditions, it can change your life.
So what are the conditions that would suggest ERP is not advisable?
Using it on the wrong problem
ERP should only be used for anxiety disorders. Anxiety disorders involve exaggerated cognitive distortions and the exposure process provides a correction to the error(s). It disconfirms the threat because the threat is inaccurate in some way. Additionally, It helps change dysfunctional expectations of the threat. Other types of problems with different dysfunctional beliefs that do not involve “overestimating threats” that are “reinforced by avoidance and safety behaviors” will not respond successfully and may even get worse like anger, addiction, depression, mood disorders, etc. It is contraindicated for anything but anxiety disorders.[2]
Not enough time
For emetophobia, assuming moderate to high anxiety, the bare minimum of sessions using ERP is approximately 15 or more. This is probably a minimum for OCD and other anxiety disorders as well. If the number of sessions is limited by insurance (private or national), finances or stopping treatment too soon, ERP is less likely to be effective and maybe counterproductive. ERP requires repetition, variability (e.g., time, stimuli used, situations, etc.) and motivation. If the exposure is too intense, patients will not continue. If there is no time to add in variability, even if the specific exposures are effective, the impact will not generalize. For example, if you are afraid of elevators, you have to be exposed to multiple elevators for treatment to be successful. Although some simple phobias can be treated within a few hours, that is virtually never the case with emetophobia, OCD, Panic disorder, etc.
Recently I was made aware of how, in a particular national healthcare system, ERP has gotten a very negative reputation in that country. This is especially true for those with emetophobia. In this particular system, CBT sessions are limited to 6 – 8 sessions. With any anxiety disorder, except for some specific phobias, this is completely untenable. I would imagine it would go something like this. One or two sessions to get the necessary background, explain the process, and provide enough psychoeducation for someone to be willing to even agree and somewhat understand ERP. That leaves 4 – 6 sessions. Then the provider has to make a decision. If one starts with less challenging exposures you won’t have time to make progress. If the provider decides the most headway will be gained by higher challenge exposures then it gets very intense, very quickly. In my experience, virtually no one will go home and practice that. Because the outcome desired is enough evidence to disconfirm the threat, this approach could have the opposite effect. Instead of disconfirming the danger, it might in fact, seem to prove the danger. If there is not enough time to even touch a normal hierarchy and the exposure cannot be repeated enough, it could backfire.
Unrealistic Expectations
You may not realize your expectations until you are surprised by them not being met. ERP may take longer and be harder than expected (way more than 6 sessions). Some individuals may expect ERP to “cure” their anxiety disorder quickly or eliminate the symptoms entirely. When this doesn’t happen, they may feel discouraged and stop treatment. It is more accurate to think of treatment as mastering a new set of skills rather than being “cured.” Like any other skill to be mastered, it takes time, persistence and practice/repetition. Be open to not knowing exactly what to expect, which is, of course, very hard when you are anxious. Ask questions. You need to understand the process as much as possible.
To summarize part 1, it is important that ERP match the problem as well as you have the time and resources to do it well and see it through. Anxiety disorders can have a massive impact. You have to be ready to respond with comparable energy and persistence to make the needed changes. Whatever it takes.
[1] Ong, C. W., Clyde, J. W., Bluett, E. J., Levin, M. E., & Twohig, M. P. (2016). Dropout rates in exposure with response prevention for obsessive-compulsive disorder: What do the data really say?. Journal of anxiety disorders, 40, 8–17. https://doi.org/10.1016/j.janxdis.2016.03.006
[2] Abramowitz J. S. (2013). The practice of exposure therapy: relevance of cognitive-behavioral theory and extinction theory. Behavior therapy, 44(4), 548–558. https://doi.org/10.1016/j.beth.2013.03.003
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