What Is ERP Psychology?
If you have ever heard two different people talking about ERP psychology, there is a chance the two conversations did not perfectly align. Like many other abbreviations, ERP can stand for more than one concept.
Although both subjects help mental health professionals understand human behavior, cognitive processes, and mental health, they are distinct. Keep reading to learn more about each of these topics and how they might apply to your life.
What is event-related potential?
In reference to brainwaves, “ERP” stands for “event-related potential.” Event-related potentials (also known as evoked-related potential, evoked responses, or evoked oscillations) focus on studying the brain’s electrical activity in direct response to a specific event or a sensory, cognitive, or motor stimulus. A highly sensitive device called an electroencephalogram (EEG) can measure the brain’s real-time neural responses in microvolts via electrodes that are adhered to the scalp. EEGs can measure activity to the millisecond.
Using event-related potential in psychology and medicine
Event-related potentials are essential elements of neuroscience psychology. Electroencephalograms (EEGs) are such perceptive machines that researchers can analyze the timing and intensity of event-related potentials to detect an individual’s cognitive processes, such as attention, memory, and language comprehension.
The latency between the stimulating action and the brain’s reaction represents the brain’s processing speed, and the amplitude of the waveform indicates the brain’s activation of recruited neurons to process the information. If an individual is tested throughout their life, medical professionals can identify cognitive changes — including cognitive decline — before symptoms are externally expressed.
In short, ERPs are powerful, noninvasive tools that allow neuroscientists to:
- Study an individual’s cognitive processes
- Diagnose and study cognitive disorders
- Explore developmental changes in the brain over time
ERPs provide an objective dataset that can help psychiatrists arrive at an accurate diagnosis for individuals experiencing mental issues such as schizophrenia and attention-deficit/hyperactivity disorder (ADHD). Following diagnosis and intervention, ERPs can be retested to assess the effectiveness of psychological treatments.
As ERPs bridge the gap between psychology and neuroscience, they are also applicable to medicine, as one might expect. For example, ERPs offer auditory screening opportunities among children and adolescents. Because the EEG records responses to stimuli, the doctor can readily determine whether the person can hear the auditory stimulus through an objective technique. ERPs can also be used to diagnose:
- Brain stem lesions
- Spinal cord injuries
- Multiple sclerosis
- Visual system disorders (especially before birth and in newborns)
What is exposure and response prevention?
“ERP” can also stand for “exposure and response prevention,” which is a therapeutic approach employed primarily for people with anxiety disorders, post-traumatic stress (PTS), and obsessive-compulsive disorder (OCD).
Exposure and response prevention therapy aims to help individuals gradually confront their fears in order to reduce the associated distress and compulsive behaviors. It is particularly effective for individuals with OCD: In one study, researchers found that up to 60% of people who participated in ERP experienced clinically significant improvement and long-term relief from their OCD symptoms.
It is important to note that while ERP therapy can be very effective, it is essential that it is conducted in partnership with a licensed health professional who understands the ethics of the approach.
How does exposure and response prevention therapy work?
The process of exposure and response prevention therapy can typically be broken down into five steps.
- Identification of triggers. Together, the individual and their licensed mental health professional identify specific triggers that provoke anxiety and/or compulsions. These triggers can range from situations to physical objects and vary widely.
- Hierarchy development. The licensed professional and the individual organize the triggers from least to most distressing. This hierarchy acts as a guide for gradual exposure.
- Exposure. Starting with the least distressing trigger, the individual is systematically exposed to the stimulus, often in a controlled environment. The trigger may be presented in the individual’s imagination, through discussion, or in real life.
- Response prevention. In this critical step, individuals refrain from engaging in their usual anxiety-reducing patterns.
- Anxiety management and habituation. Over time and with consistent ERP, individuals often learn that their imagined consequences of facing their fears are unlikely to occur, and their exposure anxiety will likely lessen over time. Habituation is another key factor in ERP.
Working with a mental health professional can help ensure that an individual moves at a pace that’s reasonably comfortable for them. If at any time the process becomes too overwhelming, the mental health professional will be there to intervene. Individuals can stop, take a break, and try again when they feel ready.
Using exposure and response prevention techniques
It is critical to note that exposure and response prevention is not simply facing fears — exposure is only half the process. ERP is also about applying response prevention techniques learned in therapy. This practice helps individuals recognize and challenge their beliefs about the necessity of their compulsions. Like any skill, this requires time and repetition to build up.
Over time, the therapist might recommend that the individual practice exposure and response prevention therapy on their own. Typically, this will only happen once they have demonstrated their fluency in the technique. Doing the work independently as well as alongside a therapist can be a powerful confidence booster and assist in an individual’s recovery journey.
How does CBT differ from exposure and response prevention?
Cognitive Behavioral Therapy (CBT) is a type of psychotherapy that operates on the assumption that people react and respond to different situations based on their thoughts and feelings about them. The idea behind CBT is to get individuals to recognize which of their thoughts are unhelpful and then shift them to be more productive. By changing how one views a situation, they can also shift their behaviors and choose healthier responses.
Exposure and response prevention is a branch of cognitive behavioral therapy in that both approaches offer systematic and practical methods of changing thoughts and behaviors. However, unlike CBT, ERP relies on an individual’s exposure to the feared stimulus along with a decision to resist engaging in any of the compulsions, avoidance behaviors, or rituals.
Supplementing exposure and response prevention with therapy
Anxiety-based mental health conditions like OCD and PTSD can be challenging to overcome alone and often require professional intervention. If you are experiencing symptoms that are affecting your daily functioning, speaking with a therapist could be helpful.
Traditional treatments for these mental health disorders can be costly and time-consuming, which may pose difficult barriers to getting the support you need. One alternative is online therapy, which is easily available through platforms like BetterHelp. With online therapy, you can connect with a licensed therapist using your preferred method, be it video chats, phone calls, or in-app messaging. The flexibility and convenience of this option may make it right for you.
Research has proven the effectiveness of online therapy in addressing a range of mental health concerns. Because numerous studies have shown that exposure and response prevention (ERP) is an effective first-line treatment for obsessive-compulsive disorder in particular, researchers sought to know whether these same results could be found using online ERP interventions. In one study, ERP was delivered via videoconferencing to 3,552 adults with an OCD diagnosis. Researchers found “clinically and statistically significant improvements, with a 43.4% mean reduction in obsessive-compulsive symptoms.” Participants also experienced reductions in anxiety, depression, and symptoms of stress, as well as improvements in quality of life.
What does ERP do to the brain?
Exposure and response prevention (ERP) therapy may increase the connectivity between different areas of the brain, specifically those that are commonly affected by OCD, like the cerebellum. This therapeutic approach may contribute to cerebellar recovery by safely exposing individuals to situations that commonly provoke obsessive thoughts and subsequent impulsive behavior. While those undergoing ERP therapy can experience some distress, participants may learn coping skills that will allow them to refrain from engaging in the compulsive behavior associated with their OCD.
Is ERP a type of CBT?
Yes, exposure and response prevention (ERP) therapy is a type of cognitive behavioral therapy (CBT). While other forms of CBT may be effective at treating a variety of mental disorders, ERP therapy can be particularly effective in the treatment of obsessive-compulsive disorder. The way that ERP therapy can treat obsessive-compulsive disorder is by exposing an individual to situations that may typically cause them to experience compulsive behavior. As a result, patients may become more accustomed to these situations and learn to resist the urge to perform compulsions, even when they feel distressed.
What is an example of ERP for OCD?
ERP therapy can take a variety of forms regarding OCD treatment, with one common example involving those who have contamination fears. Those experiencing contamination OCD may believe that dangerous germs coat every surface; as such, they may be afraid to touch surfaces or be compelled to overclean. ERP therapy could address this by having an individual touch a surface they believe is covered in germs and potentially experience distress while avoiding the associated compulsive behavior.
What does ERP feel like?
Because exposure and response prevention therapy works by exposing individuals to potentially distressing stimuli, it may cause feelings of fear or discomfort in participants. However, becoming more familiar with these situations and avoiding the associated compulsive behaviors may help someone experience a reduction in their OCD symptoms. ERP therapy participants may also start to become desensitized to the rumination or intrusive thoughts that may be associated with negative stimuli. This systematic desensitization may take a significant number of sessions but could lead to a better quality of life.
Does OCD get worse with ERP?
In some cases, it may be possible for ERP therapy to trigger a person’s obsessions in a way that may temporarily aggravate their symptoms or increase feelings of anxiety. In addition, OCD obsessions (which are often formed through classical conditioning) can be difficult to avoid, which may make treatments feel as though they are not initially working.
However, research has shown that ERP is one of the most effective forms of treatment for OCD, though there can be a significant percentage of participants who drop out of treatment prematurely. Termination of therapy can be due to a variety of reasons, but one cause may be the challenging nature of ERP. Because this therapeutic approach involves exposing an individual to stimuli that may trigger compulsions or other OCD symptoms, some may find the process uncomfortable and cease treatment early.
Does ERP make intrusive thoughts go away?
While ERP therapy may not eliminate intrusive thoughts entirely, it can show individuals ways to cope with these thoughts and potentially reduce their frequency. These outcomes may be accomplished through the process of habituation, which repeatedly exposes a person to stimuli that may induce fear or a need to engage in compulsive behavior. As a person acclimates to that stimulus, they may learn to address their intrusive thoughts and refrain from performing the compulsive rituals that would typically soothe their discomfort.
What are the disadvantages of ERP therapy?
While ERP therapy can be an effective way of treating OCD, there are several disadvantages one may experience. One drawback of ERP is the challenges one may face in finding a therapist trained in this specific technique. In addition, once a person does find an ERP therapist, they may find that the cost is too high or their insurance won’t cover the treatment.
This treatment approach can also be an uncomfortable process and may be time-consuming, as ERP involves the use of exposure techniques over multiple sessions. A person undergoing this type of therapy may need to be exposed to fear-inducing stimuli several times per week in order to experience symptomatic relief.
Is ERP used for PTSD?
While ERP therapy is commonly used for the treatment of OCD, it may also be effective at addressing the symptoms of PTSD. However, there are exposure treatments specifically designed for individuals experiencing trauma-related disorders, like prolonged exposure (PE). This type of psychotherapy teaches individuals how to address components of their trauma they may have been avoiding, including specific memories, emotions, or situations that relate to a traumatic event. ERP may also be effective at treating other mental health challenges (which may incorrectly be referred to as “mental health issues”), though whether it’s used will likely be decided by a healthcare professional.
Is ERP or CBT better for OCD?
While cognitive behavioral therapy (CBT) is often thought of as a single type of treatment, it actually contains a variety of therapy variations. Exposure and response prevention (ERP) therapy is a form of exposure therapy, which is itself a type of CBT. In fact, both CBT and ERP are considered first-line treatments for OCD, with an individual's cognitive therapy sessions often including ERP and other exposure exercises. Other CBT techniques, like relapse prevention planning, may also be used as a way to potentially improve one’s overall treatment outcomes.
Is EMDR better than ERP for OCD?
It is difficult to say whether EMDR or ERP is better for OCD, as both have been shown to be effective. Research also suggests that the two therapy types may have similar completion rates and clinical outcomes. However, OCD can present in different ways for each individual, and one therapy may be more effective for your specific experience. The best way to determine whether EMDR or ERP will be better for OCD is to speak with a licensed mental health professional. A provider may also recommend other forms of cognitive or individual behavior therapy depending on the severity and frequency of a patient’s symptoms.
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