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Help! What to do when the E/RP is done? 3 Tips to Enhance Your Exposure Work

A common mistake I find clinicians making when utilizing Exposure and Response Prevention (E/RP) is not talking about what to do after an exposure. I would argue that what one does after an exposure is just as if not more important than the exposure itself. Keep in mind the only purpose of engaging in an exposure is to have the opportunity to practice response prevention. For example, if we touch something that we view as very contaminated, but proceed to wash our hands after, we continue to reinforce to our brain that whatever we just touched is super dangerous!

 

Ask yourself, how do we teach our brain something new? While yelling at our brains about how illogical anxiety can be is often a tempting route- think about how you can show your brain new information about safety and danger. Engaging in consistent and conscious response prevention teaches our brain that no additional action is required to be safe. But wait…there’s more! I must emphasize how important it is to CONTINUE ON with valued action after the formal E/RP. You’ve done your exposure…check…you’ve maintained response prevention…check…but what now?

 

First tip: Avoid Avoidance! It’s often tempting to “shut down” after ERP is done because emotions are still just so difficult to tolerate. Consider what information you give your brain when you stop your day after a difficult exposure…you’re showing your brain you can’t handle what you just did- and you likely just reinforced previous learning about how dangerous the trigger is.

 

Second tip: Values, values, values. So, you’ve decided you’re committed to moving on with your day after a particularly tough E/RP session- what’s next? Tap into your value system- ask yourself- what do I want to do or need to do that’s important to me? If you’re still feeling anxious this can be a particularly helpful north star when big emotions might otherwise lead to big avoidance.

 

Third tip: Caution…choose your exposure carefully! Creating an exposure hierarchy and rating how challenging each would be is certainly a useful way to figure out where to start, but let’s consider an additional component. When choosing an exposure think about which exposure you can complete AND continue with your day. Completing an exposure is often no easy task, but, as we explored above, what message are we sending when we complete an exposure and then engage in avoidance. Try to commit to both your E/RP and continuing with some value-driven behavior. This will help you further increase your distress tolerance and work toward creating new patterns of learning!


For more information on exposure work and how this can be a good addition to your treatment, please contact us!

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