What is ERP with Teens
Exposure with response prevention (ERP) is a well-researched treatment that has been shown to help teens with Obsessive Compulsive Disorder (OCD) or severe anxiety. It is not unusual for teens with OCD to avoid situations that trigger their obsessive thoughts or to get stuck in rituals or routines (i.e., compulsions) that are meant to bring down their anxiety. While anxiety naturally brings on an urge to avoid, ERP approaches avoidance and compulsions as short-term solutions that may temporarily bring down anxiety, but keep fears around longer and eventually cause long-term problems at home, at school, and with friends. ERP helps fix this pattern by encouraging teens to approach rather than avoid their anxiety so that they can build resilience to their anxiety, learn that they can cope with difficult situations, and regain a sense of control over their lives.
ERP has three primary components.
- Learning about OCD and anxiety: the therapist helps teens identify what triggers the anxiety, what the anxiety feels like, and how they cope with or avoid their anxiety.
- Exposure: teens are taught skillful ways to gradually approach situations that trigger obsessive thoughts or bring on the urge to engage in rituals or routines.
- Response prevention: teens are taught alternative strategies for responding to their obsessive thoughts and anxiety so that they can get unstuck from their routines or rituals.
The goal of ERP is to help teens learn how to cope with their anxiety effectively, rather than living a life controlled by their anxious thoughts.
Therapeutic Components:
- Structure: ERP is a structured type of talk therapy that requires a commitment to practicing skills and meeting weekly. Sessions are structured around learning and practicing new skills and trying out new exposure tasks.
Theory: ERP is anchored in the theory of exposure. Exposure theory believes that our anxiety gets strengthened and sticks around for longer when we avoid the things we fear. By learning skills to approach their fears, teens can decrease how intense their fears are, how long their fears last, and the impact of their fears on their lives.
Modalities: the TAP clinic currently offers ERP with an individual therapist. For parent support, we recommend our Supportive Parenting for Anxious Childhood Emotions (SPACE) program.
How are parents included in treatment?
We know from research and experience that ERP treatment with teens is most effective when parents understand changes that their teens are making and help support them at home! We also know that many teens benefit from having a private space to process their emotions and take ownership over their treatment. Parental involvement in individual therapy may look like periodic check-ins at the start or end of session and/or brief overviews of skills learned during the session.
Oftentimes, families can also get stuck in the anxiety and OCD cycle because it can feel like there are no other choices than to help teens avoid feared situations or participate in their routines or rituals. We typically recommend that parents also receive parenting support through our Supportive Parenting for Anxious Childhood Emotions program (SPACE). SPACE helps parents make changes at home that will help support and strengthen the work that their teens are doing in ERP therapy.
It’s also not uncommon for teens to refuse or to not be ready to engage in ERP treatment due to a number of factors (e.g., motivation, time commitment). When teens are not willing or ready to be involved in treatment, we recommend that parents become involved in our SPACE program, which has been shown to be effective on its own to improve and treat OCD in teens.