This component of ERP includes exposing the patient to their trigger in real life. These triggers can be "objects, words, images or situations". These triggers are presented in a way so that triggers that cause less distress or fear are used in the beginning and patients work their way up to more distressing cues or triggers.

Exposure in vivo

This component of ERP involves the patient imagining the trigger rather being directly exposed to it. This is used in place of exposure in vivo for triggers that may be harmful for the therapist to expose the patient to in real life. If for example the patient is afraid of being infected with a serious disease if they go to a park and don't immediately wash their hands, the therapist can't in vivo them getting infected by a grave disease to expose them to their fear so they must take an imaginal approach instead to decrease the fear of getting sick by going to a park.

Imaginal Exposure

This component of ERP involves the patient preventing the compulsory action they typically carry out. This works to show the person that their compulsory action is not really necessary and that their fear won't come to fruition if they do skip out on this their ritual behavior.

Ritual Prevention

This is the final component where the patient dissects their experience with the therapist. They discuss concepts such as how the patient felt during the ERP, if the ERP confirms or contradicts their fear and if exposed to their trigger again how strong the urge for the compulsion will be now.

Processing

There are 4 main components to ERP
- Exposure in vivo
- Imaginal Exposure
- Ritual Prevention
- Processing

University of Michigan - Ann Arbor

A type of therapy where people with OCD work with a therapist to expose themselves to their obsession that induces the compulsory response and try to resist the compulsion a little by little. Continued exposure to the trigger can lead to a decrease in fear in relation to the trigger and can prevent the need for the compulsive behavior. Essentially this method of therapy gradually exposes the patient to their fears from the thing they are least fearful of working up and as they are exposed to the trigger they work with the therapists to find methods to prevent their compulsory response, and over time habituation allows the person to decrease their response. 

Exposure and Response Prevention (ERP)

Foa EB. Cognitive behavioral therapy of obsessive-compulsive disorder. Dialogues Clin Neurosci. 2010;12(2):199-207. doi: 10.31887/DCNS.2010.12.2/efoa. PMID: 20623924; PMCID: PMC3181959.
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3181959/

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