Exposure and Response Prevention (ERP) Training

Credit

Program Information

All members of the PESI, Inc. planning committee have provided disclosures of financial relationships with ineligible organizations and any relevant non-financial relationships prior to planning content for this activity. None of the committee members had relevant financial relationships with ineligible companies or other potentially biasing relationships to disclose to learners.  For speaker disclosures, please see the faculty biography.

Handouts

Speaker

Madina Alam, LMHC Related seminars and products

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Madina Alam, LMHC, is a licensed therapist and founder of Mental Health Madina, PLLC. She specializes in anxiety disorders, with a focus on Exposure and Response Prevention (ERP) for OCD, panic disorder, and agoraphobia. Madina provides therapy, training, and education for clinicians and is passionate about making evidence-based anxiety treatment accessible and practical. She earned her master’s degree from the University of Albany, is licensed in both New York and North Carolina, and is also a certified yoga instructor. She also hosts nationwide mental health events focused on reducing stigma and creating spaces where vulnerability is celebrated.

 

Speaker Disclosures:
Financial: Madina Alam is the founder and therapist at Mental Health Madina, PLLC. She receives compensation as a CEU instructor and speaker. She also receives a speaking honorarium from PESI, Inc. Madina Alam has no relevant financial relationships with ineligible organizations.
Non-financial: Madina Alam has no relevant non-financial relationships.

 

Additional Info

Program Information

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Objectives

1. Analyze cognitive, behavioral, and neurobiological findings that inform the development of exposure therapy strategies.
2. Identify the DSM-5 diagnostic criteria for OCD, Panic Disorder, Illness Anxiety Disorder, and Agoraphobia.
3. Summarize the evidence base for ERP.
4. Identify avoidance cycles and maintaining factors using functional analysis tools.
5. Restate the rationale for eliminating safety behaviors during exposure-based treatments for anxiety.
6. Examine the role of inhibitory learning in extinction and how this process can impact exposure therapy outcomes.
7. Choose exposures that ensure appropriate sequencing based on fear intensity ratings.
8. Use various exposure modalities (imaginal, interoceptive, in vivo, or virtual reality) for case scenarios for clients with OCD, anxiety, panic disorders and agoraphobia. 
9. Develop response prevention contracts, including client commitments and therapist responsibilities.
10. Analyze ethical issues, client safety, informed consent, and professional responsibility in the use of exposure therapies. 
11. Compare the advantages and limitations of telehealth versus face-to-face delivery for anxiety and OCD. 
12. Integrate Exposure and Response Prevention with ACT, CBT, and mindfulness techniques. 

Outline

Foundations of ERP & Clinical Context

• Overview of anxiety and avoidance cycles
• DSM-5™ diagnostic criteria for OCD, PD, IAD, and agoraphobia
• Functional impairment and impact on daily life
• Behavioral principles: habituation, inhibitory learning, and fear extinction
• Review of research evidence, efficacy rates, and limitations of ERP

Comprehensive Assessment & Case Conceptualization

• Standardized measures and structured interview
• Functional analysis to identify triggers, safety behaviors, and avoidance patterns
• Identity maintaining factors
• Create a clear case formulation to guide ERP interventions

How to Build Effective Exposures

• Design graded exposure ladders with measurable steps
• Write and review response prevention (RP) contracts
• Select exposure modalities: imaginal, interoceptive, in-vivo, and virtual reality
• Demonstration of exposure session planning and execution

Troubleshooting Common Challenges

• Common barriers to exposure therapies
• Working with low motivation, resistance, or ambivalence
• Address cultural factors, religious beliefs, and stigma
• Modify ERP for clients with high shame or perfectionism
• Risk management: safety planning and crisis protocols

Special Topics, Ethics, and Relapse Prevention

• Telehealth ERP delivery
• Informed consent
• Scope of practice and interprofessional collaboration
• “Booster” sessions and maintenance strategies post-treatment
• Measuring outcomes and tracking progress
• Develop a long-term implementation plan

ERP for OCD: Step by Step

• Identify obsessional themes and compulsive behaviors
• Differentiate between mental rituals vs. overt compulsions
• Combine ERP with mindfulness and cognitive interventions

ERP for Anxiety & Panic Disorders

• Target catastrophic misinterpretations of bodily sensations
• Interoceptive exposure techniques and safety behavior elimination
• Manage anticipatory anxiety and avoidance patterns
• Working with illness anxiety disorder (IAD)

ERP for Agoraphobia

• Exposure to feared environments using real-world and simulated contexts
• Incorporate client values to enhance treatment adherence
• Gradual generalization to complex social and travel situations

Integrate ERP for Comorbidity

• Working with co-occurring depression, PTSD, or substance use
• Integrate with other therapeutic modalities (ACT, CBT, mindfulness)
• Sequence treatment priorities for best outcomes

Target Audience

• Counselors
• Social Workers
• Psychologists
• Marriage and Family Therapists
• Allied Health Providers
• Registered Psychotherapists
• Nurse Practitioners