By Dr. Holly Batchelder
When it comes to facing fears—whether it’s flying, public speaking, or social situations—you might have heard about both ERP (Exposure and Response Prevention) and exposure therapy. While they share similarities, these two approaches work differently, and knowing which one is right for you can make all the difference in your progress.
In this post, I’ll break down the differences between ERP and exposure therapy, how to know which one will work best, and whether you can combine the two.
ERP and Exposure Therapy: What’s the Difference?
At first glance, ERP and exposure therapy seem pretty similar—they both involve facing fears head-on. But there’s an important distinction:
ERP (Exposure and Response Prevention) is the gold standard for OCD (Obsessive-Compulsive Disorder). It involves exposing yourself to what scares you and preventing any compulsive behaviors or rituals that would normally relieve your anxiety.
Exposure therapy focuses more on habituation—getting used to a feared situation or experience (like flying) over time, until it no longer feels overwhelming. It’s often used for specific phobias or anxiety tied to situations, objects, or events.
Both approaches can help you confront what you’re avoiding, but the way they go about it—and what they target—are different.
When Does ERP Work Best?
ERP is especially effective if your fear is linked to obsessions and compulsions. With OCD, the anxiety isn’t just about a situation like flying; it’s also tied to intrusive thoughts and behaviors designed to “neutralize” those thoughts.
Example:
If you have a fear of flying and believe, “If I don’t say a specific prayer before takeoff, the plane will crash,” that’s an OCD-driven fear. You might feel compelled to say the prayer repeatedly or engage in rituals like tapping your seat to prevent disaster. ERP would help you confront the fear of not performing the ritual and sit with the discomfort that comes up.
How ERP Helps:
Exposure: You’d face the fear (e.g., getting on the plane).
Response prevention: You’d avoid performing rituals or compulsions (like not saying the prayer).
Goal: You learn that your thoughts don’t control the outcome and that anxiety will fade without rituals.
When Is Exposure Therapy the Right Fit?
Exposure therapy is ideal for specific phobias like a fear of flying that isn’t linked to compulsions. In these cases, the anxiety is often about the experience itself—like turbulence, takeoff, or feeling trapped—not about thoughts or rituals.
Example:
If you avoid flying because the idea of turbulence makes your heart race and you’re afraid of having a panic attack mid-flight, exposure therapy is likely the better fit. The goal is to gradually expose yourself to the fear until it no longer triggers the same level of anxiety.
How Exposure Therapy Helps:
Gradual exposure: You’d break the fear down into smaller steps, like visiting the airport or watching videos of takeoff, before booking a short flight.
Goal: Over time, your brain learns that the fear is manageable, and the anxiety decreases (habituation).
How to Know Which Approach Is Right for You?
Here’s how you can decide whether ERP or exposure therapy is the best approach for your fear of flying (or any fear):
Look at Your Patterns
Are you engaging in rituals (like tapping, saying prayers, or checking flight data) to feel safe? → ERP might be the right approach.
Are you simply avoiding flying altogether or relying heavily on distractions (like music or alcohol)? → Exposure therapy is likely enough.
Notice Your Thoughts
Do you believe your thoughts will cause harm (e.g., “If I think about crashing, it will happen”)? → This points to OCD and might require ERP.
Are your fears more tied to physical sensations (like panic or turbulence) rather than thoughts? → Exposure therapy will help you habituate to those sensations.
What’s Driving Your Behavior?
If you feel driven to perform compulsions to neutralize anxiety, ERP is essential.
If you’re more focused on avoiding situations that cause discomfort, exposure therapy is your best bet.
Can You Combine ERP and Exposure Therapy?
Absolutely! If your fear of flying has both OCD elements and avoidance behaviors, it’s possible to combine both approaches.
Example:
Let’s say you’re afraid of turbulence (phobia), but you also engage in checking rituals—like obsessively monitoring the weather or flight route (OCD). In this case, a blended approach might work:
Use exposure therapy to gradually face your fear of turbulence.
Apply ERP techniques to stop checking flight data and sit with the discomfort of not knowing.
Getting Started: Facing Your Fear Step by Step
Whether you need ERP, exposure therapy, or a combination, the key is to start small and gradually build your confidence.
Here’s a simple way to begin:
Create a fear hierarchy: List the steps involved in flying—from least to most anxiety-provoking (e.g., watching videos of takeoff, visiting the airport, booking a short flight).
Expose yourself gradually: Start with the smaller steps and work your way up, repeating each one until the anxiety fades.
Work with a therapist: If you’re unsure whether OCD or a phobia is at play, a therapist trained in ERP and exposure therapy can help you find the right path.
Final Thoughts: Freedom Is on the Other Side of Fear
Whether you use ERP, exposure therapy, or both, the goal is the same: to reclaim your freedom. Facing fears can be uncomfortable at first, but the reward is a life where you feel more in control—not your anxiety.
If you’re ready to take that first step, know that you don’t have to do it alone. Both approaches are powerful tools, and with the right support, you’ll learn that fear doesn’t have to hold you back.
References
Abramowitz, J. S. (1996). Variants of exposure and response prevention in the treatment of obsessive-compulsive disorder: A meta-analysis. Behavior therapy, 27(4), 583-600.
Wiederhold, B. K., Jang, D. P., Gevirtz, R. G., Kim, S. I., Kim, I. Y., & Wiederhold, M. D. (2002). The treatment of fear of flying: a controlled study of imaginal and virtual reality graded exposure therapy. IEEE transactions on information technology in biomedicine, 6(3), 218-223.