Example Exposure and Response Prevention therapy (ERP) Workflow

For instructional purposes only.

Below you will find an example ERP workflow. This is based on a telehealth only practice and is only an example template that should be customized for each clients’ needs. It is highly recommended you also review the Exposure and Response (Ritual) Prevention for Obsessive-Compulsive Disorder: Therapist Guide (Treatments That Work) 2nd Edition (Foa, et al.) for additional direction in creating and implementing an ERP workflow.

Prior to Session:

Hello and welcome! I am looking forward to our upcoming appointment. We will use this messaging system for all communication outside of our sessions. You can expect a reply to your message within 24-48 business hours. Messaging can supplement our work together by providing a secure form of communication about appointments, homework completion, resources, etc. Messaging is not a substitute for counseling and excessive use of messaging in between sessions will be addressed and may result in billed time.

The Zoom link we use for our sessions will remain the same each time; the link will be included in reminder messages if you are signed up for these. 

Zoom session: INSERT ZOOM LINK HERE

If you have any questions please feel free to reach out, and I look forward to working with you soon.

With best regards,

INSERT NAME HERE

Session 1 - Self-monitoring and Psychoeducation Homework

Hello!  It was nice meeting you in our first session.  Here is the homework we discussed:

1. Listen to at least 1-2 podcasts about OCD. Here are some options:

2. Complete at least 8-10 entries on the self-monitoring form.

3. Review the Mental Rituals document (mental compulsions) and identify which mental compulsions you’ve experienced in the past and which ones you may be experiencing now.

4.  Read info about reassurance seeking vs. information gathering from the IOCDF here: https://iocdf.org/wp-content/uploads/2016/04/18-Information-seekers-vs-reassurance-seekers.pdf

5. Complete the psychological assessments** that will be sent before the next session. This will help us get a baseline measure and track your symptoms during our work together.

I hope you have a great week, and I look forward to our next session!

—

**(I send these psychological assessments through the online platform PsychSurveys. The assessments I request are based on my training and what is relevant to working with the specific clients. Some options you may want to include measure anxiety, depression, stress, OCD symptoms, and quality of life can also be helpful.)

Session 2 - Self-monitoring and Psychoeducation Homework

Hello, it was nice seeing you today. Here is the homework we discussed: 

1. Listen to 1-2 podcasts about OCD. Here are some options:

2. Read the following article to learn about the mental compulsion of rumination:  https://drmichaeljgreenberg.com/rumination-is-a-compulsion-not-an-obsession-and-that-means-you-have-to-stop/

3.  Read the following article about moral scrupulosity: https://www.sheppardpratt.org/news-views/story/moral-scrupulosity-ocd-part-one/

4.  Complete at least 8-10 entries on the self-monitoring form.

Session 3 - Self-monitoring and Psychoeducation Homework

Hello, it was nice seeing you today. Here is the homework we discussed: 

1. Choose a topic related to OCD that you’re interested in.  Find and listen to 1-2 podcasts on this topic.  Write down at least 2 things that stand out to you about each podcast episode.

2.  Continue to track any OCD symptoms not yet discussed and added to the ERP hierarchy.

Session 4+ - ERP Homework

Hello, it was nice seeing you today. Here is the homework we discussed: 

1. Choose a topic related to OCD that you’re interested in.  Find and listen to 1-2 podcasts on this topic.  Write down at least 2 things that stand out to you about each podcast episode.

2. Practice ERP for at least 20-45 mins / day using the following exposures:

LIST EXPOSURES HERE

LIST DAYS OF THE WEEK AND SPECIFIC TASKS THE CLIENT WILL DO

CREATE A GOOGLE FORM OR USE A HIPAA COMPLIANT APP FOR THE CLIENT TO LOG ERP HOMEWORK COMPLETION.

Homework Instructions for the Client

ERP Homework Instructions:  Set the timer for 20-45 minutes. Engage in the exposure. Pause to use non-engagement responses at any “pain points” or times you find yourself wanting to engage in compulsions in order to help yourself sit with the uncertainty and discomfort.

Track your SUDS (0-10 scale) levels: Keep a paper next to you that you can use to track your anxiety/distress/discomfort/guilt/etc. 

  1. To start, rate how much you think this exposure will cause you to experience anxiety/distress/discomfort/guilt/etc. (anticipatory anxiety). 

  2. Once you start the exposure, approximately every 2-5 minutes ask yourself, on a scale of 0-10, 10 being highest, how much anxiety/distress/discomfort/guilt/etc. am I experiencing related to this specific exposure I am doing right now? 

  3. Notice any patterns. Was the actual experience less, equal to, or more uncomfortable than you anticipated?