After our last blog, we received a question that is worth pursuing a little further. Here is the question: “I’m wondering if you can help me understand the difference between desensitization and exposure and response prevention (ERP). They feel very similar to me.  Is the difference really in the depths you are going? Does desensitization focus on the trigger? ”

We thought this was a great question and here are both of our responses:

Elizabeth DuPont Spencer: ERP or exposure and response prevention means that you do the trigger activity, and you stay with it.  Usually anxiety falls, but that isn’t the point.  The point is you didn’t do the response (compulsion for OCD, or avoidance for anxiety.)  You taught your brain that you could tolerate it.  

 In the old days of desensitization, we were looking for anxiety to go away to the triggering event.  We now know that isn’t always possible, and we frustrate people if we say it is the ultimate goal.  

 We people with anxiety can have spontaneous panic or new phobias because our brains just trigger easily.  It’s not a huge problem once we learn that we can tolerate the anxious feeling, and by not adding a lot of distorted thoughts (“oh no, I can’t take this;”  “darn it all, here it is again”)  the anxious feelings just move on by.

Kimberly Morrow:  You are correct, that desensitization focuses on the trigger. ERP focuses on the fear ( you may have an obsession about heights but your fear is not that you will fall, the fear is that you could push someone else over. You also may have fears of harming others in different trigger situations like walking by the water and pushing someone in). Just as important, ERP focuses on  your ability to develop anxiety tolerance so you can apply this skill to any triggering situation. (so when you face heights, you do not want to desensitize to heights, you want to learn to tolerate your thoughts about harming someone when you are up high or near the water and tolerate the accompanying anxiety without engaging in avoidance or safety behaviors).

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