This CBT worksheet guides therapists and clients though the key steps of exposure and response prevention (EPR, EX/RP).
Offers theory, guidance, and prompts for mental health professionals. Downloads are in Fillable PDF format where appropriate.
Includes client-friendly guidance. Downloads are in Fillable PDF format where appropriate.
An editable Microsoft PowerPoint version of the resource.
Exposure and Response Prevention (ERP, also known as EX/RP) is an effective intervention for treating obsessive compulsive disorder (OCD). This worksheet serves as a comprehensive guide for therapists and clients, outlining the essential steps involved in the ERP process.
This resource supports the use of exposure and response prevention (EPR, EX/RP). It helps clients:
This resource is designed for clients experiencing obsessions and compulsions.
Pinpoint the obsession and related compulsion specific to the client.
Develop a shared understanding of how ERP will be beneficial.
Have the client face the identified trigger without engaging in compulsions.
Document subjective units of distress (SUDS) during exposure to track changes in anxiety levels.
Exposure and Response Prevention (ERP) is a first-line psychological treatment for obsessive-compulsive disorder (OCD), backed by decades of research and recommended in major clinical guidelines (Foa & Kozak, 1986; NICE, 2005). ERP involves helping clients gradually face anxiety-provoking situations, thoughts, or images (exposure) while resisting compulsive behaviours (response prevention). By tolerating anxiety without ritualising, clients learn that distress reduces over time and that feared outcomes are often unlikely or manageable. This process supports emotional regulation, weakens compulsions, and fosters cognitive change (Abramowitz, 1996; Franklin & Foa, 2011).
ERP is most effective when based on a collaborative formulation that identifies obsessions, compulsions, feared consequences, and avoidance patterns. Exposures are usually organised into a hierarchy, but varying intensity and sequencing may optimise learning by promoting surprise and maximising disconfirmation of feared beliefs (Kircanski et al., 2012). Crucially, response prevention must be maintained throughout. Without it, exposure may reduce fear temporarily but leave maladaptive beliefs intact. Therapists should watch for covert rituals or safety behaviours — such as mental checking or self-reassurance — that can undermine treatment effects (Rachman, 2003; Abramowitz et al., 2011).
While early models emphasised habituation — the reduction of anxiety through repeated exposure — more recent approaches focus on inhibitory learning, which highlights the formation of new, non-threatening associations. Clients don’t simply “get used to” fear; they learn that they can tolerate it, and that feared consequences may not materialise. This perspective shifts the emphasis toward violating expectations and building flexibility in how clients relate to distress (Craske et al., 2008). Clients are encouraged to track their distress using subjective units of distress (SUDS), which helps monitor progress and reinforce learning. Although habituation may occur, the broader aim is to build tolerance for uncertainty and shift underlying appraisals through corrective emotional experiences (Craske et al., 2014).
ERP consistently shows strong, lasting outcomes across a range of OCD subtypes, including contamination, checking, symmetry, and intrusive thoughts (Foa et al., 2005; McKay et al., 2015). Its effectiveness has been demonstrated across delivery formats, including individual, group, and intensive approaches (Olatunji et al., 2013). This resource supports ERP delivery by providing a clear framework for implementing exposure tasks, preventing rituals, and monitoring outcomes.
