60 Exposure and Response Prevention Questions to Ask Clients in Therapy Sessions –

Exposure and Response Prevention (ERP) is a form of Cognitive Behavioral Therapy (CBT) that is used to treat Obsessive-Compulsive Disorder (OCD). The prevalence of OCD within the  United States is estimated to be 2.3%, or 1 out of every 40 adults. With ERP, you will help your clients confront thoughts, objects, or images that provoke distressing symptoms, including anxiety and obsessions. The goal of this approach is to help your client experience their obsessions without engaging in compulsive behaviors to relieve their distress. Keep reading to learn 60 Exposure and Response Prevention questions to ask clients in therapy sessions.

It is natural for clients to experience an increase in their anxiety, uncertainty, or obsessional thoughts. In the initial stages of treatment, you will help them identify specific fears and compulsions. They will then create a hierarchy of anxiety-provoking situations. You will gradually help your client confront their fear within a safe, supportive, and controlled environment.

As a therapist, you will provide reassurance, real-time feedback, and help your client implement effective coping strategies. This can help them tolerate the distress that they experience and work to rewire their typical response to anxiety and other symptoms. A core component of ERP is a strong therapeutic alliance. This ensures that clients feel safe as they work through challenging emotions. Over time, clients will learn that nothing bad happens when they stop engaging in their compulsive behaviors.

Overall, 50% to 60% of those who complete ERP therapy show a clinically significant decrease in symptoms. Additionally, treatment gains are often long-term, which can increase your clients’ overall quality of life. 

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Getting Ready for Your First ERP Therapy Session with a New Client

You may find yourself feeling more prepared for your session with a new client if you take time to review the information that you have received so far about their concerns. This may include referral paperwork, self-assessment, pre-admission paperwork, or other forms of documentation. If their intake has been completed, you may have access to a complete biopsychosocial assessment. This can help you gain a clear picture of your client’s current concerns, clinical diagnosis, and overall level of functioning.

Once you have an idea of your client’s concerns, you can then begin to think of topics you would like to explore and how you would like your session to flow. You may find that worksheets are helpful in your initial session or later stages of treatment. TherapyByPro offers customizable and high-quality worksheets that can be used in clinical sessions. Examples of ERP worksheets that you may incorporate into your clinical questions include:

What ERP Therapy Questions Should I Ask In Sessions?

Questions can play an important role during various stages of ERP therapy. Initially, ERP questions can be used to help your client develop a hierarchy of feared situations or experiences. Questions can then be used to see how your client is feeling, allowing you to determine how you can best support them. You may also use questions to follow up on their experience and help them begin to recognize the discrepancies between their fears and the actual consequences that they experience. Continue reading for examples of ERP therapy questions that you can incorporate into your sessions:

1. Can you tell me what brought you in today?
2. What are you hoping to gain from treatment?
3. Could you describe your intrusive thoughts or fears in detail?
4. Do you have more than one trigger?
5. Is there a trigger that occurs more often than others?
6. Can you think of a trigger that causes more distress than others?
7. Can you describe the compulsion or avoidance behaviors that you engage in?
8. Can you think back to when you began having these fears or compulsions?
9. Was there anything that happened during that time of your life that may have contributed to the onset of your symptoms?
10. How much of your time would you say that your compulsions take daily?
11. Do you feel as though your compulsions have negatively impacted your relationships?
12. What are some ways in which you have tried to cope with or manage your symptoms?
13. Have you found any effective coping skills?
14. Do you believe that your symptoms have affected your work or academic performance?
15. If you were to wake up tomorrow without these fears and behaviors, how would your life be different?
16. Do you have any questions about ERP therapy?
17. Have you heard about ERP therapy before? If so, what is your understanding of it?
18. A component of ERP therapy is facing your fears. What emotions come up for you thinking about doing this?
19. How ready, or willing, are you to experience discomfort during your exposures?
20. Can you tell me about your support system outside of therapy?
21. Please share what has helped you cope with anxiety in the past.
22. In what ways do you feel I could best support you in treatment?
23. How would you rate your experience with ERP thus far?
24. Can you tell me about the physical sensations you experienced in your body during this exposure?
25. What were your thoughts like during your exposure?
26. How did they change when you were resisting engaging in your usual compulsions?
27. What coping skills or strategies helped you the most during this exposure?
28. Can you tell me about what the hardest part of today’s session was for you?
29. Did your feared outcome occur when you resisted?
30. What was that like for you when the consequence did not happen?
31. Would you be open to trying a more challenging exposure in your next session?
32. Are there any changes we could make to the next exposure to make it more impactful?
33. Can you tell me about the thoughts that were the most challenging for you during your exposure?
34. What strategies helped you the most when you were resisting engaging in the compulsions?
35. Have you noticed any changes in your triggers since we began ERP therapy?
36. How have your compulsions changed since beginning ERP therapy?
37. Can you tell me about any setbacks or moments of doubt that you’ve experienced?
38. Have you experienced any self-criticism during this process?
39. How can you incorporate compassion and kindness towards yourself as we continue in ERP therapy?
40. Have you received any feedback from others about changes they’ve noticed in you since beginning ERP therapy?
41. Are there any shifts or changes in your motivation since we began?
42. Can you tell me about your thoughts and emotions when an exposure does not go as we planned or hoped it would?
43. What compulsions have you been able to eliminate since beginning ERP?
44. Have you noticed any changes in the way that you manage anxiety since engaging in therapy?
45. Have any specific exposures been more impactful than others? Why do you think this one stands out?
46. Do you have any fears or concerns that you would like to address before ending treatment?
47. Have you thought about what will help you maintain your progress after therapy?
48. What are some signs you can notice when you’re beginning to struggle?
49. How could you cope with or manage setbacks?
50. How is your confidence about being able to maintain your progress?
51. Are there any lifestyle changes or habits that have helped you manage your symptoms?
52. What are some of the positive effects that ERP therapy has had on different areas of your life?
53. How have your thoughts shifted since we began ERP therapy?
54. What role do you feel that self-compassion and kindness will have in your recovery?
55. How can you challenge yourself in everyday life?
56. Do you feel as though ERP has affected your relationships?
57. What do you feel is your biggest takeaway from engaging in ERP therapy?
58. How do you feel that patience fits into your recovery?
59. Do you feel as though your quality of life is different from what it was when we began ERP therapy?
60. How has your ability to manage discomfort changed throughout the ERP therapy process?

Final Thoughts On Asking the Right ERP Therapy Questions in Sessions

We hope that this article has helped you gain insight into ERP therapy questions that you could incorporate into your counseling sessions with clients. ERP is an effective treatment option for OCD, though it may not be used as often as it could be. Over time, your client will begin to see a decrease in their anxiety symptoms, which can help them break the cycles associated with their OCD. Additional benefits to using this approach include improving their confidence and promoting independence. They may find that their emotion regulation skills have improved, which can help improve their overall quality of life.

A notable benefit to ERP therapy is that it can help your clients learn long-term strategies that help them manage their OCD symptoms. With long-term changes in behaviors and the use of regular self-compassion skills, you can provide whole-person care.

If you would like to learn more about ERP or begin gaining the knowledge and experience needed to utilize this approach in a clinical setting, we encourage you to explore continuing education and training experiences. With proper education, training, and supervision, you can develop the skills needed to effectively offer ERP therapy within your clinical setting.

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