Foundations of ERP & Clinical Context
- Overview of anxiety and avoidance cycles
- Habituation, inhibitory learning, and fear extinction
- DSM-5™ diagnostic criteria for anxiety and fear-based disorders
- Functional impairment and impact on daily life of clinical anxiety and fear
- Research, risks and limitations of ERP
Comprehensive Assessment & Case Conceptualization
- Standardized measures and structured interviews
- Functional analysis to identify triggers, safety behaviors, and avoidance patterns
- Identify maintaining factors
- Create a clear case formulation to guide ERP interventions
How to Build Effective Exposures
- Selecting exposure types: imaginal, interoceptive, in-vivo, and virtual reality
- Design graded exposure ladders with measurable steps
- Using and interpreting SUDS
- Write and review response prevention (RP) contracts
- Demonstration of exposure session planning and execution
Troubleshooting Common Challenges
- Address comorbid presentations
- Mental compulsions
- Detect safety behaviors and distraction
- Work with core fears rather than superficial triggers
- Risk management: safety planning and crisis protocols
Complementary Cognitive Strategies in ERP
- Role of cognitive therapy
- Common cognitive errors
- Non-attachment and “bossing back”
- Non-engagement responses
- Using humor in treatment
Special Topics, Ethics, and Relapse Prevention
- Informed consent
- Telehealth ERP delivery
- “Booster” sessions and maintenance strategies post-treatment
- Measure outcomes and track progress
ERP for Anxiety and Worry-Based Disorders
- Self-focused attention, negative self-imagery, anticipatory anxiety
- Covert safety behaviors
- Exposure targets: social performance, interpersonal risk-taking, spontaneity
- In vivo exposures with behavioral experiments
ERP for Panic Disorder & Agoraphobia
- Catastrophic misinterpretation of bodily sensations
- Agoraphobic avoidance, safety items
- Interoceptive targets + situational avoidance mapping
- In vivo exposures to avoided settings (crowds, driving, stores)
- Response prevention of checking, reassurance seeking
ERP for Obsessive-Compulsive Disorder
- Misinterpretation of thoughts, inflated responsibility, intolerance of uncertainty
- Identify covert mental rituals, reassurance loops, subtle avoidance
- Trigger – obsession – feared consequence – compulsion mapping
- Sort exposures into in vivo, imaginal, and behavioral experiments
ERP for Specific Phobias
- Classical conditioning, avoidance, catastrophic beliefs
- Safety behaviors
- Graded in vivo steps, use of variability and unpredictability
- Using in vivo exposures and “behavioral experiments”
ERP for PTSD
- Fear structures, trauma reminders, cognitive distortions about responsibility or danger
- Trauma type, triggers, dissociation, avoidance patterns
- Differentiate situational vs. memory-based avoidance
- Imaginal exposure (narrative retelling of trauma with processing)
- In vivo exposure to safe but avoided reminders


