Exposure and response prevention
Exposure planner: one sheet for each exposure
One sheet per exposure. You write down what you expect before you start, then what actually happened and what you learned, so it is on paper and cannot be quietly forgotten.
A4, free, no sign-up. The PDF is tagged for screen readers.
Who the planner is for
The planner is for adults and teenagers doing exposure and response prevention (ERP) for
OCD, which means facing a trigger on purpose and not doing the compulsion, and for people
facing a phobia, panic or health anxiety. Younger children can use it with a parent holding
the pen. It is useful once exposure work has started, and for the rest of treatment.
Planned, not accidental
An exposure on this sheet is something you decide to do in advance: what you will face,
when, and what you will leave out. Facing a trigger that turned up on its own and getting
through it is worth noticing, and you can note it on the
practice log, but it does not get a sheet. In an
unplanned encounter you usually do not know what you were going to leave out, the
compulsion often slips in without a decision, and afterwards it is hard to say what was
learned. A planned exposure is the opposite: the compulsion is named before you start, so
when it is over you can see that you managed without it, and that is the learning the
treatment is built on.
Why the Before section is filled in first
Once the outcome is known, memory rewrites what you expected, and someone who expected to be
overwhelmed will often say afterwards that they knew it would be fine. That matters most for
the expectation people with OCD have about themselves, that they will not be able to stand
the anxiety or the not knowing, because that is the one an exposure answers most directly.
The feared outcome is different. If the fear is that you might one day harm someone, no
exposure can settle it, and trying to would turn the sheet into one more compulsion, so that
line about the feared outcome is worth filling in only for fears that can be checked, such
as fainting in a panic attack.
An example of the first half filled in
This is the Before section for someone with contamination OCD whose exposure is to touch
the kitchen bin and then make a sandwich.
Example entries | On the sheet | What they wrote |
|---|
| The exposure, and when | Tomorrow, lunchtime. Touch the bin lid with my right hand, then make and eat a cheese sandwich without washing. |
|---|
| What I am not going to do | Wash, wipe my hands on my jeans, hold the bread in kitchen roll, or ask Sam if the bin is clean. |
|---|
| What the OCD says will happen | If I don’t wash I might pass something on to the kids, and I’ll feel so dirty I won’t manage more than one bite. |
|---|
| How strongly I believe it | 85 |
|---|
Afterwards they might write that they ate the whole sandwich, that the anxiety was high for
about forty minutes and then faded, and that they felt dirty for most of the evening and
still did not wash. Whether anything gets passed on is left open, because one sandwich
cannot answer that. The line about anything that made it easier often shows a small
protective habit to drop next time, such as eating with the other hand, and the belief
rating at the end is about whether they could handle it, which they now know they could.
Where it can go wrong
A common problem is judging the exposure by how anxious you felt. An exposure where
the anxiety stayed high and you still did not wash has done its job, provided you do not
undo it later by washing or by going over it in your head until it feels safe. With OCD, if
you find yourself going over what the OCD said for certainty, stop; the sheet is about how
you handled it, not whether the fear was true.
The overall approach is well supported, but most of the evidence for the individual
techniques comes from laboratory studies and from treatments that combine several of them,
and few clinical trials separate them out.