Exposure and response prevention
Between-session practice log for exposure work
A week on one page. One line a day for what you practised and what you noticed, and three questions at the end that we start the next session with.
A4, free, no sign-up. The PDF is tagged for screen readers.
Why the week matters more than the session
Compulsions happen in the days between appointments, and so does the practice that weakens
them. In exposure and response prevention (ERP), where you face a trigger on purpose without
doing the compulsion, the session is where we plan and try things, and practice at home is
where the new response gets repeated until it becomes the usual one. This log brings that
week into the room, rather than relying on memory at the next session.
Filling in a row
The log is for use from the first week of exposure work. Each row needs a few words written
on the day, on paper or in a phone’s notes app, and a typical Wednesday for someone
working on checking might read like this.
Example row | Day | What I practised | Dropped the compulsion? | What I noticed afterwards |
|---|
| Wed | Locked the front door once and walked to the car without going back | Mostly. Checked the handle once in my head at the lights | Urge peaked at the corner, gone by the time I parked at work |
“Mostly” or “partly” is a useful answer in the middle column,
because a compulsion that was shortened, delayed or moved into your head tells us what to
plan next. In the last column, if the anxiety did not fade and you stayed with it anyway,
write that, because it is often the most useful line.
A missed week, and the evidence
Fill in what you can rather than leaving the week blank. A half-empty log with a note saying
work was chaotic from Tuesday still gives us something to plan around.
A 2010 meta-analysis by Kazantzis and colleagues, pooling 46 studies, found that therapy
with homework produced larger effects than the same therapy without it, and that people who
did more homework tended to do better. That second finding is a correlation, since people
who are already improving may find it easier to practise.