Creating an ERP Treatment Plan: What to Include + Example

Exposure and Response Prevention (ERP) therapy is viewed as the first-line treatment, or gold standard of care, for treating Obsessive-Compulsive Disorder (OCD). OCD can be a severe, and debilitating, mental health disorder. This mental illness is known for causing distressing thoughts (obsessions) and repetitive behaviors (compulsions). These symptoms commonly cause significant distress, are difficult to control, and are time-consuming. In this resource, I highlight how to create an ERP treatment plan, and what you should include.

Studies have indicated that ERP is an effective treatment approach for OCD in both inpatient and outpatient treatment settings. It has also been found to have lasting results, helping clients maintain their symptoms for up to two years after completing treatment. ERP is grounded in the belief that clients can experience anticipatory anxiety about situations and environments that are known to be upsetting or cause distress. In an attempt to avoid experiencing unwanted distress, they can avoid situations and environments that are known to elicit these emotional reactions. By doing this, they are reinforcing their avoidance behaviors through the use of operant conditioning.

When we take this belief and apply it to OCD, we can understand that engaging in compulsions can decrease the anxiety that arises with obsessional thoughts. Engaging in these behaviors or rituals reinforces underlying fears, and strengthens both obsessions and compulsions. ERP focuses on helping clients learn to cope with and manage the distress they experience to decrease avoidance and compulsive behaviors.

ERP can be customized to your client’s needs, which means that it can occur within various levels of care. Shared characteristics across settings include psychoeducation about OCD, collaboratively identifying triggers for symptoms, exploring the relationship between obsessions and compulsions, and identifying the fear associated with not engaging in compulsions.

View all of our Exposure and Response Prevention Therapy Worksheets

Setting Goals and Objectives With Clients in ERP Therapy Treatment Plan

After you have completed your evaluations and assessment, you should have a better understanding of your client’s current symptoms, level of functioning, mental health history, and treatment goals. You may have had time to share knowledge about OCD with your client to help them better understand their mental health condition. If not, this should be a priority during your next session.

When you begin to develop your ERP treatment plan, we encourage you to ensure that your identified goals are appropriate for their symptoms and level of functioning, and are realistic given their current support and resources.

Many clinicians incorporate worksheets into sessions to reinforce discussion, and to promote participation in treatment.  TherapyByPro is a premier resource provider for mental health professionals, offering an assortment of ERP worksheets. Examples that could be incorporated into your ERP treatment plan for OCD include:

• Exposure and Response Prevention (ERP) Therapy Worksheet Bundle
• ERP Intrusive Thoughts and Compulsions Worksheet
• In Vivo Exposure Hierarchy Worksheet
• ERP Symptom Monitoring Worksheet

What to Include in a Treatment Plan for Exposure and Response Prevention

For the remainder of this article, we will focus on developing an exposure and response prevention therapy treatment plan using the treatment plan template available with TherapyByPro. Continue reading for John’s story:

John’s story:

John is a 23-year-old male who sought help due to continued distress from recurrent thoughts and behaviors. John explained that he has been struggling to get to class and other academic-related activities on time because of the time it takes him to leave his apartment. John experiences intrusive thoughts about germs and viruses, and the illnesses that they can cause. He often feels as though he is not clean, and showers multiple times per day, sometimes for over an hour. He reported washing his hands excessively throughout the day and experiencing dry skin on his hands. He explained that these thoughts tend to intensify in spaces that he feels are not clean, like public bathrooms, and some shared spaces on campus.

Because of his fear of germs, he avoids places on campus that he feels are dirty. This has led to complications with study groups, attending class, and interacting with his peers. John reported cleaning his apartment at least once per day, noting that he has multiple UV light cleaners in his apartment. He noted that he throws away items that he believes are contaminated, which has created challenges with his roommates at times.

John noted that he began experiencing these symptoms about 4 months ago and that they have worsened over time. He noted that just before he developed symptoms, he had a family member getting severely ill unexpectedly due to a viral infection. He recognizes that his behaviors and thoughts are extreme, which was a contributing factor to seeking treatment.

Agencies Involved and Plans for Care Coordination

In this case, it would be appropriate to refer him to a psychiatrist to explore if medications would improve his ability to manage his distress. The outpatient student counseling center you work in has a psychologist on staff he could meet with before your next session.

Example for John:

Care Coordination:Meet with Dr. Smith within the student counseling center, (123)456-7890.

Clinical Diagnoses

In this case, John is struggling with obsessive-compulsive disorder. The DSM outlines this condition, indicating that symptoms need to be present for a minimum of 2 weeks. Additionally, symptoms need to be time-consuming, and not result from substance abuse, medical conditions, or other mental health conditions. He experiences clear obsessions and delusions related to a fear of contamination and germs. He does have insight into his symptoms and recognizes that they are out of proportion

Example for John:

Clinical Diagnosis: Obsessive-Compulsive Disorder, 300.3 (F42), with good insight

Current Medications and Responses

John is not currently taking medications, though he has a referral with a medical professional. Medications can be used to help manage OCD symptoms, and you can modify this section of your treatment plan accordingly if needed. 

Example for John:

Current Medications: None at this time

Presenting Problem and Related Symptoms

This section of your treatment is designed for you to include a case conceptualization. This allows you to highlight the symptoms, challenges, and underlying causes of your client’s current mental health concerns. We encourage you to include details that can help others understand the direction taken in your treatment plan goals and objectives.

Example for John:

John, a 23-year-old college student, attended an initial assessment due to significant distress caused by recurrent intrusive thoughts and compulsive behaviors. He reported pervasive fears of germs and viruses, particularly concerns about contracting an illness. John described difficulty leaving his apartment due to prolonged rituals, including showering multiple times daily, often exceeding an hour. He also engages in excessive handwashing, resulting in noticeable dryness and irritation of his skin.

His distress intensifies in environments perceived as unclean, including public restrooms and shared campus spaces. This has led to avoidance behaviors that interfere with his academic responsibilities and social interactions. He noted challenges attending class, participating in study groups, and engaging with peers due to his avoidance behaviors. At home, he cleans his apartment daily, uses multiple UV light cleaning devices, and discards items he perceives as contaminated. This has contributed to tension with his roommates because they do not have the same perspectives and fears as him.

John reported the onset of these symptoms approximately four months ago, following a family member’s severe illness due to a viral infection. He recognized the excessive and intrusive nature of his thoughts and behaviors, which motivated him to seek professional help. He indicated that his symptoms have progressively worsened over time, and significantly impacted his daily functioning and quality of life.

Goals and Objectives

You will outline your specific goals with your client in this section. They should be realistic and attainable for your client. These can be modified when needed if you feel that they are not a good fit for where your client is in their recovery.

Example for John:

Goal 1: Decrease Compulsive Cleaning Behaviors

• Objective 1: Gradually limit his cleaning routine to include shorter time frames
• Objective 2: Using small increments of time, delay cleaning behaviors when the urge arises
• Objective 3: Exposure to items that are viewed as dirty without cleaning them

Goal 2: Reduce Avoidance Behaviors

• Objective 1: Gradual exposure to shared campus spaces, begin with spaces that lead to the least amount of anxiety, then move to more distressing environments
• Objective 2: Go in public restrooms, and learn to manage distress while remaining in this public space
• Objective 3: Use mindfulness practices to manage distress that arises during exposure exercises 

Goal 3: Decrease Excessive Showering Behaviors

• Objective 1: Limit showering to set durations at a specific time of the day
• Objective 2: Slowly go into unclean spaces and handle unclean objects without engaging in cleaning behaviors afterward
• Objective 3: Utilize response prevention strategies as distress tolerance skills for the urge to shower after exposure to unclean spaces and objects

Specific Interventions to Be Used

This section of your treatment plan will outline specific ERP interventions that can be used to complete your identified goals. This ERP treatment plan template allows you to note who is responsible for the technique, which can be a good reminder during later sessions.

Example for John:

Intervention 1:

Progressive Desensitization

Responsible person: Counselor A and John

Intervention 2:

Delay in Compulsive Behaviors

Responsible person: John

Intervention 3:

Restricted Cleaning

Responsible person: John 

Intervention 4:

Utilizing Breathing Strategies During Exposure Exercises

Responsible person: John

Intervention 5:

Cognitive Reframing

Responsible person: Counselor A and John 

Family Involvement

At this time, it does not appear necessary to engage his family as counseling.

Example for John:

Family Involvement: None at this time

Additional Services and Interventions

Since he is engaging in outpatient therapy, it may be beneficial for him to engage in group therapy sessions. You can review this option with him, reviewing the benefits, so he can decide if he would like to engage in this service 

Example for John:

Additional Services: Review available support group options

Estimation for Completion 

ERP treatment can last around 12 weeks. This time frame aligns with the typical duration of an academic semester. You can re-evaluate at the end of the semester and determine if additional treatment is required. 

Example for John:

Estimated Time for Completion: 12 weeks of biweekly individual therapy sessions

Aftercare Plans

The aftercare section of your treatment plan should be written to inform him of recommendations if he were to terminate treatment before you have achieved your treatment goals. You may need to modify this section of your treatment plan during different stages of treatment, to accurately reflect his progress. 

Example for John:

Aftercare Plans: Meet with primary care physician to obtain a referral for OCD treatment and support

Final Thoughts On Creating an ERP Treatment Plan

Thank you for taking time to read our article about developing an Exposure and Response Prevention Treatment Plan. It is understandable why ERP is the go-to treatment for clients living with OCD. It can help reduce overall distress, decrease avoidance behaviors, and help clients learn to sit with their anxiety symptoms. Learning healthy coping strategies can be helpful for various challenges in their life.

If you would like to learn more about how ERP can help clients feel confident about their ability to manage their obsessions and compulsions, we encourage you to explore available training and CEU opportunities within your niche of counseling. With the right knowledge, experience, and supervision, you can begin to implement ERP into your work with clients struggling with OCD.

TherapyByPro is an online mental health directory that connects mental health pros with clients in need. If you’re a mental health professional, you can Join our community and add your practice listing here. We have assessments, practice forms, and worksheet templates mental health professionals can use to streamline their practice. View all of our mental health worksheets here.

View all of our Exposure and Response Prevention Therapy Worksheets

Resources:

• Hezel DM, Simpson HB. Exposure and response prevention for obsessive-compulsive disorder: A review and new directions. Indian J Psychiatry. 2019 Jan;61(Suppl 1):S85-S92. doi: 10.4103/psychiatry.IndianJPsychiatry_516_18. PMID: 30745681; PMCID: PMC6343408.

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