In-Vivo Versus Imaginal Exposures in ERP

Written By Eliane Nevares

Exposure and Response Prevention (ERP) is a highly effective modality that was developed to treat Obsessive Compulsive Disorder (OCD).

A fundamental part of ERP is the integration of exposures. By confronting exposures that trigger the obsessive thought while consciously not engaging in the compulsive behaviours, clients will find themselves back in the driver’s seat as opposed to the OCD being in control.

There are two types of exposures in ERP. Below you will find a description of both.

In-Vivo Exposures

  • Real-life, direct confrontation with fear objects and/or situations

  • Used when the fear trigger exists in the real world and is safe to face (e.g. contamination fears or social anxiety)

  • An example may be touching a “contaminated” door knob without washing hands afterwards

  • The goal is to break the link between the fear and avoidance in the real world

Imaginal Exposures

  • Confronting feared thoughts, images, or scenarios in the mind via storytelling or scripts

  • Imaginal exposures are spoken in first-person and in “live time”

  • Used when the fear is internal, abstract, or can’t be safely recreated (e.g. intrusive thoughts related to harm or sexual obsessions)

  • An example may be writing and/or listening to a story about accidentally harming someone

  • The goal is to expose the person to distressing thoughts or scenarios that are not possible to face in the real world 

If you are interested in booking a Discovery Call to learn more about ERP, feel free to be in touch directly. I look forward to hearing from you soon and supporting you in your healing journey!

Eliane Nevares
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Challenging Cognitive Distortions