A Beginners Guide To Therapy: Inhibitory Learning vs ERP

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As therapists, we often use various techniques to help our clients manage their mental health issues. Two such techniques are Exposure and Response Prevention (ERP) and Inhibitory Learning. Though these methods aim to help people overcome fears and anxieties, they do so in slightly different ways. Let’s dive into what these terms mean and how they compare, using language that’s easy for everyone to understand.

What is ERP?

ERP stands for Exposure and Response Prevention. It’s a type of therapy that’s especially effective for treating obsessive-compulsive disorder (OCD). Here’s a simple way to understand it:

  1. Exposure: This part involves gradually facing the things that make you anxious or afraid. For example, if someone has a fear of germs, they might start by touching a doorknob, then a table, and eventually something more challenging, like shaking hands with someone.
  2. Response Prevention: This means not doing the things you usually do to feel safe or less anxious after the exposure. In the case of the person afraid of germs, it would mean not washing their hands right after touching something they think is dirty.

The idea behind ERP is that by facing your fears and not performing your usual safety behaviors, your brain will learn that the feared situation is not as dangerous as it seems. Over time, your anxiety decreases.

What is Inhibitory Learning?

Inhibitory Learning is a newer way of thinking about exposure therapy. While it still involves facing fears, it focuses more on what your brain learns during this process. Here’s how it works:

  1. Learning New Associations: Instead of just trying to reduce fear, inhibitory learning aims to create new, positive associations with the things that make you anxious. For example, if you’re afraid of dogs, you might learn to associate dogs with fun and positive experiences, rather than just trying to make the fear go away.
  2. Strengthening These Associations: The goal is to make these new, positive associations stronger than the old, negative ones. This helps the brain ‘inhibit’ or block out the fear response when encountering an anxiety-provoking situation.
  3. Variety and Unpredictability: Inhibitory learning emphasizes the importance of varying the exposure exercises and making them less predictable. This helps the brain learn that safety can be found in many different situations, not just the specific scenarios practiced during therapy.

Similarities Between ERP and Inhibitory Learning

Both ERP and inhibitory learning share some key principles:

  1. Facing Fears: Both methods involve confronting the things that make you anxious or fearful. This is a crucial part of both therapies because avoiding fears usually makes them stronger.
  2. Reducing Anxiety Over Time: Both approaches aim to reduce the power that fear and anxiety have over you. By repeatedly facing what scares you, your brain gradually learns that the situation is not as threatening as it initially thought.
  3. Behavior Change: Both therapies encourage changing your behavior in the face of anxiety. For example, if you usually avoid dogs because you’re afraid of them, both ERP and inhibitory learning would involve you spending time around dogs.

“Do the thing you fear, and the death of fear is certain.”

– Ralph Waldo Emerson

Differences Between ERP and Inhibitory Learning

While ERP and inhibitory learning share some similarities, there are also key differences in their approach and focus:

  1. Goal of Exposure: In traditional ERP, the goal is to reduce the anxiety associated with the feared object or situation. In contrast, inhibitory learning focuses more on creating and strengthening new, positive associations. It’s not just about reducing fear but building a new way of thinking about the fear.
  2. Role of Safety Behaviors: ERP strictly avoids safety behaviors, believing that they prevent the full experience of exposure. Inhibitory learning, however, sometimes allows for minimal safety behaviors if they help maintain engagement with the exposure exercises. The focus is more on what is learned rather than what is avoided.
  3. Use of Variety and Unpredictability: Inhibitory learning places a stronger emphasis on varying the exposure scenarios. The idea is that by mixing things up and making them less predictable, the brain learns to generalize the feeling of safety to a wider range of situations. ERP can be more structured and predictable, focusing on specific feared situations.
  4. Measurement of Success: Traditional ERP often measures success by the reduction in fear and anxiety levels. Inhibitory learning, on the other hand, looks at how well new, non-fearful associations are formed and how these new associations can inhibit the old, fear-based ones.

Practical Examples

Let’s look at some practical examples to see how these differences play out:

Example 1: Fear of Public Speaking

  • ERP Approach: If you’re afraid of public speaking, ERP might involve gradually increasing your exposure. You might start by speaking in front of a small, supportive group, then move on to larger groups, and finally give a presentation to a large audience. Throughout this process, you would avoid any safety behaviors like reading from notes or looking only at friendly faces.
  • Inhibitory Learning Approach: In contrast, inhibitory learning would also have you practice public speaking but with more variety. You might practice speaking in different settings, to different types of audiences, and under different conditions (like with and without notes). The focus would be on learning that you can handle these situations in many different ways, not just reducing the anxiety.

Example 2: Fear of Germs

  • ERP Approach: For someone with a fear of germs, ERP would involve touching ‘dirty’ objects and then not washing hands afterward. Over time, the person would learn that nothing bad happens even without washing their hands.
  • Inhibitory Learning Approach: In this case, inhibitory learning might include touching various objects perceived as dirty in different ways and different contexts. The aim would be to create new associations with these objects, such as feeling accomplished or proud for facing the fear rather than just reducing the anxiety.

How Therapists Use These Approaches

As therapists, our goal is to help clients find the most effective way to manage their fears and anxieties. Here’s how we might decide between ERP and inhibitory learning:

  1. Client’s Needs and Preferences: Some clients may respond better to the structured approach of ERP, while others might benefit more from the flexibility of inhibitory learning. We take into account each client’s unique situation and how they respond to different types of interventions.
  2. Nature of the Fear: The type of fear or anxiety can also influence the choice of approach. For example, specific phobias might be well-suited to ERP, while generalized anxiety or complex OCD cases might benefit more from the varied approach of inhibitory learning.
  3. Therapy Goals: The goals of therapy can also guide the choice. If the primary goal is to reduce anxiety in specific situations, ERP might be the best fit. If the goal is broader, such as improving overall resilience to anxiety, inhibitory learning could be more effective.
  4. Progress and Feedback: We constantly monitor progress and gather feedback from clients. If a client isn’t making the expected progress with one approach, we might integrate elements of the other approach. For instance, if strict ERP isn’t reducing anxiety as hoped, introducing more variety and focusing on new learning might help.

“Strength doesn’t come from what you can do. It comes from overcoming the things you once thought you couldn’t.”

– Rikki Rogers

In summary, both ERP and inhibitory learning are valuable tools in a therapist’s toolkit. They share the common goal of helping individuals manage their fears and anxieties but do so in slightly different ways. ERP focuses on reducing fear through repeated exposure and preventing safety behaviors, while inhibitory learning emphasizes creating new, positive associations and using varied, unpredictable exposures.

As therapists, we aim to tailor our approach to each client’s needs, sometimes combining elements of both ERP and inhibitory learning to achieve the best outcomes. By understanding these methods and how they differ, we can better support our clients on their journey to overcoming anxiety and living fuller, more confident lives.