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With its roots in the classical conditioned response studies of Pavlov and others,
Exposure Response Prevention, ERP, therapy seeks to use conditioning to modify
behaviors through repeated exposure to fears, anxieties or situations, combining
the exposure with therapy that helps subjects better cope with and, hopefully,
overcome their problems. ERP therapy has been used most extensively, and has
been found most effective, in treating obsessive compulsive disorders, but the
technique has also often been used to treat eating disorders as well.
About 15 years ago, SLS Health Group of Brewster, NY, a diversified behavioral health
care company with an extensive addiction treatment focus, began to examine why
so many drug addicts and alcoholics, about 75 percent of them, relapse within one
year of receiving treatment for their disease. SLS co-founder Dr. Joseph Santoro,
who acts as the company’s chief operating officer, thought that perhaps one of the
reasons was that, although treatment centers warned patients to avoid “people,
places and things,” they often didn’t prepare their clients for the inevitable time
when their addictive cravings would, at some point, be triggered by some person,
event or situation. “We decided to do something about it,” says Rob DeLetis, who
has for the past sixteen years been leading SLS Health’s efforts to treat relapse
triggers through the use of ERP. “We identified ERP as potentially promising in
treating relapse triggers.” DeLetis, who’s full-time job at SLS is now as director
of ERP therapy, has over the years done over 10,000 ERP treatments personally,
integrating the therapy as an essential element of the large range of modalities
offered at SLS Health.
And now, after finding the treatment highly efficacious
within its own practice, SLS is placing increasing emphasis on expanding the
use of the therapy outside its own walls. Over the years, DeLetis has offered
certification in ERP techniques for treating substance abuse triggers,
completing about 30 so far in both the U.S. and
Europe. But Dr. Santoro and DeLetis want to see
these numbers rise substantially and are therefore
making a more aggressive effort to spread what
they have experienced as a very effective tool in
reducing relapse rates. Over the last two years,
sales of the ERP kits, pictured to the left, and the
accompanying certification trainings have risen
sharply.
There has been particularly strong
interest shown from prison-based treatment
providers, who are acutely aware that staying
away from “people, places and things” may not
be so easy for those just getting out of prison.
A typical addiction trigger ERP session begins
with a period of relaxation, then clients are asked
to rate their craving level after being exposed to
a range of using trigger stimuli from the ERP kit,
including syringes, simulated marijuana, pipes
and even spoons, which are often used by
addicts for cooking heroin. Generally, at this
point, clients are experiencing elevated pulse
levels, sometimes becoming over stimulated.
When this happens therapy is temporarily
terminated. While being exposed to the trigger
stimuli, patients repeat phrases, or cognitive
scripts, that help them deal therapeutically with
their cravings. Often, Real World ERP Therapy
is undertaken, where clients are exposed to real
world triggers with their counselors, who then
help their clients develop coping skills.
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