Exposure and Response Prevention (ERP) Therapy for Social Anxiety and Panic Attacks

At Inner Wisdom Psychotherapy, we understand how overwhelming social anxiety and panic attacks can feel—especially when they begin to interfere with your relationships, career and daily peace of mind. That’s why we offer the effective, evidence-based approach of Exposure and Response Prevention (ERP) therapy, a powerful tool for breaking the cycle of avoidance and fear that fuel social anxiety and panic attacks.

Whether you’re navigating public speaking fears, struggling with panic in social situations or feeling trapped by anxiety symptoms, ERP can help you reclaim confidence and connection. ERP allows you to re-wire your brain by learning new responses to triggering situations and experiences. In this article, we’ll explore how ERP therapy works, why it’s different and what to expect in treatment.

If you're ready to begin your healing journey, explore our services or learn more about us, our Ontario-based virtual practice is here to support you. Accessing high quality anxiety treatment in Ontario is now easier than ever. Whether you live in London, Kitchener, Hamilton, Brantford, Guelph, Cambridge or another city in Ontario, you can receive compassionate, tailored care. Inner Wisdom Psychotherapy offers virtual sessions ensuring that professional support is always within reach.

1. Understanding Exposure and Response Prevention (ERP) Therapy

Exposure and Response Prevention (ERP) is a structured, short-term form of cognitive behavioural therapy designed to help individuals gradually face the situations, thoughts and physical sensations that trigger anxiety—without engaging in avoidance responses. Over time, this leads to reduced fear and greater emotional resilience. ERP teaches you how to intentionally change your autopilot reactions, thoughts and beliefs, when faced with triggers, so you can regain control over your anxiety and your life! 

ERP is most widely known for its success in treating obsessive-compulsive disorder (OCD), but it is equally effective for social anxiety disorder, panic disorder and phobias. 

How does ERP differ from traditional exposure therapy?

While both ERP and traditional exposure therapy involve facing feared situations (like speaking in public or experiencing physical symptoms), ERP goes a step further by also helping you resist the urge to escape, avoid and engage in rituals that temporarily soothe anxiety. This process supports long lasting change and transformation, allowing your brain and body to re-learn that the feared stimulus is not dangerous—reshaping your response over time. 

With ERP, your therapist will never force you to face feared situations before you are ready. Instead, with your therapist by your side, you will choose a low anxiety triggering situation that you want to build confidence and skill in facing. You will then practice facing it with your therapist guiding you step-by-step through the process.  Once you have confidence and success in facing the low anxiety triggering situation, you then decide on a more challenging anxiety triggering situation to face. Again, your therapist will be with you to guide you as you do this. Eventually, you will have enough confidence and skills to practice facing triggering situations outside of therapy sessions. 

Is ERP based on Cognitive Behavioral Therapy (CBT)?

Yes. ERP is a specialized form of Cognitive Behavioural Therapy (CBT). It combines exposure techniques with insights into the thought-feeling-behaviour cycle. While ERP focuses more on direct behavioural, ERP therapy also integrates CBT tools such as cognitive reframing, stress management, and emotion regulation strategies to support long-term recovery.

2. ERP Therapy for Social Anxiety and Confidence Building

Social Anxiety Disorder can lead to intense fear of being judged, embarrassed or rejected in social situations. Social anxiety heightens your perceived sense of threat and danger in social situations. It also reduces and distorts your ability to accurately assess how well you function and interact with others in social situations. 

ERP helps by gently and gradually exposing you to these feared experiences to teach your brain that social interactions are not inherently dangerous and you have the skills and ability to  effectively be in social situations. As you do ERP, social anxiety starts to lose its hold and power and you gain freedom to be social in ways you long for.

What social fears are commonly addressed in ERP?

ERP for social anxiety typically focuses on scenarios that trigger fear of negative evaluation or social scrutiny, including:

• Initiating conversations

• Making eye contact

• Public speaking

• Speaking in group situations

• Talking to new people

• Taking public transpiration

• Eating in front of others

• Attending social events

• Asking for help or clarification

These exposures are tailored to each person’s unique fears and goals, often using a hierarchy of triggers to guide progress in manageable steps.

How does ERP reduce avoidance behaviours in social anxiety?

Avoidance behaviors—like declining invitations, needing alcohol to socialize, avoiding eye contact, staying quiet, playing on your phone instead of interacting and excessively rehearsing conversations—can temporarily reduce anxiety but reinforce the belief that social situations are dangerous. ERP interrupts this cycle by encouraging clients to face these situations without avoidance. When we stop avoiding, desensitization to triggers occur.

Over time, this process helps recalibrate the brain’s internal “alarm system,” often associated with the fight-flight-freeze response, reducing reactivity and restoring emotional balance.

Can ERP therapy improve long-term social confidence?

Yes. By reducing anxiety and eliminating safety behaviors, ERP promotes real, long lasting change and social confidence. Clients often report feeling freer, more present in conversations and better able to connect socially without fear. This transformation enhances self-esteem, strengthens relationships and contributes to overall mental health and emotional well-being.

3. Using ERP to Reduce Panic Attacks and Regain Control

Panic attacks often involve a sudden, intense wave of fear accompanied by physical symptoms such as racing heart, dizziness, shortness of breath and nausea. ERP helps individuals re-train their response to these physical sensations and the fear they generate.

How does ERP address the fear of panic symptoms?

ERP targets the fear of fear itself. Rather than avoiding the sensations of panic, clients are gently guided to experience them without escaping or trying to suppress them. This approach teaches the brain that panic symptoms are not life-threatening, even though they feel distressing.

What role does interoceptive exposure play in treating panic attacks?

Interoceptive exposure is a core part of ERP for panic disorder. It involves intentionally inducing physical sensations (e.g., spinning to create dizziness, holding your breath briefly to mimic shortness of breath) in a safe, controlled environment with your therapist by your side guiding you through the entire process. This repeated practice:

• Builds tolerance to uncomfortable sensations

• Weakens the connection between sensations and catastrophic thoughts

• Reduces fear of the body’s natural responses

For example, to create a similar sensation of heart racing from panic attacks, you and your therapist will jog on the spot for a short period of time to get your heart pumping. Then your therapist will guide and empower you on how to feel and manage the feeling of heart racing confidently so you build tolerance to it and build skills for managing any distressing thoughts that come from it. You then practice these skills outside of therapy sessions.

Over time, clients reclaim trust in their body and gain the confidence to move through life without fear of panic.

Does ERP help clients regain control over panic triggers?

Yes. One of ERP’s greatest strengths is how it empowers clients to take back control from anxiety. By practicing exposures regularly and resisting avoidance or escape, individuals learn they can handle discomfort—and that it will eventually pass. This reduces panic frequency, intensity and duration, improving daily functioning and quality of life.

4. A Step-by-Step Overview of a Typical ERP Therapy Session

ERP is highly structured but personalized, ensuring that clients feel safe, supported and empowered throughout the entire process. At Inner Wisdom Psychotherapy, we work collaboratively with you every step of the way.

What are the Stages of ERP: Assessment, Hierarchy Building and Exposure

Each ERP treatment plan follows a general structure:

• Assessment – We gather information about your history, symptoms, triggers and goals.

• Hierarchy building – Together, we create a list of feared situations or sensations ranked by difficulty from low difficulty to high difficulty.

• Exposure and prevention – You’ll begin with mild exposures and work your way up, practicing until anxiety naturally decreases.

Throughout this process, we ensure that each exposure feels challenging but achievable.

How are safety behaviors and rituals gently reduced?

Safety behaviors—like carrying water in case of panic, standing closest to the building exit at social events, drinking alcohol for courage to speak, playing on your phone to avoid talking or avoiding eye contact in social settings—can prevent full exposure from taking effect. In ERP, these are gradually removed as your confidence builds. This ensures change is long-lasting.

What coping strategies are taught during ERP?

While ERP emphasizes not escaping anxiety, it doesn’t mean you’re left without tools. Clients learn:

• Mindful attention to feelings without judgment

• Breathing techniques to reduce physiological arousal

• Social skills training to boost comfort and ease when interacting with others

• Cognitive strategies to challenge unhelpful thoughts and negative core beliefs

• Grounding skills to stay present during exposures

• Personal values to boost motivation and empower yourself to face triggers

These techniques help clients stay engaged and supported, making exposures feel more manageable.

5. Proven Effectiveness of ERP for Treating Anxiety in Ontario

Yes—Exposure and Response Prevention (ERP) therapy is one of the most effective treatments for social anxiety disorder and panic attacks. It is well-supported by decades of clinical research and recommended by leading organizations such as the Canadian Psychological Association (CPA), Anxiety Canada, and the American Psychological Association (APA).

What does the research say about ERP outcomes for Social Anxiety and Panic Disorders?

Multiple peer-reviewed studies show that ERP significantly reduces the severity and frequency of panic attacks, social fear and avoidance behaviours. In fact, ERP is considered a first-line treatment for anxiety-related conditions. Research suggests:

• Up to 80% of clients with panic disorder or social anxiety experience significant improvement

• Results are typically long-lasting, even after therapy ends

• ERP is more effective than medication alone in preventing relapse

When guided by a skilled therapist, ERP can help rewire your brain’s fear response and restore a sense of calm and control.

How does ERP compare to other anxiety therapies in terms of success rates?

Compared to traditional talk therapy, ERP works more directly with the behavioural and physiological components of anxiety, which can lead to faster and more durable results. While cognitive-based approaches like CBT are also effective, ERP is often preferred for more severe or persistent cases of panic and social avoidance because it builds real-world tolerance rather than just intellectual understanding.

At Inner Wisdom Psychotherapy, we often integrate ERP with other methods, tailoring care to what each client truly needs.

6. Can ERP be Integrated with Trauma-Informed and 2SLGBTQ+ Affirming Care

Absolutely. While traditional ERP has a behavioural focus, it can and should be adapted through a trauma-informed, identity-affirming lens—especially for clients navigating complex emotional and sociocultural experiences.

We provide affirming, inclusive care that honours each client’s identity and lived experience. Our team recognizes that social anxiety and panic can be compounded by experiences of discrimination, microaggressions and marginalization—especially for 2SLGBTQ+ individuals.

How does ERP integrate with trauma-sensitive approaches?

For clients with trauma histories, ERP must be approached with care. At Inner Wisdom Psychotherapy, we:

• Prioritize emotional safety and establish consent and collaboration from the start

• Focus on empowerment, not re-traumatization

• Integrate self-regulation tools, window of tolerance awareness, and grounding strategies

• Respect client pacing and boundaries throughout the exposure process

This trauma-informed approach ensures that therapy is supportive, not overwhelming, even when working with intense fears.

Our therapy practice in Ontario is committed to fostering dignity, agency, and healing for everyone we serve.

7. Expanding Access to ERP Through Virtual Anxiety Therapy in Ontario

For adults across Ontario, especially in rural or underserved areas, virtual ERP therapy makes specialized care more accessible—without compromising quality.

Is online ERP therapy as effective as in-person sessions?

Yes. Research shows that telehealth ERP therapy is just as effective as face-to-face treatment, particularly when led by trained clinicians. In fact, virtual care can offer added comfort for those working on social fears by allowing them to begin therapy in a familiar space.

At Inner Wisdom Psychotherapy, we provide ERP virtually to clients across Ontario using secure, easy-to-use platforms tailored for therapeutic engagement. Virtual therapy can also allow you to ‘bring your therapist with you’, via virtual sessions on your cell phone, if you want to practice exposure skills in real life settings during therapy sessions. 

What are the benefits of virtual ERP for adults with busy lives?

• Flexibility: Schedule sessions around work, parenting or caregiving responsibilities

• Comfort: Begin exposure exercises from your home environment

• Privacy: Eliminate the stress of commuting or waiting rooms

• Consistency: Maintain progress during life transitions or travel

Many of our clients find virtual sessions more accessible and sustainable, allowing for steady growth without disrupting daily routines.

How does Inner Wisdom ensure PHIPA-compliant, secure online care?

We take your privacy seriously. All virtual sessions are conducted on PHIPA-compliant platforms, ensuring your health information remains confidential and protected. You can read more about our commitment to security and compassionate care on our contact page.

8. Identifying Whether ERP Therapy Is the Right Fit for Your Needs

ERP can be a powerful fit if you feel trapped by fear, avoid social interactions or experience recurring panic attacks that limit your life.

What signs suggest ERP might be helpful for social anxiety or panic?

You may benefit from ERP therapy if:

• You frequently avoid situations due to fear of embarrassment, rejection or judgment

• You experience panic symptoms like a racing heart, dizziness, or shortness of breath

• You’ve tried other therapies but still feel stuck in anxiety cycles

• Your fears lead to avoidance behaviors that impact work, relationships or self-worth

• You want to build confidence, presence and emotional freedom

Whether you're new to therapy or looking to try something different, ERP can offer the structured support needed to overcome fear and rebuild confidence.

Who is not a good candidate for ERP therapy?

While ERP is highly effective, it may not be the best initial approach for individuals who:

• Are in active crisis or experiencing suicidal ideation

• Are currently struggling with untreated PTSD or complex trauma

• Need stabilization or emotional regulation skills before facing exposure work

In these cases, our team may recommend beginning with trauma-informed care first. We’ll help you create a plan that honours where you are now and moves at your pace.

9. Beginning ERP Therapy in Ontario: How to Take the Next Step

If you’re ready to address your anxiety and reclaim your life, taking the next step toward Exposure and Response Prevention therapy can feel empowering—especially when you’re supported by the right professional.

How can I find a qualified ERP therapist in Ontario?

When seeking an ERP therapist in Ontario, look for someone who:

• Specializes in anxiety disorders and OCD-spectrum conditions

• Has clinical training in CBT and ERP methods

• Offers trauma-informed and identity-affirming care

At Inner Wisdom Psychotherapy, Heidi Klett, MSW RSW is a Certified Anxiety Treatment Professional and offers specialized ERP therapy for social anxiety, panic attacks and certain types of OCD. Whether you’re new to therapy or returning to deepen your healing, we meet you with experience, compassion and care.

What can I expect when starting ERP with Inner Wisdom Psychotherapy?

When you begin ERP therapy with us, here’s what the process looks like:

• 1:1 Consultation – You’ll meet with a licensed therapist to explore your goals, symptoms and readiness 
  

• Personalized Care Plan – We build a hierarchy of feared situations tailored to your unique life and experiences
  

• Safe Exposure Work – With guidance and encouragement, you’ll begin gradual, supported exposure tasks to reduce avoidance and build resilience

• Ongoing Support – We check in regularly, adjust the plan as needed, and integrate skills for emotional regulation, self-compassion and progress tracking

We offer secure, PHIPA-compliant online ERP therapy across Ontario, allowing you to access care from the safety of your home or wherever you feel most comfortable.

Frequently Asked Questions

1. Can ERP therapy help if I’ve had anxiety for years?

Yes. ERP is highly effective for both new and long-standing cases of anxiety, including panic attacks and social fears that have persisted for many years.

2. Is ERP therapy scary or overwhelming?

No. While ERP does encourage you to challenge yourself, and build your tolerance for facing anxiety triggers, it will never be unsafe, forceful or overwhelming. At Inner Wisdom Psychotherapy, we will guide you at a pace that feels manageable and help you build confidence step by step.

3. How long does ERP therapy typically take?

Many clients notice improvements within 8–12 sessions, though the exact timeline depends on your specific goals and the severity of your symptoms.

4. Is ERP only for OCD?

While ERP is a first-line treatment for OCD, it's also incredibly effective for social anxiety, panic disorder and phobias.

5. Can I do ERP therapy online?

Yes! Virtual ERP therapy is just as effective as in-person sessions. Virtual therapy also provides a unique advantage of ‘taking your therapist with you’ to practice ERP in real life settings. We offer secure, private online therapy for clients across Ontario including Kitchener, Hamilton, Brantford, Guelph, Cambridge and London, ON.

Conclusion

Whether you’re navigating the isolating fear of social situations or the unpredictability of panic attacks, Exposure and Response Prevention (ERP) therapy offers a proven and empowering way forward. At Inner Wisdom Psychotherapy, we specialize in helping adults across Ontario build emotional resilience and lasting confidence through ERP and other evidence-based approaches.

Our secure, PHIPA-compliant virtual sessions make it easy to access personalized, trauma-informed care—no matter where you are in Ontario or how busy your schedule may be. If you're curious whether ERP is the right next step for your healing journey, we invite you to reach out for a consultation. You can contact us directly, call us at (548) 290-7677, or email [email protected] to get started. We're here to support you in moving beyond avoidance, easing your anxiety and reconnecting with the life you want to live!