A Q&A with Dr. Nikki Bishop, Clinical Director at SunCloud Health
About the Author
Dr. Nikki Bishop, PsyD, is the Clinical Director at SunCloud Health, where she leads the adolescent and adult clinical teams across all levels of care. Dr. Bishop brings deep expertise in trauma-informed treatment, adolescent development, and integrated care for complex mental health and co-occurring conditions. She is passionate about helping teens build lives grounded in meaning, values, and resilience.
Q&A: Understanding ERP for Teens
Q: What is Exposure and Response Prevention (ERP), and why is it used at SunCloud Health?
Dr. Bishop: ERP is a form of cognitive behavioral therapy specifically designed to treat obsessive-compulsive disorder (OCD), though it’s also effective for a range of anxiety-related conditions. At its core, ERP helps individuals gradually face fears or distressing thoughts (exposures) while resisting the urge to engage in avoidance behaviors or compulsions (response prevention).
At SunCloud Health, we use ERP as part of our adolescent programming because it directly addresses the cycle that keeps anxiety and OCD symptoms in place. It’s a highly effective, evidence-based approach—especially when delivered in a setting that integrates family support, peer connection, and trauma-informed care.
Q: How is ERP adapted for teens?
Dr. Bishop: Adolescents need to feel safe, heard, and involved in their treatment. We adapt ERP by meeting each teen where they are developmentally and emotionally. This means working collaboratively with them to create personalized exposure hierarchies—essentially, a step-by-step plan for gradually facing anxiety-provoking situations. We also involve parents and caregivers through family therapy and psychoeducation.Q: Why is ERP especially important during the summer months?
Dr. Bishop: Summer offers a unique window of opportunity. Without the demands of the school year, teens have more flexibility and emotional bandwidth to focus on treatment. At SunCloud, our summer adolescent programming integrates ERP into a structured, therapeutic day that also includes DBT, ACT, expressive arts, and peer support.This steady, immersive approach helps teens develop confidence, reduce avoidance, and return to school in the fall with better tools to manage anxiety or OCD symptoms.
Q: What kinds of challenges or symptoms does ERP help address in adolescents?
Dr. Bishop: ERP is particularly effective for teens experiencing:- Obsessive-compulsive disorder (OCD)
- Generalized anxiety disorder (GAD)
- Social anxiety
- Panic attacks
- School refusal or avoidance behaviors
- Health anxiety or contamination fears
- Perfectionism and intrusive thoughts
These symptoms often drive avoidance—whether that’s skipping school, avoiding certain places, or performing rituals to manage distress. ERP helps teens break that pattern by gradually increasing their ability to tolerate discomfort without relying on avoidance or compulsions.
Q: What does a typical ERP session look like at SunCloud Health?
Dr. Bishop: Each ERP plan is individualized, but a typical session may include identifying a specific fear or trigger, practicing an exposure task in a safe, supported setting, and processing the experience with a clinician. Over time, teens begin to see that the feared outcome often doesn’t occur—or if discomfort does arise, they can manage it without resorting to compulsions.ERP is never about forcing a teen into a situation they’re not ready for. It’s a collaborative process that builds trust, autonomy, and resilience.
Q: How can families support their teen through ERP-based treatment?
Dr. Bishop: Education is key. When families understand the principles of ERP and how avoidance or accommodation can unintentionally sustain symptoms, they can play a much more supportive role. At SunCloud, we offer family support and psychoeducation so caregivers feel equipped and empowered. We also encourage open communication at home, validation of the teen’s experiences, and reinforcement of the teen’s willingness to take small, brave steps outside their comfort zone.
Q: What makes SunCloud Health’s approach to ERP unique?
Dr. Bishop: What sets us apart is our integrated, whole-person approach. ERP isn’t offered in isolation—it’s part of a multidisciplinary program that addresses co-occurring conditions like depression, trauma, disordered eating, and substance use. We provide ERP in a structured setting that prioritizes safety, peer connection, and values-based living.In our summer program, teens with OCD receive ERP alongside other evidence-based therapies like DBT and ACT, expressive therapies, and academic support planning. This holistic care model helps create sustainable change, not just symptom reduction.
Learn More
To learn more about SunCloud Health’s summer adolescent programming and how ERP is used to support teens with anxiety and OCD, visit our program page or contact us here.