Exposure and response prevention (ERP) therapy is a highly successful treatment for all subtypes of OCD; it works by gradually exposing you to feared situations or thoughts while teaching you to resist compulsions.
Between intrusive thoughts and compulsive behaviors like avoidance, checking, and reassurance-seeking, navigating obsessive-compulsive disorder (OCD) can feel incredibly tough. Luckily, relief is possible with the right treatment.
Through exposure and response prevention (ERP) therapy—a form of cognitive behavioral therapy, specifically designed to treat obsessive-compulsive disorder (OCD)—you can learn strategies for tolerating anxiety, without resorting to compulsions. ERP is highly effective; 80% of people with OCD who use it experience a reduction in symptoms within eight to 16 weeks.
ERP can be challenging—after all, it takes energy and motivation to confront your fears—but the results are worth it. Learn more about how ERP works for different OCD subtypes, what you can expect in treatment, and how to find a therapist below.
How does ERP treat OCD?
Obsessive-compulsive disorder (OCD) is a chronic mental health condition characterized by obsessions, or intrusive thoughts, sensations, images, feelings, or urges that cause significant distress. In response, someone with OCD performs compulsions—repetitive behaviors or mental acts meant to reduce anxiety, neutralize a thought, or prevent something bad from happening. However, compulsions only provide temporary relief, exacerbating the cycle of OCD.
Fortunately, OCD is highly treatable. ERP therapy works by helping you gradually confront intrusive thoughts and triggers that cause anxiety, while learning to resist performing compulsions. The goal of ERP is to help people with OCD build the confidence to tolerate uncertainty and anxiety, allowing them to break free from the endless loop of obsessions and compulsions.
According to NOCD therapist Tracie Ibrahim, MA, LMFT, CST. “A reduction in OCD symptoms looks like feeling less anxiety and fear when triggered, getting triggered less often, and having the anxiety pass much more quickly.” Let’s dig into what ERP looks like in action, and how it can help you achieve these goals.
Find the right OCD therapist for you
All our therapists are licensed and trained in exposure and response prevention therapy (ERP), the gold standard treatment for OCD.
How does ERP therapy start?
ERP therapists typically begin by asking you about your fears and compulsive behaviors. This may feel intimidating, but ERP therapists have ample experience and have heard it all before. Your therapist will create a non-judgemental space for you to openly share.
Your first session typically covers four topics:
- Your intrusive thoughts, sensations, images, feelings, and urges.
- Your mental and physical compulsions.
- What you fear will happen if you don’t perform a compulsion.
- Any situations, people, thoughts, or objects you try to avoid in order to prevent intrusive thoughts or compulsions.
Dalton, a 27-year-old NOCD member from Houston Texas says his first couple of sessions were where he learned to “vocalize” his fears. “I would be like, “I’m scared that I’m going to fade out of reality or just cease to exist.’”
Dalton came to ERP therapy ready to do the work. “I went into it really fired up,” he says. “I just got fed up with running from fears.” Dalton says he made a commitment from the start to listen to his therapist, follow her instructions and “get to the bottom of” his symptoms—which helped him remain motivated throughout the process.
Discussing your fears can help your therapist design an exposure hierarchy—a list of ERP exercises based on your fears, ranked by how much distress they cause you. From there, your therapist will work with you to design exposure exercises—opportunities to gradually confront these fears head-on.
For Dalton, exposures initially looked like watching YouTube videos that raised philosophical questions that caused anxiety. “My therapist and I would watch YouTube videos together, and she’d pause them and ask: “Scale from 1 to 10. How are you feeling?””
From there, he moved on to exposures he found more distressing, including listening to recordings of himself describing his fears. “Doing that…is where I really started to notice a difference,” he says. “Listening to myself vocalize the fears really put into perspective how silly they were. Saying them out loud took the power away.”
With each new exposure, your therapist will coach you on resisting compulsions. Over time, your tolerance for anxiety will increase, and what once felt overwhelming can become more manageable.
“ERP can be intimidating,” Dalton says. “But, you can either face the fears now for a short period of time in ERP and learn how to manage them, or you can live with your fears for potentially the rest of your life…I decided I was going to face my fears.”
What do ERP exposures look like for OCD subtypes?
Everyone’s experience with OCD is unique, so ERP provides an individualized approach. Your therapist will create a plan that is personalized and realistic, catering to your specific needs and goals.
Depending on which OCD subtype(s) you experience, Ibrahim says your specific ERP exercises may look different for each individual—but will follow the basic approach: confronting your obsessions and triggers in a gradual, controlled way, while resisting the urge to perform compulsions. Read on to learn more.
Relationship OCD
Relationship OCD (ROCD) is a subtype in which obsessions and compulsions center on close personal relationships.
Obsession: You may worry that your partner is not the ‘one’ for you, or that they may be attracted to someone else.
Compulsion: In response to these thoughts, you may constantly ask your partner for reassurance, or mentally review past interactions to try to confirm or disprove your fears.
ERP exercise: Your therapist might ask you to sit with the uncertainty that you may never know if your partner is the ‘one’ for you, or that they may or may not be attracted to other people. Over time, this exercise helps reduce the power of intrusive thoughts and allows you to engage in your relationship without the constant need for certainty or reassurance.
Checking OCD
People with checking OCD often fear that something bad is going to happen to them or others if they don’t frequently check and re-check their behaviors.
Obsession: You may worry that you didn’t turn your stove off or that you accidentally hit someone while driving.
Compulsion: You may compulsively check household appliances, or excessively retrace your steps to make sure you didn’t make a mistake. You may also mentally review past events.
ERP exercise: Your therapist might suggest you start by trying to leave the house without checking the locks, and then work up to leaving the house without checking the stove.
Harm OCD
Someone dealing with harm OCD has obsessions that center around fears of harming yourself or others.
Obsession: You may have fears about accidentally hurting someone or yourself with a sharp object.
Compulsion: You may try to prevent harm by avoiding sharp objects, like knives, scissors—or staying away from the kitchen, altogether.
ERP exercise: Your therapist may ask you to start slowly by looking at a photo of a knife. From there, you might try spending five minutes in your kitchen. Eventually, you might be encouraged to try holding a knife.
Contamination OCD
Contamination OCD may cause you to have intrusive thoughts about dirt, germs, or harmful substances.
Obsession: You may have thoughts about contaminating others or becoming contaminated. Compulsion: You may excessively wash your hands, repeatedly disinfect surfaces, or avoid crowded public spaces.
ERP exercise: Your therapist might ask you to gradually confront your fears of contamination by visualizing touching doorknobs then working up to actually doing it in real life—touching one public doorknob per week, to start. Instead of immediately washing your hands afterward, you’ll be encouraged to sit with your feelings. Over time, you’ll work your way to more difficult exposures such as touching more doorknobs per week without resorting to compulsions.
Sexual Orientation OCD (SO-OCD)
Sexual orientation OCD (SO-OCD) can cause intrusive thoughts about your sexual identity.
Obsession: You may wonder if you’re secretly attracted to the same sex. These thoughts can be overwhelming—in large part because uncertainty is often difficult for people with OCD to tolerate.
Compulsion: You may analyze past interactions with people to confirm your sexual identity, or try watching different types of pornography to try to test your response.
ERP exercise: Your therapist might have you write down scenarios that cause anxiety, or think about attractive celebrities you’re worried you’re attracted to. In doing so, you can learn that intrusive thoughts are just that—thoughts—and that they don’t have to determine your identity or drive your actions.
Bottom Line
ERP is considered the most effective treatment option for breaking the cycle of obsessions and compulsions. With the guidance of a licensed therapist, ERP therapy exercises can give you the knowledge and tools to address your fears head-on, without responding with compulsions. If you aren’t sure where to start, reach out to a therapist specializing in OCD and ERP to discuss treatment.
Key takeaways
- Exposure and response prevention (ERP) therapy helps you confront your intrusive thoughts, while resisting the urge to do compulsions.
- ERP therapy starts by creating an exposure hierarchy—ranked from least to most distressing.
- An ERP therapist will work with you to design exposures that gradually help you face your fears head-on—building tolerance for discomfort.
- ERP exercises vary based on OCD subtype, but share the same core principle.
