Exposure and response prevention (ERP) therapy is the most effective form of treatment for OCD, because it teaches your brain new ways to respond to—and reduce—distress. In this article, six OCD experts and advocates discuss their experiences with response prevention—and share why this element of ERP is so important for OCD treatment.
If you’ve struggled with OCD symptoms, you might know a bit about the concept behind exposure and response prevention (ERP) therapy: a trained therapist helps you confront your fears and teaches you to resist the urge to engage in compulsions. ERP therapy was designed specifically to treat OCD and is the most effective form of therapy for the condition, working with around 80% of people. But, many people still have misconceptions about how ERP actually works.
The “E” in ERP therapy (exposure) gets a lot of attention. After all, the idea of facing your biggest fears head-on can be intimidating. But, if we focus too much on exposures, it’s easy to miss what truly makes ERP work: response prevention. According to Dr. Patrick McGrath, PhD, Chief Clinical Officer at NOCD, that’s what allows you to change the behaviors that keep you stuck in the OCD cycle. It’s why we’re so focused on response prevention as a core aspect of our specialized OCD treatment approach, here at NOCD.
“Basically, response prevention means doing the opposite of what OCD wants you to do,” Dr. McGrath explains. “Being exposed to fears and obsessions is nothing new for people with OCD—they’re already exposed to their fears in everyday life. If exposure was enough on its own, they wouldn’t need therapy.”
Compulsions offer quick relief from distress and anxiety, but they actually reinforce obsessions and make them worse over time. “That’s where response prevention comes in,” Dr. McGrath explains. “When people resist doing compulsions, they start to realize they can handle anxiety and discomfort on their own. They don’t need to do what OCD tells them to do.”
If confronting your obsessions and anxiety sounds scary, know that ERP therapy works gradually—and the results are worth it. Here’s what two other OCD experts and three dedicated advocates for the OCD community say about their personal experiences with response prevention: what it feels like in therapy and daily life, why it’s so important, and how it gets easier over time.
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Jonathan Grayson, PhD, licensed psychologist specializing in OCD and adjunct clinical professor of psychiatry and behavioral sciences at the University of Southern California
Jonathan Grayson, PhD, is a licensed psychologist, and the director of the Grayson LA Treatment Center for Anxiety & OCD. According to Dr. Grayson, exposures alone don’t make fears dissipate: “If I do an exposure, and then I don’t do response prevention, I am undoing the exposure.” Dr. Grayson believes ERP therapy is most effective when it leads to a true acceptance of uncertainty. Moving toward this acceptance requires not just confronting your fears in controlled settings, but working with a therapist to learn to live with an overall tolerance of low-level risk.
For example, he points out that someone who fears getting cancer won’t have their fears assuaged by doing exposures. They’ll have to learn to live with the possibility that they could encounter cancer. “Accepting uncertainty means I’m willing—not that I desire—to allow the worst thing to happen, and I will try to make the best of it,” he explains. “Response prevention becomes critical.”
Dr. Grayson explains that working with a good, ERP-trained therapist is important—because they can help you learn how to tolerate risks and uncertainty, and explain why response prevention will be helpful. “Therapists never make anyone do anything,” he says. It’s all about helping patients understand what they risk by facing their fears, and what they risk by avoiding them. “I actually tell people treatment is as hard as endless ritualizing. But, one leads to endless rituals, and one leads to an end in rituals,” he explains.
Accepting uncertainty can be uncomfortable, but Dr. Grayson says people who commit to response prevention often gain more than just the skills necessary to manage their OCD: “Generally, if people do this…they’re not normal—they’re better than normal.”
Dierdre Rae, community advocate, London
Dierdre Rae has been experiencing OCD symptoms for as long as she can remember, but it took years to understand what was going on. “OCD is like an iceberg,” she explains. “You see the tip of it, but you don’t see all the intrusive thoughts below the surface.
Rae’s symptoms escalated while she was in college—forcing her to leave school and seek immediate treatment. At first, practicing response prevention in therapy was difficult, but with time it became easier. In fact, she says “almost every single time, it gets better.” Rae believes response prevention works because a trained ERP therapist can help you re-train how your OCD responds to your thoughts, which she says is more memorable than the exposures themselves. According to Rae, response prevention is a way of “proving that you’re okay, not because you did the compulsion, but [because] you went without it.”
Rae still experiences daily OCD symptoms, but she’s better prepared to navigate them now. Recently, she went to fill a cup with drinking water at the sink, and in doing so, placed it near a dark spot. “To me, dark equals bad,” she explained. Her initial urge was to toss the cup and use a completely different one. “I was like, this cup is technically contaminated now,” she explains. But, response prevention helped her fight this response. Instead, she filled the cup with water, and drank the whole glass. “I’m anxious for a second…and I keep on going,” she says.
Dierdre says ERP given her a sense of resiliency that makes her feel better equipped to manage her mental health altogether: “As bad as OCD has been, [ERP] therapy has given me so many tools…it did not give me my life back—it gave me a life, full stop.”
Chris Leins, MA, LPCC-S, NCC, Kentucky
Chris Leins is an OCD treatment specialist with a private practice in Kentucky. He’s also experienced OCD symptoms—and misdiagnosis—firsthand. “I saw several therapists through the course of my life, and was never diagnosed with OCD,” he explains, noting that this is often a common experience.
Leins believes in response prevention, because he thinks changing your behavior is the best way to change the way you feel. “As long as we act anxious, we’re going to feel that way,” he says. “If we can change or modify the ways [we] act …we’re going to feel less anxious.”
Leins says one of the reasons people are sometimes hesitant to engage in ERP therapy is that they confuse obsessions and compulsions—especially if their compulsions take the form of mental rituals. Because obsessions are uncontrollable, people who mistake compulsions for obsessions may feel especially intimidated by response prevention, since learning to stop these behaviors may seem impossible. But, Leins says it’s important to remember that “compulsions are always behavioral choices,” and you have the ability to make a different choice. Response prevention teaches people how to make a different choice.
“You can’t control anxiety and the intrusive thoughts, but you can control your responses,” he explains. “Let’s employ some resilience…work hard at it, and you’re going to make some progress.” Leins has seen this progress with his own OCD, which caused intrusive thoughts about relationships when he was younger. When faced with individuals with more “domineering” personalities, Leins used to experience intrusive images of being laughed at, or beaten up. In response, he’d avoid these individuals altogether—being especially careful to avoid conflict. He says response prevention helped him build confidence: “I confronted people when I didn’t want to…and walked away feeling strong and feeling powerful.”
Hannah Zidansek, community advocate, Pennsylvania
When Hannah Zidansek was first diagnosed with OCD, she was somewhat skeptical of treatment. “I was a teenager…so there was some defiance,” she explains. This changed the more she participated in ERP therapy: “The more you [do] exposure and response prevention, the more you gain evidence…that OCD is a liar.”
For Zidansek, response prevention has been crucial, because unwanted thoughts show up constantly; how you deal with them is what really matters. “You must resist the compulsions, so your brain learns that you don’t need them to cope,” she explains.
Zidansek also discovered that much of her discomfort around exposures was actually tied to her tendency to ruminate—reinforcing the importance of response prevention. For example, when Zidansek first began practicing ERP exercises for contamination OCD, she might force herself to consume food that someone else had prepared—only to find herself thinking thoughts like, the person who made this food probably hasn’t been exposed to germs recently.
Once she realized these ruminations were a type of compulsive behavior, she learned to resist them, and her distress dissipated sooner. “OCD…wants you to seek a level of certainty that is never able to be sought,” she explains. “The only thing you can really do is starve it.”
Over time, practicing response prevention has helped Zidansek become more self-assured. “You start to gain this confidence…and the rituals are easier to resist,” she says. “Once you learn to sit with that, it’s life-changing.”
Stuart Ralph, psychotherapist, UK
Stuart Ralph is a counselor and psychotherapist specializing in OCD, who began experiencing his own symptoms when he was seven—but wasn’t diagnosed until his late twenties. As a child he says he felt he couldn’t speak up about his compulsions: “[Everyone] used to call OCD the secret illness, and that felt very true for me as a kid.” He recalls struggling to cross the threshold of a doorway for half an hour, until it felt right, while his parents sat downstairs. He remembers feeling the need to share what he was going through, but being terrified to do so.
Like many people, when Ralph did seek help, he didn’t see improvements from ERP therapy overnight. “Learning to delay compulsions…was a learning curve,” he explains. “Over time…the urge got weaker.” Today, Ralph describes his symptoms as “dramatically reduced.” When his condition flares, he feels he has the skills he needs to address it: “OCD doesn’t stop me from living life how I want.”
Ralph believes “response prevention is vital, because it’s how the brain learns.” He says adjusting your responses is the best way to give your brain a chance to learn new ways for coping with negative emotions. That being said, Ralph knows that response prevention isn’t easy. He emphasizes that the process can be gradual, and there are strategies for easing into it—like, trying to delay your compulsions, until they no longer appeal to you. For those considering ERP, he says: “Give it a go, give it time, and give it practice.”
Bottom line
At NOCD, response prevention is a fundamental part of our therapy practice. We’re doubling down on our strategy in 2025—ensuring that all of our clinicians know how to prioritize this core aspect of our specialized approach to OCD treatment. All NOCD therapists have an initial training in response prevention, with added booster sessions and quizzes to make sure they truly understand what the method entails—and how best to support our community members. According to Dr. McGrath, “our therapists say it’s more training than they’ve ever had at any job they’ve ever worked.”
We know it takes courage to seek help, so we’ve made sure our therapists are armed with the best possible tools to guide you through your treatment journey. If you’re interested in learning more, we’re here to help.
Key Takeaways
- Response prevention is a crucial component of ERP therapy; if you’re engaging with exposures without resisting the urge to compulse, you won’t learn the skills to get better.
- Tackling response prevention can help you build the resilience necessary to better manage your OCD symptoms, and your overall mental health.
- Response prevention can feel intimidating, but ERP therapy works gradually, and compulsions are the part of OCD that you can ultimately gain control over.
- In time, you can learn to accept uncertainty and live the life you want, not the life OCD tells you to lead.