Exposure and response prevention (ERP) therapy is the most effective treatment for obsessive-compulsive disorder (OCD). While the goal of ERP is to eventually be able to utilize response prevention skills in daily life, starting with a therapist’s guidance is recommended.
Many of us feel drawn to the internet when seeking answers to health questions. If you have a mental health condition like obsessive-compulsive disorder (OCD), you may find yourself searching online for treatment advice. But, even if information is readily available, it doesn’t mean you should rely on it—especially if you’re navigating a condition as complex as OCD.
The most effective treatment for OCD is exposure and response prevention (ERP) therapy, which works by gradually exposing you to potential triggers in a controlled environment, so you can learn how to experience obsessions without engaging in compulsions. While ERP is very effective, there can be barriers to accessing the treatment—including lack of insurance, concerns about the time commitment, and feelings of shame about speaking to a stranger about your symptoms.
If you’re concerned about any of these issues, you may be wondering if it’s possible to tackle ERP therapy on your own. However, experts say it’s crucial to begin ERP therapy with a specialist, as there are key elements of treatment you may miss without expert guidance. Read on to learn more about how ERP works, why working with a therapist is so important, and when practicing ERP skills on your own can actually become helpful.
What is ERP and how does it work?
Before diving deeper into ERP therapy, let’s touch on the basics of OCD—a chronic, but treatable, mental health condition characterized by two primary symptoms: obsessions and compulsions. Obsessions are recurrent and unwanted thoughts, sensations, images, feelings, or urges that cause distress. People with OCD respond to the negative emotions caused by obsessions by performing compulsions—repetitive behaviors or mental acts done in an attempt to ease discomfort or prevent a “bad” thing from happening.
ERP therapy gradually exposes you to the triggers that cause your intrusive thoughts, so that you can learn new ways of responding. To kick off the process, you and your therapist will work together to identify your intrusive thoughts and compulsions. From there, your therapist will design exposures that can gradually help you face your fears. In between sessions, you’ll work on your own to practice the skills you’ve learned from your therapist.
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Can you start ERP on your own?
If ERP sounds like something you’d like to try, but you’re intimidated to reach out to a therapist, you might wonder why you can’t just start work on your own. However, Dr. Patrick McGrath, PhD, and Chief Clinical Officer at NOCD, warns that people who approach ERP therapy alone often fail to accurately identify all of their compulsions. This makes it impossible to fully succeed at response prevention.
Therapists that specialize in OCD have the training needed to design ERP exercises that will be most successful,”
Dr. Patrick McGrath
NOCD therapist Heather Brasseur, LMHC, LPC agrees: “When people practice ERP on their own, they often miss main aspects, like response prevention—without it, they are essentially just practicing OCD, rather than working to overcome it.” In addition to making sure you’re doing ERP correctly, Brasseur says working with a therapist can provide an extra layer of accountability and consistency.
A trained therapist can also help you make sure you don’t take on too much too soon. An ERP therapist will work with you to develop an exposure hierarchy—a list of exercises ranked based on the amount of discomfort they cause you. As you tackle exposures, your therapist will encourage you to step further outside of your comfort zone—while making sure you’re not doing anything you’re not ready for. “My therapist was really invaluable in helping me design the hierarchy of exposures,” says Daniel, a NOCD member. He describes this support as a crucial safety net.
The gradual nature of ERP is necessary for its success. “Starting an exposure exercise that you’re not ready for is sort of like lifting weights that are too heavy for you without proper form or a spotter,” says Dr. McGrath. It’s easy to strain yourself, and feel frustrated in the process. In fact, only 4% of people with OCD recover without professional help.
“Symptoms are reduced much faster and more effectively when you work with an ERP-trained, licensed therapist,” says Dr. McGrath. “Eventually, you should strive to become your own therapist, but conducting therapy on your own is not the best way to begin managing your OCD.”
What kind of therapist is best?
A therapist trained in OCD and ERP will be your best bet for OCD treatment. OCD is often misdiagnosed, and many clinicians are undereducated on the condition. It’s also important to avoid too much online research, as Brasseur says that behavior can inadvertently become a compulsion—satisfying a need to seek reassurance, or ruminate. “While it may feel like it provides answers or comfort, it usually does not help the person really understand or address their concerns,” she explains. “Instead, it feeds the OCD, reinforcing the cycle of doubt.”
It can be scary to share your most personal and taboo fears with someone new, but an ERP therapist has heard every intrusive thought you can imagine—and there’s nothing that can shock them. They’re not here to judge, and they want to teach you how to be as indifferent to those thoughts as they are. At first, Daniel was nervous about sharing obsessions with his therapist, but those fears faded with time. “Knowing that it was someone who knew why I was having those thoughts helped remove some of the fear of judgment,” he explains.
ERP therapists are equipped with the best training, and have racked up hours of clinical experience designing and implementing exposure exercises for every type of OCD subtype. An ERP therapist will be able to fine-tune ERP practices for your specific needs.
Understanding your role in ERP therapy
Even though it’s best to start ERP therapy with the guidance of a therapist, there are important parts of the treatment process you’ll need to tackle on your own—from homework, to staying motivated in-session, to applying the skills you learn to your daily life.
Doing ERP homework by yourself
Staying on top of practicing ERP exercises outside of therapy sessions is critical to getting well. Your therapist will typically assign you homework that focuses on practicing the exposures you’ve already tried in-session. Tracie Ibrahim, LMFT, CST, and Chief Compliance Officer says completing these assignments is important, because you may only see your therapist for an hour a week, but you’re with yourself 24/7.
Keep in mind that while independent homework assignments are an important part of ERP therapy, it’s still crucial to be meeting with a therapist regularly at the start of your treatment journey—so you can receive updated assignments, and seek guidance if you face challenges.
Daniel says it was really helpful to work with a therapist before getting into homework assignments because his therapist helped him identify what he was ready to face by himself versus what he’d need more guidance on. ”You can be honest with your therapist about whether you can or can’t handle something,” he explains. ”Trust that your therapist is not going to just throw you into the deep end with no flotation device.”
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Tips for getting the most out of ERP therapy sessions
You only get as much out of ERP therapy as you put in, so it’s important to find your source of motivation and stick to it. If you were eager to tackle OCD by yourself, seize on that drive, and try to utilize it during tough moments in therapy. At the same time, it’s also crucial to let your therapist guide the session. Remember that they are the expert, and you don’t have to know what to do or say all the time. Your therapist is there to walk you through it, so let them take the lead.
Finally, remember to communicate what you’re feeling with your therapist. If you’re feeling especially anxious, or concerned about a specific exercise, let your therapist know. They can help you figure out the root cause of your feelings, and coach you through feelings of discomfort. It’s normal to need some time to adjust to the process of ERP. “Starting ERP feels unnatural because you’re supposed to allow thoughts, images, and urges that violate the most fundamental elements of your character in your head as opposed to resisting them,” says Dr. McGrath. But, your therapist will help you learn new strategies for navigating your anxiety.
Practicing ERP skills in daily life
Incorporating ERP skills into your daily life involves sitting with triggers as they show up in the real world—and resisting the urge to compulse in response. For Daniel, using the checklist in the NOCD app really helps him to stay on top of practicing exposures everyday. Eventually, these skills will become easier to implement, as you practice them more. As Ibrahim puts it, in time, you’ll learn to “build ERP into your daily lifestyle.”
As you begin to incorporate more ERP skills into your daily life, remember to practice self-compassion. Experts stress that perfection is not the goal with ERP. Judging or berating yourself for slip-ups, like engaging in a compulsion you thought you kicked, won’t help.
Key takeaways
- ERP therapists provide guidance, support, and accountability to make the process of overcoming OCD effective and manageable.
- While starting ERP therapy on your own may seem easier, working with a trained therapist is crucial for identifying all compulsions, building a tailored treatment plan, and achieving long-term recovery.
- In time, you will gain the skills needed to be your own therapist—so you can enact response prevention in your daily life, regardless of what you’re faced with.