Exposure and Response Prevention (ERP) for OCD

The gold-standard treatment for breaking free from obsessive-compulsive cycles

If you live with OCD, you know what it's like to be caught in a loop. A disturbing thought appears. Anxiety spikes. You do something—mentally or physically—to make it go away. It works, briefly. Then the thought returns, and the cycle starts again.

The compulsions feel protective. They promise relief, certainty, safety. But over time, they don't just reduce anxiety—they teach your brain that the thoughts are dangerous, that the only way to cope is to keep performing the rituals. This cycle produces a profound sense of “stuck-ness”, shifting your time and attention away from the things that are most important to you.

ERP breaks that cycle.

What Is ERP?

Exposure and Response Prevention is a type of cognitive-behavioral therapy specifically designed for OCD. It's the most well-researched and effective treatment we have—not because it eliminates intrusive thoughts, but because it changes your relationship to them.

ERP has two parts:

• Exposure: Deliberately and gradually facing the thoughts, images, situations, or sensations that trigger your obsessions—without trying to neutralize or escape them.

• Response Prevention: Resisting the compulsions, rituals, or mental maneuvers you typically use to reduce anxiety or gain certainty.

The goal isn't to prove the thoughts are harmless. It's to learn that you can tolerate uncertainty and discomfort without needing to control it. Over time, the anxiety loses its grip, and flexibility returns.

What ERP Looks Like in Practice

We start by understanding your specific obsessions and compulsions—what triggers the anxiety, what you do to manage it, and what you've been avoiding. From there, we build a hierarchy of exposures, starting with challenges that feel difficult but doable.

Exposures are tailored to your symptoms. They might involve:

• Touching a "contaminated" surface without washing

• Writing or saying a disturbing thought without neutralizing it

• Leaving the house without checking locks or appliances

• Sitting with uncertainty about whether you've harmed someone

• Tolerating intrusive images without seeking reassurance

The work happens both in session and at home. I'll guide you through the process, but the real learning occurs when you practice on your own—when you choose not to ritualize, even when every part of you wants to.

ERP Isn't Just Exposure

Traditional ERP can sometimes feel mechanistic—like you're just white-knuckling through anxiety. My approach integrates exposure work with psychological flexibility, self-compassion, and values-based action.

That means we're not just confronting fears. We're exploring what those fears cost you, what matters most to you, and how to build a life where OCD doesn't call the shots. I often fold in Acceptance and Commitment Therapy (ACT) principles to help you make space for discomfort rather than fighting it, and to reconnect with what you care about beyond symptom reduction.

Some clients also benefit from parts work—understanding the protective functions of compulsions and bringing empathy to the parts of you that are scared. This doesn't replace exposure, but it can make the process less adversarial and more collaborative.