ERP for OCD: What to Expect and How to Prepare
Author: Mokshvi Shah, BS Northeastern University Student
Published: May 2024
If you've recently been diagnosed with Obsessive-Compulsive Disorder (OCD) or are supporting someone who has, you may have come across the term ERP, short for Exposure and Response Prevention. It’s considered the gold standard for treating OCD, with decades of research showing its effectiveness. But like most evidence-based treatments, it can feel intimidating at first glance.
What Is ERP?
At its core, ERP is a type of cognitive-behavioral therapy (CBT) designed specifically to treat OCD. It involves two key components:
Exposure – You’ll gradually and safely face the thoughts, images, or situations that trigger your anxiety or obsessions.
Response Prevention – You’ll learn to resist the urge to engage in compulsive behaviors or mental rituals in response to that anxiety.
The goal? To retrain your brain to tolerate distress and break the cycle of obsession and compulsion.
What to Expect in ERP Therapy
1. A Personalized Plan
Your therapist won’t throw you into your biggest fear on day one. ERP is collaborative and tailored to your specific OCD themes, whether they relate to contamination, harm, morality, relationships, or something else entirely. You’ll work together to create a fear hierarchy, starting with situations that provoke mild anxiety and gradually moving to more challenging exposures.
2. Facing Fear, Gaining Freedom
While it might sound daunting, ERP helps you build tolerance to uncertainty and discomfort, two experiences that OCD convinces us we must avoid. With practice, most people report feeling more in control and less afraid of their thoughts.
3. Homework Is Part of the Process
Therapy sessions are just the beginning. You’ll be asked to complete exposures between sessions, applying what you learn to real life. These exercises are essential for creating lasting change.
4. Discomfort (Yes), but Also Progress
ERP isn’t about feeling better right away, it’s about getting better over time. It’s normal to feel anxious or uncomfortable during exposures. That’s not a sign of failure; it’s a sign the therapy is working. Over time, your brain learns: “This is uncomfortable, but I can handle it.”
How to Prepare for ERP
If you’re considering starting ERP or have an intake scheduled, here are a few tips to get you ready:
Educate Yourself About OCD Understanding how OCD works, the intrusive thoughts, the compulsions, and the vicious cycle, can help normalize your experience.
Expect Anxiety, Not Perfection You don't need to feel ready to start ERP, you just need to be willing. If you wait until you're no longer afraid, you may never begin. Part of ERP is learning that anxiety is survivable, and that you don't need to be 100% sure or in control to take a step forward.
Be Honest with Your Therapist ERP is most effective when there’s trust. Let your therapist know what feels overwhelming, what you’re avoiding, and when you feel stuck. This openness helps them adjust the plan to support your growth.
Lean on Support but Not for Reassurance It’s helpful to have supportive people in your life who understand the ERP process. However, OCD often pulls others into the loop through reassurance-seeking. Instead of asking loved ones to tell you "everything will be okay," try letting them remind you, "You're doing hard work, and you can handle this discomfort."
