How Exposure and Response Prevention Therapy Can Help You
If you've been told to try ERP for your OCD, you might be picturing someone forcing you to face your worst fear all at once. That's not how it works. ERP is gradual, and you're in charge of the pace.
By Nathan Peterson, LCSW, OCD therapistWhat is exposure and response prevention therapy?
Exposure and response prevention, or ERP therapy, is the treatment with the most research behind it for OCD. It has two parts:
- Exposure: on purpose, you get close to the thoughts, situations, or objects that set off your OCD.
- Response prevention: you skip the compulsion you'd usually do to feel better, like checking, washing, asking for reassurance, or reviewing.
You don't argue with the thought or try to prove it wrong. You let it be there, and you let your brain learn that you can handle the discomfort without doing the ritual.
How ERP works, step by step
- Make a list. Write down the situations that trigger your OCD, from easier to harder.
- Start small. Pick something near the bottom of the list, around a 3 or 4 out of 10.
- Face it and skip the ritual. Stay with the trigger and let the anxiety rise without checking, washing, or reassuring.
- Let it pass on its own. Anxiety goes down by itself. You don't need to make it go down.
- Repeat, then move up. Practice until it feels easier, then try the next step on your list.
I know, "let the anxiety rise on purpose" sounds like the opposite of what you came here for. That's the part that teaches your brain something new. If it isn't working for you, see ERP not working? 5 mistakes.
Benefits of ERP therapy
- Less time lost to compulsions. The rituals take up less of your day.
- Getting back what OCD took. You start doing things you'd been avoiding.
- Trusting yourself again. You learn you can handle a thought without needing to fix it.
- Skills you keep. When OCD picks a new theme, you already know what to do.
If you take medication for OCD, keep taking it as prescribed. Any changes are a conversation for your doctor.
Who can benefit from ERP therapy?
ERP was built for OCD, and it works across all OCD themes, including contamination, harm, HOCD, relationship OCD, scrupulosity, and pure OCD. Exposure-based therapy is also used for phobias and some other anxiety problems.
Pick one small trigger today, something around a 3 out of 10. Face it and skip the ritual one time. (The anxiety will say "this once, check." That's the moment the practice happens.)
If you want help building the whole plan, that's what Master Your OCD is for.
Common questions about ERP therapy
Is ERP the same as CBT?
ERP is a type of cognitive behavioral therapy, but it's the specific one built for OCD. Some CBT focuses on challenging or changing thoughts, which can turn into another way of arguing with OCD. ERP skips the argument.
Will ERP make my anxiety worse?
At first, you'll feel anxious during exposures. That's expected, and it's part of the practice. You start with easier steps and build from there, so it stays something you can handle.
Can I do ERP on my own?
You can do ERP with a therapist, or start on your own with a structured program. Master Your OCD walks you through it step by step. If your OCD is severe, work with a therapist who treats OCD.
How long does ERP take to work?
It depends on the person and how often you practice. Changes often show up within a few months of regular practice.
