ERP Not Working? 5 Mistakes and How to Fix Them

I hesitate to call these mistakes, so before you get defensive, know that almost everyone in ERP makes at least one of them. They're sneaky. Even people who've been in treatment for months miss them.

Maybe you read this whole thing and think, "I'm golden. I don't do any of these." Good job. Go do more exposures.

Mistake #1

Leaving the Exposure Too Early

You start the exposure, the anxiety spikes, and you bail the second it gets uncomfortable.

Why this is a problem

When you leave early, you're teaching your brain:

"See, the only reason I felt better is because I left. It was dangerous. Thank you for getting me out of there."

Your brain never gets the chance to learn that the fear might have been wrong.

Two ways to stay in the exposure

1. The habituation method. Stay in the exposure until the anxiety drops to about half of where it peaked. It comes down on its own. Maybe that takes 5 minutes, maybe 10. While you're in it:

• You keep doing the action
• You answer the thought with uncertainty, like "maybe, maybe not"
• You don't do the compulsion

2. Inhibitory learning. Here the goal is retraining your brain, not lowering the anxiety. I can do the exposure for 5 minutes or 15. If my anxiety is still high when I'm done? That's okay.

I'm not leaving because of the anxiety. Ideally I'm leaving because I'm bored.

Mistake #2

Still Doing Compulsions (Especially Mental Ones)

The physical compulsions are easy to spot: checking, washing, asking for reassurance. Mental compulsions are the ones that slip by, even for people who've been doing ERP for a while.

Rumination as a mental compulsion

Rumination is so darn sneaky. It includes:

• Mentally reviewing
• Analyzing
• Replaying
• Undoing thoughts
• Thinking about it over and over

I'm not thinking about it because I enjoy it. I'm thinking about it because my brain's like:

"Well, but what if? But are you sure you did that? Did you touch it this way? Are you inappropriate? I know you moved past it, but really..."

It's trying to get certainty by thinking about it over and over again. More on OCD rumination and how to stop obsessive thoughts.

How to handle rumination

Rumination is going to happen. You don't have much control over that. You do get to control how you respond once it shows up.

It could be:

• Pushing a thought away
• Reassuring yourself: "This is OCD. Don't worry about it."
• Problem solving

Write them down so you'll know: "The next time I do this exposure, my brain is going to want one of these. And I'm not doing it."

When you are ruminating

Because you will. Let the thoughts be there, and answer them like this:

• "It's not my thing. Cool. Yeah, sure. Maybe, maybe not. Awesome."
• "So cool. Love that you're giving me these thoughts right now, man."
• "You're welcome to join while I'm here at lunch. Awesome."
• "You think I touched that thing? Amazing. Maybe I did. Hope so."
• "Am I going to die now? Maybe. Anything's possible."

Mistake #3

Avoiding the Real Fear

You're exposing to the surface-level triggers, but not the core fear underneath them.

What's a core fear?

It's the deeper meaning behind your obsession:

• What does contamination mean for you?
• What does harm OCD mean for you?
• What does relationship OCD mean? It's usually about more than making the wrong choice.

Example: contamination OCD

You're touching the doorknob. But the real fear is "I'll get sick and die alone in a hospital with no one there."

So yeah, we're doing contamination exposures. But if we never touch the dying-alone part, we're missing the point. That goes into the exposure too.

How to find your core fear

Ask yourself, "If this happened, what would that mean?" Then ask the same question about your answer, and keep asking.

Mistake #4

Using Distractions or Safety Behaviors During an Exposure

You're doing the exposure, but:

• You're still on your phone
• You're talking to someone
• You're holding your breath
• You're clenching your fists

You've built yourself an escape hatch: "I can handle this as long as I have my distraction."

What your brain learns

Your brain learns, "I need a distraction to be safe." So we want exposures with zero safety behaviors.

Wait, can I use my phone during exposures?

Yes. You can do exposures while you're on your phone, at work, while you're living your life. I know that sounds like I'm contradicting myself. The difference is whether you're using the phone to escape.

How to know the difference

If it sounds like "I have to get on social media right now" or "I have to play this game every time I get anxious," that's a distraction.

I want you living your life. Build exposures into whatever you're already doing.

Mistake #5

Doing Exposures Inconsistently

This one is big. You're doing exposures when you feel ready.

• I'll do one and then wait a week
• Then I'll do another
• "Okay, I did my one exposure. Check box. All right, cool. Awesome."

What to do instead

Do the exposure. Then do it again 5 minutes later, and again 5 minutes after that.

Think about learning anything else

Say you're getting into pickleball. You don't hit one good shot and walk off the court. You drill the same shot hundreds of times until you don't have to think about it.

That's what we're doing with exposures.

Don't let OCD decide when you practice

OCD doesn't wait until you're ready, so you can't either. Do exposures every day, even small ones. I know: "But I already went to work, and I went to the gym, and I have to deal with my kids..."

When's that going to end? It won't. Your life is going to keep happening.

Bonus mistake

Treating ERP Like You Have to Get Rid of Anxiety

"The only way I'm doing ERP is if I don't feel anxious anymore and I don't fear this thing."

The better mindset

I would love for you to say:

"I'm not doing exposures to prove anything. I'm doing them to retrain my brain."

OCD says I'm in danger. I'm teaching it: maybe I am, maybe I'm not. I don't know, and I'm willing to risk it. Then I do it again.

Still anxious afterward? Great. Not anxious? Also great.

The truth

I do want you to feel better, and over time exposures help with that. But making the anxiety go away isn't the goal of any single exposure.

What are you going to change?

As you went through these mistakes, which ones sounded like you? Here's the fix for each:

1. Stay in exposures longer (habituation or inhibitory learning)
2. Identify and stop mental compulsions (write them down)
3. Find your core fear (ask "what would that mean?" until you can't go further)
4. Remove safety behaviors and distractions
5. Do exposures every day with repetition
6. Stop treating ERP like anxiety removal

Pick the one you're doing most and fix that one this week. New to ERP? Start with what ERP therapy is.

Common questions about ERP not working