
Intrusive thoughts—those unwelcome guests in your mind that bring distress and anxiety—are a common human experience. If you’re struggling with them, you’re not alone, and you can learn to manage them. According to the International OCD Foundation (IOCDF), Exposure and Response Prevention (ERP) is one of the most effective methods for treating OCD and intrusive thoughts.
If you’re new to the concept of intrusive thoughts, check out my Intrusive Thoughts Pillar Page for an in-depth overview.
Exposure and Response Prevention is a specialised form of Cognitive Behavioural Therapy (CBT). Multiple guidelines, including the NICE Guidelines for OCD, highlight ERP as a first-line treatment. It helps you gradually confront feared thoughts and resist compulsions, teaching your brain that the anxiety-inducing “threat” is not actually dangerous.
If you would like a comprehensive overview of how ERP works, please see my Exposure and Response Prevention Guide where I explain the science behind ERP.
Why ERP Works for Intrusive Thoughts
While ERP is broadly effective for various types of OCD, it’s especially helpful for intrusive thoughts. If you want to explore ERP specifically for intrusive thoughts in greater detail—covering more examples, classical conditioning principles, and subtypes like HOCD—visit my dedicated page on Exposure Response Prevention for Intrusive Thoughts From there, you’ll get even deeper insights into the step-by-step process of facing intrusive thoughts head-on without resorting to compulsions or avoidance.
This guide offers a detailed, step-by-step approach to using ERP techniques at home to regain control over your thoughts.
Here’s how to do ERP at home:
1. Become a Thought Detective (with practical instructions)
Grab a notebook or use your phone:
Dedicate a specific notebook or a note-taking app on your phone to become your “Thought Detective Journal.” This will be your dedicated space for recording and analyzing your intrusive thoughts.
Every intrusive thought gets recorded:
Don’t let any slip by! The moment an intrusive thought pops up, no matter how fleeting or distressing, grab your journal and write down the following:
- Date and Time: Be precise. Note the exact date and time the thought occurred. This helps you spot patterns later, such as whether intrusive thoughts are more frequent at certain times of day or on specific days of the week.
- The Trigger: What were you doing immediately before the thought? Were you reading, watching TV, interacting with someone, or simply daydreaming? Be as specific as possible! For example, instead of “watching TV,” write “watching a news report about a car accident.” If you can’t identify a specific trigger, write “unknown.”
- The Intrusive Thought: Write down the exact thought, image, or urge, even if it’s distressing. Don’t censor yourself. If it was a disturbing image, describe it in detail. If it was an urge, describe the urge precisely. The more detailed your description, the better you’ll understand your intrusive thoughts.
- Emotions: Identify the emotions you felt and rate their intensity on a scale of 0-10 (0 being no anxiety, 10 being the most intense anxiety you’ve ever felt). Were you anxious, scared, disgusted, guilty? Be honest about the emotional impact of the intrusive thought.
- Your Response: What did you do after the thought?
- Try to push the thought away or distract yourself?
- Seek reassurance from someone by asking them to confirm that the thought isn’t true or that you’re a good person?
- Engage in a mental ritual, such as counting, repeating a phrase, or praying?
- Avoid a situation or object that you associate with the intrusive thought?
- Do something to try to “neutralize” the thought, such as touching something a certain number of times or saying a specific phrase?
Analyse your records (with examples):
After a week or two of consistently recording your intrusive thoughts, review your journal. Look for recurring themes and patterns:
- Trigger Patterns: Do your intrusive thoughts seem to appear more often in certain places, at certain times of day, or when you’re feeling a particular emotion (e.g., tired, stressed)?
- Thought Content: Are there common themes or topics in your intrusive thoughts? This can help you understand the underlying anxieties that fuel them.
- Response Patterns: Do you tend to respond to intrusive thoughts with the same compulsions or avoidance behaviors? This highlights the patterns you’ll need to break with ERP.
Need more help with Intrusive Thoughts?
All my materials are now online in a structured online course containing ERP and CBT. I’ve been working with OCD for 20 years and over 3500 people have taken this course.
Dr Ryan; MoodSmith
If you would like a copy of these instructions, please feel free to download my ERP worksheet in PDF.
2. Build Your Exposure Hierarchy (with a concrete example)
Understanding Exposure
Exposure means deliberately confronting the thoughts and situations that trigger your anxiety. The idea is to gradually get used to these triggers so they lose their power over you. You do this by repeatedly exposing yourself to the trigger until the anxiety it evokes starts to decrease. This approach is a cornerstone of best ERP exercises for OCD and intrusive thought management.
Example Hierarchy for Fear of Contamination
- Level 1 (Least Anxiety): Imagining touching a public door handle.
- Close your eyes and vividly imagine yourself touching a door handle in a busy public place. Imagine the texture, the temperature, and any other details that make the image feel real.
- Level 2: Touching a public door handle and then writing about it in your journal.
- Go to a public place, touch a door handle, and then immediately write about the experience in your Thought Detective Journal. Describe the sensations, your thoughts, and your emotions.
- Level 3: Touching a public door handle and waiting 5 minutes before washing your hands.
- Touch a public door handle and then set a timer for 5 minutes. Resist the urge to wash your hands until the timer goes off. Notice the anxiety you feel during those 5 minutes and observe how it changes over time.
- Level 4: Touching a public door handle and then eating a snack without washing your hands.
- Touch a public door handle and then eat a snack (e.g., a piece of fruit, a biscuit) without washing your hands first.
- Level 5 (Most Anxiety): Using a public restroom and then shaking hands with a friend without washing your hands.
- Use a public restroom and then meet up with a friend. Shake their hand without washing your hands first.
Tailor It to You
Your hierarchy will be unique to your specific fears and intrusive thoughts. Use your thought record to identify your fears and rank them from least to most anxiety-provoking. Start with situations that cause mild anxiety and gradually work your way up to the most challenging ones. Be creative and include variations in your hierarchy, such as:
- Imaginal Exposure: Vividly imagine the feared thought or situation in detail.
- In Vivo Exposure: Confront the fear in real life.
- Written Exposure: Write the thought down repeatedly.
- Oral Exposure: Say the thought out loud to yourself.
- Sensory Exposure: If your intrusive thoughts involve specific sensations (e.g., fear of contamination), create exposures related to those sensations.
Download MoodSmith’s ERP Worksheet – Exposure Hierarchy Builder
3. Embrace Exposure (practical tips)
- Schedule it in:
Don’t wait for exposures to happen by chance. Schedule specific times in your week for ERP practice, just as you would schedule any other important appointment. Treat these practice sessions as a priority—this is key for self-help for intrusive thoughts and OCD. - Start small and build up:
Begin with the easiest item on your hierarchy and repeat it until your anxiety starts to decrease. This might take several sessions. Don’t move on to the next level until you feel significantly more comfortable with the current one. - Use a timer:
Time your exposures. Aim for at least 30 minutes per session. This allows enough time for your anxiety to peak and then start to decrease. - Stay present:
Focus on the present moment during the exposure. Notice the sensations, thoughts, and emotions you’re experiencing without judgment. Observe your anxiety as it rises and falls. - Don’t rush:
Move to the next level of your hierarchy only when you feel comfortable with the current one. There’s no need to hurry. Take your time and focus on gradual progress.
4. Master Response Prevention (with clear examples)
Identify Your Compulsions (Be Honest)
Common compulsions include:
- Seeking reassurance: Asking others if you’re okay, checking things repeatedly, searching for information online to alleviate your anxiety.
- Mental reviewing: Going over events in your mind to try to “figure things out” or make sure you didn’t make a mistake.
- Neutralizing: Trying to cancel out a thought with another thought or action, such as saying a prayer or performing a specific ritual.
- Avoiding situations: Staying away from places, people, or activities that trigger intrusive thoughts.
Resist the Urge
When you experience an intrusive thought, make a conscious effort not to engage in your usual compulsions. This will be difficult at first, but it gets easier with practice. Remind yourself that compulsions only provide temporary relief and actually strengthen intrusive thoughts in the long run.
Develop Alternative Coping Strategies
Instead of compulsions, try these healthy ways to manage anxiety:
- Mindfulness: Pay attention to your breath and the sensations in your body. Notice the present moment without judgment.
- Deep breathing exercises: Inhale slowly and deeply through your nose, filling your lungs completely. Exhale slowly through your mouth.
- Progressive muscle relaxation: Tense and release different muscle groups in your body, starting with your toes and working your way up to your head.
5. Monitor Your Progress and Adjust (with guidance)
- Track your anxiety:
During each exposure, rate your anxiety level every few minutes on a scale of 0-10. This helps you see if your anxiety is decreasing over time. You can even plot your anxiety levels on a graph to visualize your progress. - Review your thought record:
- Are your intrusive thoughts becoming less frequent or intense?
- Are you finding it easier to resist compulsions?
- Are you noticing any new patterns or triggers?
- Be flexible:
If an exposure is too easy or too difficult, adjust your hierarchy accordingly. You can add new levels, remove levels, or change the order of levels. - Celebrate your successes:
Acknowledge your progress and effort. ERP is challenging, so it’s important to recognize and celebrate your achievements, no matter how small they may seem.
By following these detailed steps, you’ll be well on your way to managing intrusive thoughts using exposure therapy. Remember to be patient, kind to yourself, and seek professional support from a qualified CBT therapist if needed. They can provide personalized guidance, support, and motivation throughout your journey.
Final Words
Compulsions maintain your intrusive thoughts. Avoidance and reassurance seeking keep the cycle going. Exposure and Response Prevention for intrusive thoughts eliminates the compulsion through a new learning process, and this habituation helps you recover from unwanted thinking patterns.
If you’re ready for more intrusive thoughts self-help techniques—or want a structured plan with professional insights and guided practices—consider enrolling in my online course, where we dive deeper into how to do ERP at home, tailor-made for all types of obsessive fears.
By practicing these steps, you’ll learn that intrusive thoughts lose their power when faced head-on. With consistent application and the right support, you can break free from the grip of anxiety and start living life on your own terms.
Disclaimer
This guide is for informational purposes and does not substitute professional medical or mental health advice. If your symptoms are severe or you experience increased distress, consult a licensed mental health professional.
Remember: You are not defined by your intrusive thoughts. With ERP, you can change your response to them, reducing their intensity and impact on your life. You’ve taken a courageous first step by learning about ERP—keep going, and you will see real progress.