The constant battle with intrusive thoughts, the endless rituals to silence them, the exhaustion of trying to keep everything under control. Obsessive-Compulsive Disorder (OCD) is relentless, but you’re not alone, and there’s a way through it. In my 20+ years of working with individuals who have OCD, I’ve witnessed incredible transformations. The therapy that makes this possible is Exposure and Response Prevention, or ERP. ERP is a widely recognised, evidence-based treatment for OCD, as highlighted by the International OCD Foundation (IOCDF)1 and recommended as the first choice of treatment by NICE2. In this article I shall explain how it work and help you to understand how it can help.
What is ERP, and How Does It Help?
Think of ERP as the ultimate personal trainer for your brain. It’s not easy, it’s not glamorous, but wow, does it work. ERP helps you confront your fears head-on while resisting the urge to perform compulsions—those things you do to temporarily ease your anxiety, like washing your hands for the fifteenth time or mentally replaying an interaction to make sure you didn’t say anything wrong.
Imagine you’re scared of spiders (a classic, right?); and I’m not making light of that, as I am a person who was terrified of spiders up until a few years ago. I would like to credit my own psychological brain for reducing my fear, but sadly it was not. I remember hearing someone describe seeing the spider first as a large cuddly toy, with the type of eyelashes that Disney would create, and I took it from there. An ERP therapist wouldn’t throw you into a pit of tarantulas and say, “Good luck!” No, it’s gradual. First, you might look at a picture of a spider. Then maybe you’d be in the same room as one (securely contained, of course). Eventually, you might even touch one—though let’s be real, no one’s asking you to become Spider-Man. For OCD, we take the same idea and apply it to intrusive thoughts and compulsions.
Here’s an example from my practice: A client I’ll call Sarah had intrusive thoughts about harming her partner. She couldn’t even stand near a knife without panicking. Her compulsion was to hide all sharp objects in the house. Together, we started small. In session, she simply looked at a knife on the table. At first, her anxiety shot up, but we stayed with it. Over time, she practiced sitting with the discomfort until it lessened. Weeks later, she was chopping vegetables with her partner by her side, something she hadn’t done in years.
ERP works because it teaches your brain that you can survive the anxiety. The fear diminishes, and so does the compulsion.
The Cycle of OCD—and How ERP Breaks It
Here’s the thing about OCD: it thrives on a vicious cycle. A thought pops into your head—let’s call it an obsession. For example, “What if I didn’t lock the door?” Anxiety skyrockets. So, you check the door (the compulsion), and ahhh, sweet relief. But only for a moment. Before you know it, the thought returns stronger than ever. OCD doesn’t play fair.
ERP steps in and says, “Enough!” It helps you face that initial anxiety without doing the compulsive behaviour. The more you practice this, the less power the obsession holds.
I once worked with a man who couldn’t leave the house without checking his stove at least 20 times. We started by writing down all his fears about what would happen if he didn’t check—the house burning down, him being blamed for it, everyone hating him. Then, he walked out of the house without checking the stove even once. “Am I allowed to swear?” he asked me when we sat in the car. “Because this feels terrifying as hell.” We laughed, and then he sat with his anxiety. It peaked, then gradually fell. Over weeks of practice, he stopped being a slave to that stove.
Real-Life Examples of ERP in Action
ERP can be tailored to the specific themes of your OCD and you can learn more about ERP for intrusive thoughts here. Let me share a few examples from my clinical practice:
Harm OCD: One of my clients, a teacher, had intrusive thoughts about harming her students. She avoided being alone with them, always leaving the classroom door open. Her ERP journey began with staying in the room alone for a few minutes at a time, gradually building up her confidence. She learned that her thoughts were just that—thoughts, not intentions.
Contamination OCD: A nurse I worked with struggled with compulsive handwashing, going through an entire bar of soap in a single day. We started with small exposures, like touching her desk and waiting five minutes before washing her hands. Gradually, she worked up to eating a snack without washing her hands first. “It’s gross,” she said at first. “But it’s also kind of freeing.”
Religious or Moral Scrupulosity: Another client feared that she might think or say something blasphemous in church. During ERP, she practiced imagining worst-case scenarios, like accidentally shouting something inappropriate. We even wrote down blasphemous phrases together, and she carried them in her pocket. Each time she resisted the urge to reassure herself, she reclaimed a little more peace.
HOCD (Homosexual OCD): A client doubted their sexual orientation and compulsively checked their attraction to others. ERP involved looking at pictures of people of the same sex and sitting with the uncertainty about what they felt. Over time, the need to “check” lessened. You can learn more about ERP for HOCD here.
ROCD (Relationship OCD): Doubts about whether their partner was “the one” consumed another client. Together, we imagined scenarios like their partner leaving them or not being “perfect.” They learned to tolerate the uncertainty, strengthening their relationship in the process.
How ERP Works in Practice
Let’s say you have intrusive thoughts about accidentally shouting something inappropriate in a meeting. Instead of avoiding meetings, ERP would involve attending one and letting the thought come. You’d sit with the anxiety, resist the urge to excuse yourself or seek reassurance, and eventually see that nothing catastrophic happens. It’s not easy, but it’s powerful.
Another client told me, “But I’ll always feel anxious!” To which I replied, “No one feels anxious while eating ice cream. Let’s get through this first, and I promise ice cream later.” ERP isn’t about eliminating anxiety overnight; it’s about taking control back, one step at a time.
A Warm Word of Encouragement
I know this all sounds daunting, but ERP isn’t about doing it perfectly. It’s about showing up and trying. Every time you face a fear, no matter how small, you’re rewriting the story OCD tells you.
In my practice, I’ve seen people regain their freedom—parents playing with their kids without fear, students attending class without rituals, professionals thriving in careers they thought they’d lose to OCD. ERP works because you do the work, and that makes every victory truly yours.
If you’re struggling with OCD, know that help is out there. You’re not broken, and you’re not alone. ERP might just be the tool that helps you rediscover the joy and peace you deserve.
To explore more about ERP, visit my detailed guide on ERP here. If you’re ready to take the next step, whether through therapy or self-help, know that recovery is possible—and it starts with hope.