If you have been diagnosed with OCD and your obsessions focus on your sexual orientation, you probably have come across Exposure and Response Prevention (ERP) in your quest to get better. In today’s articles I want to show you some ERP examples for HOCD that you can try by yourself, or in conjunction with your therapist, if you are getting psychological help.
I’m going to give you realistic, values-led ERP examples you can actually use; they are the same sort of examples I would explain to clients in session.
Throughout, I’ll use SO-OCD / HOCD interchangeably and if you haven’t already read it, I recommend you familiarise yourself with this subtype of OCD, by reading my Guide to SO-OCD/HOCD.
What’s the purpose of ERP in SO-OCD?
Exposure and Response Prevention (ERP) is part of Cognitive Behavioural Therapy and is recognised internationally as a first-line psychological treatment for OCD, including SO-OCD.
There are many articles explaining ERP on my site including
- Complete Guide to Exposure and Response Prevention
- Explanation of how ERP is used to treat HOCD
- Articles on how to apply ERP
ERP is a nutshell is:
- Exposure (that’s the ‘E’ in ERP) = you deliberately move towards the things that trigger your obsessions (thoughts, images, situations, feelings).
- Response prevention (that’s the ‘R’ ‘P’ in ERP) = you choose not to do the usual compulsions (checking, analysing, avoiding, asking, researching).
It’s the response prevention – not doing the ritual or compulsion that eventually stops HOCD.
The goal is not:
- to “prove you’re straight”,
- to “prove you’re gay”, or
- to find the one perfect test that settles it forever.
The goal is to get rid of the need for certainty.
Before we start: identity, values and justice-based ERP
A very important point:
- Being gay, straight, bi, queer or anything else is not a problem.
- The problem in SO-OCD is relentless doubt and compulsive checking, not the existence of LGBT+ identities.
There’s growing discussion ( and rightly so) in the research world (justice-based ERP) about doing ERP in a way that doesn’t reinforce stigma towards LGBTQ+ people and instead respects everyone’s dignity.
In practice, that means your ERP should:
- Never treat being gay (or straight, or bi) as “bad” or “less than”.
- Treat your fear as “fear of uncertainty and loss of identity”, not as “fear of becoming a bad person because of a particular orientation”.
- Be guided by your values – for example: honesty, kindness, equality, intimacy, spirituality, family – rather than by “what would prove I’m definitely X or definitely Y”.
If you’re genuinely questioning your sexuality without OCD, you may need something different: space to explore, not ERP. SO-OCD is when the process feels like a stuck, anxious loop, not open exploration.
Core principles of ERP for SO-OCD (in my words)
Take a note of these as you will use them and keep coming back to them when you are working on and designing your own exposure. You can think of them as a set of rules, or how-to’s.
Target compulsions, not the thoughts
You can’t stop intrusive thoughts, you’re always going to get random images and “what if?” thoughts, but the trick is changing what you do next:
- Staring at people to check for attraction
- Replaying memories to see “what you really felt”
- Testing yourself with certain videos or images
- Asking friends, partners, forums for reassurance
- Monitoring groinal sensations and heart rate
ERP works when you change the response to the thought, not when you try to control the thought itself.
Practise staying with uncertainty, not getting rid of it
Many people (understandably) use ERP as a test:
“If I do this exposure and feel nothing, I must be straight.”
“If I do this and feel something, I must be gay.”
That keeps you stuck.
In values-led ERP, the goal is more like:
“I will watch this video, notice all the doubts and sensations that show up, and practise not solving them.”
Exposures must respect consent and your morality
ERP is not “do anything, no matter how it affects other people.” It must be:
- Consensual – we do not “use” real people as experiments.
- Values-consistent – if you value honesty, for example, ERP should not involve leading someone on purely as a test.
We work with your existing life, not at the expense of other people’s.
Start small and go gradually
You don’t need to jump straight to your worst fear. In fact, that often leads people to abandon ERP altogether.
If you were in session with me right now, I would tell you to;
- Start with milder triggers.
- Stay there long enough to learn something new.
- Repeat until the anxiety comes down..
- Only then move up the ladder.
Map your OCD cycle (with SO-OCD examples)
Before we build any hierarchies, it helps to see your own pattern. Take a moment to consider this:
The obsession (thought / image / sensation)
“What if I’m actually gay?”
“What if I’m lying to my partner?”
“Why did I feel that groinal sensation when I saw that person?”
Triggers
- Seeing an attractive same-sex person
- Seeing an LGBT+ couple in public or in a film
- Being in changing rooms / gym
- Hearing news or stories about people coming out
- Being intimate with your partner
- Feeling any sensation in your groin
Compulsions / safety behaviours
- Mentally replaying interactions to analyse your reaction
- Comparing current and past attractions
- Checking your body for sensations (groin, chest, heart rate)
- Using porn or images as a “test”
- Avoiding friends / places / media that trigger doubts
- Googling HOCD, reading forums, asking for reassurance
ERP will always be some version of:
Expose: move towards trigger on purpose
Prevent response: drop or reduce your usual compulsions
Building a values-led hierarchy for SO-OCD
An exposure hierarchy is simply a list of triggers, from “easiest” to “hardest”, with a rough anxiety rating—for example 0–10 or 0–100.
I will be talking a lot about hierarchies, you can learn more about building ERP hierarchies in this article
Use whatever scale feels intuitive; I’ll use 0–10 below.
Step 1: Clarify your values
Ask yourself:
- What kind of person do I want to be in relationships (romantic, family, friendships)?
- How do I want to treat other people, regardless of their orientation?
- What do I want my life to be about besides OCD and certainty?
You might write:
- “I value being a loving, present partner.”
- “I value fairness and equality.”
- “I value integrity: living truthfully, not on autopilot.”
- “I value spirituality / creativity / work / family…”
We’ll use these later to decide why you are doing each exposure.
Draft sample hierarchies (you can adapt these)
Below are example hierarchies. Please adapt them to your own triggers and orientation. If you’re working with a therapist, you can explore them together.
Example A: Heterosexual man afraid of being gay
Values highlighted in italics.
Low-mid level (2–4/10)
- Read a neutral article about LGBT+ rights and sit with any anxiety that arises (value: fairness, equality).
- Look at photos of same-sex couples holding hands for 2–3 minutes without checking your feelings.
- Walk past a clothes shop with a Pride display and deliberately look at it instead of avoiding it.
Mid level (5–7/10)
- Watch a film with a same-sex romantic storyline, staying for the full scene.
- Sit in a café where you can see a same-sex couple and allow all your “what if?” thoughts without analysing them.
- Talk briefly with an LGBT+ friend or colleague about their weekend, without monitoring your internal reaction.
Higher level (8–9/10)
- Attend an LGBT+ friendly event (e.g. Pride-themed talk at a bookshop) as an ally, and stay for a set time.
- Write an imaginal script in which you might realise you’re gay and imagine how you’d still live by your values (kindness, honesty, respect), and read it daily.
Notice: none of these exposures say “Being gay would be terrible.” Instead, they help you face the uncertainty while treating LGBT+ people with respect.
Example B: Lesbian woman afraid of being straight (yes, this happens)
SO-OCD affects people of all orientations.
Low-mid level (2–4/10)
- Look at photos of heterosexual couples on social media without unfollowing or avoiding.
- Read a short story featuring a straight relationship, letting anxiety rise and fall without checking.
Mid level (5–7/10)
- Spend time with straight friends who are in relationships, noticing all the “What if I end up like them?” thoughts and not engaging with them.
- Watch a film with an opposite-sex romantic storyline and stay for the ending.
Higher level (8–9/10)
- Write an imaginal script in which you might realise you’re straight and imagine still building a meaningful life (friendships, values, work) even amidst that uncertainty.
- Go on a normal date with your actual partner, allowing doubts like “Am I really gay?” without confessing just to get reassurance.
Example C: “What if I never know for sure?”
Some people with SO-OCD are less fixated on one direction (“What if I’m gay?”) and more on never being certain of any label.
Values-led exposures might look like:
- Choosing to show up fully in your current relationship (whatever it is), while allowing the “What if I chose wrong?” thoughts to be background noise.
- Joining a hobby group or class consistent with your values (art, volunteering, sport), and practising not running mental sexuality-checks whilst there.
- Writing a script that ends with: “Maybe I’ll never have 100% certainty about my sexuality—and I’m willing to live a rich, meaningful life anyway.”
ERP examples by theme (with clear response-prevention rules)
Below are some more concrete examples, because people often say, “I get the idea, but what do I actually do?”
For each example I’ll give you:
- The exposure
- The “not doing” list (compulsions you practise dropping)
- The values link
Media-based exposures
Example 1 – Short YouTube clip
- Exposure
Watch a 3–5 minute clip with a same-sex romantic scene (or opposite-sex if that’s your feared direction). - Response prevention (what you don’t do)
- No pausing or rewinding to “check” your reaction.
- No looking away at the “worst” bits.
- No scanning your body to see if you feel aroused or disgusted.
- No immediate Googling “Does HOCD mean I’m actually gay/straight?” afterwards.
- Values link
“I’m practising being someone who can consume media like anyone else without OCD running my life.”
Example 2 – Reading personal stories
- Exposure
Read a first-person coming-out story, or a story of someone realising they’re straight after assuming they were gay – whichever aligns with your feared scenario. - Response prevention
- No using the story as proof that “This is just like me” or “This could never be me.”
- No comparing every detail of their life to yours.
- No going down rabbit holes of similar stories.
- Values link
“I value empathy and learning about others’ experiences, even if my OCD tries to co-opt them as evidence.”
Real-life social exposures
Example 3 – Being around feared triggers
- Exposure
Sit in a café, park, or workplace area where you are likely to see people you find triggering (e.g. same-sex people you might find physically attractive). - Response prevention
- No staring to check for attraction.
- No deliberately trying to feel aroused or trying not to feel aroused.
- No mental rating of each person (“6/10 attractive”, “2/10 attractive”).
- No replaying the situation later to decide what you “truly” felt.
- Values link
“I want to be able to move freely in public spaces without avoiding or categorising everyone. I value freedom and everyday normality.”
Example 4 – Conversations
- Exposure
Have a brief, natural conversation with someone who triggers your fears (same-sex colleague, opposite-sex acquaintance, etc.) about something ordinary – their day, a hobby, work. - Response prevention
- No scanning your body mid-conversation.
- No replaying the conversation afterwards to see if you smiled too much or felt “too comfortable” or “too tense”.
- No seeking reassurance from another friend: “Do you think I was flirting?”
- Values link
“I value treating people as whole humans, not as tests or threats.”
Working with groinal response and body sensations
Many people with HOCD/SO-OCD get stuck on the groinal response – normal bodily sensations that get mislabelled as “proof” of a hidden orientation.
Example 5 – Mindful noticing
- Exposure
While sitting or walking, deliberately bring gentle attention to your groin area for 1–2 minutes. - Response prevention
- No trying to create or block sensations.
- No scrolling through memories to see “when I felt this before”.
- No deciding what the sensation “means” about your identity.
Example 6 – Exposure + neutral touch
If appropriate and not triggering traumatic memories, some people practise:
- Exposure
Sitting or standing in a neutral position that might cause small shifts in sensation (crossed legs, certain clothes, light movement), and noticing what arises. - Response prevention
- No checking repeatedly during the day, “Is it still there?”
- No scanning past events for whether you felt this with people of different genders.
Response-prevention not working?
I’ve been working as a psychologist for a long time, and specifically with OCD for 20 years, and usually half way through therapy someone tells me that ERP is not working, I want to break that down now, in case that happens to you, as the model is solid, but the way it gets applied, might need looking at. Check if you are doing any of the following.
Using exposures as orientation tests
- Looks like:
Watching a video and then thinking, “If I’m turned on, it means X; if I’m not, it means Y.” - What to do instead:
Go into each exposure with this intention:“The goal is to practise not measuring or solving this. The goal is to build tolerance for doubt.”
Hidden mental checking during exposures
- Looks like:
Internally scanning: “What am I feeling now? What about now? And now?” or comparing to past crushes. - What to do instead:
Gently redirect your attention to what’s in front of you (the film scene, conversation, sounds in the room).
It’s fine if checking thoughts pop up – you just don’t feed them.
Subtle avoidance and safety behaviours
- Looks like:
Choosing seats where you can’t see triggering people, muting LGBT+ topics online, keeping your eyes on the floor, picking clothes that don’t show your body shape. - What to do instead:
As you progress through ERP, begin to drop these little safety behaviours. For example, choose a normal seat, allow your eyes to look around naturally.
Going too hard, too fast
- Looks like:
Forcing yourself to do your “worst nightmare” exposure first, then never wanting to touch ERP again. - What to do instead:
Return to your hierarchy. Start at something that brings moderate anxiety (say, 4–6/10), not a 10/10. Build confidence gradually.
A simple weekly structure to get you started
If you’re using this article alongside therapy or self-help work, you might try a structure like this:
Day 1–2
- List your main obsessions, triggers, and compulsions.
- Write down 3–5 values that matter to you.
- Draft a small hierarchy (maybe 6–10 items).
Day 3–5
- Choose one low-to-mid anxiety exposure (around 4–6/10).
- Do it once per day, with clear response-prevention rules written down.
- After each exposure, jot down:
- What you did
- What compulsions you didn’t do
- What you noticed (anxiety level, any new learning)
Day 6–7
- Review:
- Did anxiety slowly reduce, or did it simply become a bit less scary?
- Did you learn anything like, “I can handle this”, “feelings are not facts”, “sensations change”?
- Decide whether to:
- Stay at the same level for another week, or
- Move one small step up the hierarchy.
It’s perfectly fine to go slower than you think you “should”. Consistency matters more than speed.
When to seek extra help
SO-OCD can be deeply distressing.
You may benefit from professional help if:
- You spend several hours a day on obsessions / compulsions.
- Your relationships, work, study or daily functioning are suffering.
- You feel depressed, hopeless, or have thoughts of harming yourself.
- You’ve tried self-help ERP and feel stuck or overwhelmed.
Evidence-based guidelines recommend CBT with ERP as a first-line treatment for OCD, sometimes alongside medication such as SSRIs, depending on severity.
You can look for:
- A therapist who specifically mentions OCD, ERP, and ideally experience with SO-OCD / HOCD.
- Reputable OCD organisations (such as national OCD charities or specialist associations) often list clinicians trained in ERP.
If you’d like structured self-help from me, I’ve taken what I do in sessions and built it into an HOCD online course with CBT, ERP and neuroscience-based tools.
