What Is ERP?
ERP is a specialized form of CBT that treats OCD by breaking the obsession-compulsion cycle. It involves:
- Exposure: Deliberately confronting triggers that cause obsessive anxiety
- Response Prevention: Resisting the compulsion that usually follows
This teaches your brain that the anxiety will decrease on its own without compulsions, and that the feared outcome won't happen (or you can cope if it does).
Why ERP Is Counterintuitive
ERP asks you to do the opposite of what OCD demands: instead of avoiding triggers, you approach them. Instead of performing compulsions, you sit with uncertainty.
This is uncomfortable. But compulsions only provide temporary relief while strengthening OCD long-term. ERP provides lasting change.
How ERP Works
- Build a hierarchy: List triggers from least to most anxiety-provoking
- Start small: Begin with lower-anxiety exposures
- Prevent response: Resist compulsions (including mental rituals)
- Stay in it: Remain with the anxiety until it naturally decreases
- Progress up: Gradually tackle more challenging exposures
Why General Therapy Fails OCD
Well-meaning therapists often accidentally reinforce OCD by:
- Providing reassurance: "You're not a bad person" feeds the compulsion to seek reassurance
- Analyzing the content: Exploring "why" you have intrusive thoughts treats them as meaningful
- Teaching relaxation: Using relaxation to reduce anxiety becomes another compulsion
Finding ERP Treatment
Questions to Ask a Potential Therapist
- "Are you specifically trained in ERP for OCD?"
- "Where did you receive your ERP training?"
- "How many OCD patients have you treated with ERP?"
- "What does a typical ERP session look like with you?"
If they say they do "talk therapy for OCD" or "help you understand your intrusive thoughts," find someone else.