How ERP Works: A Step-by-Step Guide to Conquering OCD
In honor of ICODF’s OCD awareness week earlier this month, I’m writing about ERP to provide a glimpse into what therapy for OCD looks like and promote awareness about treatment options. If you’re someone who lives with OCD and are curious about getting help, you’re in the right place! ERP is a powerful, evidence-based approach designed to help you face fears and learn new ways to respond, reclaiming your life from OCD. In this step-by-step guide, I’ll break down how ERP works using the example of Relationship OCD (ROCD) and what you can expect in therapy.
Step 1: Understanding the Cycle of OCD
OCD works in a relentless cycle. It starts with an obsession—an unwanted, intrusive thought, image, or urge that creates a rush of anxiety and fear. Common obsessions might include fears of contamination, harming someone, or, in the case of ROCD, doubts about one’s feelings, partner’s compatibility, or the overall “rightness” of the relationship. To alleviate the anxiety, you may perform a compulsion—a repetitive behavior (internal or external) aimed at reducing the distress. But while this compulsion offers temporary relief, it also reinforces the obsessive fear, setting the cycle in motion all over again.
While engaging in compulsions can help you feel safe or comforted in the moment, you’ve probably realized over time that as your fear/doubt gets triggered, you have to keep re-engaging in the compulsions to maintain temporary relief, which can feel exhausting and defeating.
When you continue to engage in compulsions, it blocks your brain from gaining new information that could challenge and weaken the fears linked to your obsessions. Instead, the fear gets reinforced, as does the need to rely on the compulsion. This is where we see how easy it is to get trapped in their OCD cycle, and how hard it can be to break without adequate support.
ERP tackles this cycle head-on, helping to break the link between obsession and compulsion, so you can teach your brain a new way to respond to anxiety.
Step 2: Identifying Your Obsessions and Compulsions
The first step in ERP is working with your therapist to identify your specific obsessions and compulsions. In therapy sessions, we identify your obsessions and compulsions, and I support you in learning how to self-monitor these in between sessions using a tracking log.
If you’re dealing with ROCD, for example, your obsessions might involve persistent doubts about whether you truly love your partner, whether they’re the “right” person, or whether you’ll always feel secure in the relationship. Your compulsions could include constant reassurance-seeking from your partner, repeatedly checking your own feelings, comparing your relationship to others, or mentally analyzing “signs” to determine if you’re truly compatible. By laying out these patterns together, we will create a roadmap for your ERP journey, zeroing in on the situations that cause anxiety and the behaviors you typically turn to for relief.
Step 3: Creating a Hierarchy of Fears
With ERP work, you’re never thrown into the deep end. Based on your tracking log, together we create a “fear hierarchy,” a list of situations/triggers related to your obsession ranked from least to most anxiety-inducing. This hierarchy will guide our exposure work, allowing you to start with manageable challenges before building up to more intense ones.
For example, if you have ROCD, your hierarchy might start with reading a relationship article without overanalyzing it for signs, then progress to higher-level tasks like intentionally sitting with doubts about your feelings without seeking reassurance from your partner.
Step 4: Gradual Exposure to Triggers
With your hierarchy set, the work of ERP begins. Exposure involves intentionally facing your fears in a controlled, gradual way. We start with the lower-level fears on your list and work your way up, exposing yourself to situations that trigger your ROCD while resisting the urge to perform your usual compulsive behaviors.
Here’s how this might look in practice: If reading a relationship article makes you want to mentally analyze your feelings toward your partner, I may ask you to read it and then sit with the discomfort that follows, resisting the urge to analyze. Over time, these exposures will increase in difficulty, allowing you to gradually confront and neutralize fears at higher levels.
Step 5: Practicing Response Prevention
The “Response Prevention” part of ERP is as important as the exposure itself. This means refraining from doing the compulsive behavior that usually follows the obsessive thought or feeling. When you expose yourself to a trigger but resist the compulsion, you’re teaching your brain that it can tolerate the anxiety without the ritual—and that the feared consequences don’t actually happen.
This new learning disarms the idea that compulsions are what prevent disaster and alleviate anxiety. Over time, you are able to develop a tolerance for discomfort and uncertainty. This helps decrease overall peak anxiety levels, and you return to your baseline anxiety level faster than you would engaging in compulsions.
For instance, if reading about relationships makes you want to ask your partner for reassurance about their feelings for you, response prevention involves sitting with that urge and letting it pass without seeking reassurance. At first, your anxiety will spike, but over time, you’ll notice the intensity of the urge and anxiety start to fade. This experience, called habituation, helps you build resilience to anxiety and weakens the OCD cycle, empowering you to not feel held captive by it.
Step 6: Building Tolerance for Uncertainty
A crucial part of ERP is learning to tolerate uncertainty, which occurs as we gradually work through the fear hierarchy and practice response prevention. Many obsessions are rooted in the need to feel absolutely certain or “safe,” like wanting to know for sure that your relationship is “right.” ERP helps you learn to embrace the reality that absolute certainty is often impossible—and that’s okay.
By sitting with uncertainty, you’ll gain confidence in your ability to handle anxious thoughts and feelings without letting them dictate your actions. This growing tolerance for imperfection and ambiguity is a skill that will benefit you not only in treating OCD but also in many aspects of life, helping you to build resilience and feel empowered as you confront ups and downs.
Step 7: Practicing Consistently and Building Confidence
ERP isn’t a quick fix, and it’s not easy; it’s a process that requires patience and consistent practice. The more exposures you do, the easier they’ll become, and over time, situations that once triggered intense anxiety will feel manageable, maybe even easy.
As we work together through your hierarchy, you’ll likely notice improvements in how you handle everyday situations. Tasks that once felt overwhelming or impossible will become more doable, and you’ll build confidence in facing your fears. With ERP, you’ll gain practical skills to resist compulsions and feel a greater sense of freedom and control.
The Impact of ERP: A Life Less Constricted by OCD
ERP isn’t about eliminating all anxious thoughts; it’s about changing your relationship with anxiety and learning to live fully even when uncomfortable thoughts arise. By breaking the obsession-compulsion cycle and learning to tolerate uncertainty, ERP empowers you to engage more fully in your life, rediscover joy in small moments, and feel less constrained by the need to seek reassurance or perform rituals. My hope for those who go through ERP treatment is that they feel a greater sense of empowerment and confidence in all aspects of their lives.
Is ERP Right for Me?
As you read this post, you may be feeling anxious at the thought of trying ERP. I understand that the cycle of OCD has been reinforced over and over, and so it makes perfect sense to me that the thought of trying something new would be daunting. Ask yourself, “what would be different about my life if I didn’t feel so captive by OCD?” Notice what comes up for you to imagine this. With all my clients, I share that there is a cost to treatment, and there is also a cost to maintaining the status quo; you get to decide what you’re ready for.
If you’re feeling tired of OCD running the show and are ready for relief, ERP can be a great option. ERP has helped countless people find relief and reclaim their lives, and is considered the gold standard in OCD treatment. If you’re struggling with OCD and want to explore ERP, remember you don’t have to go through this alone. Working with a trained therapist can provide you with support and strategies tailored to your unique experience, making it easier to take those brave first steps toward healing. If you’re ready to heal from OCD, I invite you to reach out to me:
Reach Out: Take the first step by contacting me here.
Let’s Chat: Schedule a consultation to discuss your experience with OCD, ask questions and see if we’re a good fit.
Start Healing: Embrace a personalized approach to reclaiming life beyond OCD!