Dr. Jeremy Carpenter, a psychiatrist with LifeStance (a NOCD partner), lays out his evolving approach to OCD treatment—from learning to identify lesser-known symptoms to how referring patients for exposure and response prevention (ERP) therapy right away has led to a dramatic shift in clinical outcomes.
Dr. Jeremy Carpenter, a psychiatrist with LifeStance Health, says OCD treatment has come a long way in the past 15 years. When Dr. Carpenter was first getting trained, he didn’t learn much about exposure and response prevention (ERP) therapy—the most effective form of treatment for OCD. Now, when patients show up with signs of OCD, he refers them to ERP therapy as a first line of treatment.
ERP itself isn’t new. About 80% of people experience significant symptom reduction through this evidence-based approach, which helps people break the cycle of obsessions and compulsions by gradually facing fears without performing rituals.
Prior to trying ERP therapy, Dr. Carpenter observed that his patients with OCD “were at the mercy of these really horrible thought processes that disrupted their lives.” But ERP therapy—both on its own and in combination with medication—has given them “a means to engage, to change the landscape” of their minds.
We spoke with Dr. Carpenter to learn more about his evolving experience identifying and treating OCD, and the “huge” shifts he’s observed in clinical outcomes after referring patients for ERP.
What did your clinical education teach you about OCD and ERP?
It was more focused on traditional or “textbook” types of OCD—such as counting and handwashing—and we also received a lot of education on medication management. We were aware that CBT (cognitive behavioral therapy) could be helpful, but ERP was not something that was really emphasized 15 years ago. It’s primarily something I’ve become more aware of over the past four years.
My earlier education was definitely lacking in identifying the full range of presentations and the non-medication treatment options available. After NOCD offered education on the different subtypes of obsessions and compulsions, I began seeing more and more patients presenting this way. Before, I don’t think I always had the right language to identify all of the symptoms and move forward with the most appropriate treatment.
When did you begin referring your patients for ERP therapy, in addition to medication management?
To be honest, it was after NOCD introduced their services. Before that, I would usually recommend general cognitive behavioral therapy (CBT). I now understand that we also have excellent ERP providers within LifeStance, which is great. This whole experience has really expanded that knowledge.
What sorts of outcomes have you seen since you started referring patients for ERP therapy, whether at NOCD or elsewhere?
One patient in particular comes to mind. He was out of work, and OCD played a major role in that. I recommended NOCD, and it’s been huge. We had struggled to make meaningful changes due to medication side effects and limited response, but once he started ERP, he was really encouraged because he began seeing benefits.
He had a fear of harm if his heart rate reached a certain level. His NOCD Therapist coordinated with me and even did an exposure session using an exercise bike. That goes beyond what I traditionally think of as in-office ERP, which often focuses more on mental imagery.
I think of other patients as well. One in particular, after completing ERP, said, “I think I might want to try reducing my medication.” That was never suggested by the NOCD Therapist—it came from the patient feeling more confident and equipped. They finally had the tools they didn’t have before. Overall, I’ve seen really positive outcomes with ERP, especially through NOCD.
Can you talk more about the role that ERP plays for a patient who is on medication?
We’ve traditionally relied more on a medication-first approach. Now, when patients clearly meet criteria for OCD and symptoms are persistent and impairing, my recommendation is to start ERP right away. With medication, we often have to wait up to 12 weeks at higher doses to assess benefit, which is a long time when other effective treatments can already be underway. Because of that, my recommendation for ERP has become much earlier in the process.
What do you think it is about ERP that makes it successful?
My patients often describe a sense of agency and mastery. Before, they felt at the mercy of these intrusive and disruptive thought patterns. ERP gives them a way to engage with those thoughts differently and change that landscape.
There’s a big perspective shift—from feeling controlled by OCD to recognizing it as something they can manage while focusing on the rest of their lives. They also like having a non-medication option that actually works. It helps them feel more engaged and empowered in treatment.
And from your perspective, how does working with NOCD and our therapists complement or enhance the care that you and other LifeStance providers are able to provide?
I can send a referral immediately and often hear back within a few hours. I receive updates on patient progress, which helps with follow-up. The integration has been great. With many outside referrals, maybe about half actually connect with care. With NOCD, the follow-through rate is much higher. It’s been a very accessible and effective resource.
Is there anything else you think providers should know about ERP?
I would encourage providers to recommend ERP earlier in treatment. It’s been exciting and extremely helpful. I’ve learned a lot through this experience, and my patients have really benefited. I’m grateful to see how well it’s working.
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It takes an average of 14-17 years for someone with OCD to find appropriate care, and research has shown that 70% of OCD cases are misidentified. The lack of identification and proper diagnosis has detrimental effects on patients and can lead to an elevated risk of suicide and substance abuse disorders, as well as increased emotional and physical distress. Early, empathetic screening, accurate diagnoses, and an ever-growing network of informed providers are critical to alleviate the suffering caused by OCD.
NOCD collaborates with providers to properly diagnose patients and help them effectively manage symptoms using exposure and response prevention (ERP) therapy—the most effective treatment for OCD—both as a supplement to medication and a standalone treatment. All NOCD Therapists receive expert training in OCD and can assess patient symptoms and help them start effective treatment, while collaborating with their care providers.
