OCD and ERP Therapy: What You Should Expect

By Patrick McGrath, PhD
4 min read
OCD and ERP therapy: what to expect

The following is a transcript of a video shot and produced by NOCD. The copy below has been only lightly edited for clarity purposes.

Several things you ought to really know about doing exposure and response prevention therapy is:

1. It’s going to be Difficult

Unlike what you might see on television where people are laying on a couch and it’s [a] very calm and soothing experience, ERP is purposely difficult. We are going to be having you sit with your discomfort, sit with your fears and learn how to handle those things. So, we have to create some anxiety or feelings of maybe guilt or shame or disgust or something so that you learn ultimately how to handle those without performing compulsions. That’s number one. 

2. You Have To Do The Work

If you take piano lessons and you only play during the piano lessons, you only get half an hour better a week. Similar to therapy for OCD, you’ve got to take the exposure and response prevention therapy exercises that you’re working on in therapy sessions, and then do them outside of therapy sessions too. Otherwise, you’re not going to see that generalization that we want to see throughout your whole life, where you’re going to be able to start to learn that you can see a decrease in the OCD and the influence that it has on your life. 

3. Be Honest With Your Therapist

You have to tell them everything that’s going on. That means whatever the obsession is, whatever that intrusive thought or image or urge is and no matter how gross or awful or horrible or disgusting or anxiety-provoking or bad or evil or wrong you think that thing is, you have to be open with your therapist about that. 

The good thing is that OCD therapists have heard these things for years and years already. You’re not going to surprise them with anything that’s going on. And in fact, you might find it very relieving to finally be able to tell someone about what it is that’s been going on in your life, and to have them understand and not judge you for it because they recognize it as obsessive-compulsive disorder and not on you as a person. 

4. Get Out Of Your Own Way 

You will second-guess yourself while doing therapy. There will be times that you wonder, why am I putting myself through this? Why am I sitting with all these difficult things? Wouldn’t it be easier just to do a compulsion? Couldn’t I just get one more bit of relief and then I promise, that’s the last reassurance I’ll ever get? 

And you know that you’ve probably used those excuses multiple times already. It’s time to decide that we’re not going to use excuses anymore. We’re going to walk away from safety behaviors. We’re going to stop seeking reassurance, distracting ourselves, avoiding things that are difficult using substances as a way to manage our feelings, and we’re going to ultimately stop doing compulsions. Those are the things that need to happen in order to see true successful exposure and response prevention therapy happen for obsessive-compulsive disorder. 

5. Expect Setbacks

Finally, along the way there’s probably going to be some setbacks. There will be days that it’s more difficult than other days, even after therapy. There may be times that a stressor occurs in your life, and OCD, being the advantageous jerk that it is, is going to try to take advantage of that and to say hey, I’ve got a solution for you, let’s go back to doing some of those compulsions. 

And just remember that’s the way OCD works, but just because it works that way doesn’t mean that you have to listen to it. Your ultimate goal in doing this therapy is to recognize, I can handle whatever thoughts or images or urges popped into my head. I don’t have to believe them to be true, and I don’t have to follow the advice that my OCD tells me as a way to manage things, I can just go on and live my life, even if I have obsessive-compulsive disorder. 

If you need exposure and response prevention therapy, check out NOCD.com or treatmyocd.com, we have trained therapists who utilize exposure and response prevention therapy for the treatment of obsessive compulsive disorder. I personally supervise that network as well. And we look forward to helping you and working with you to see if we can help make some changes in your life, and get rid of that influence that the OCD has.

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Patrick McGrath, PhD
WRITTEN BYPatrick McGrath, PhD