How to do ERP for OCD at home, and when not to

If you wanted to go online and learn how to train your dog to sit and stay, you could do that in two minutes, right? And while you’re at it, you might also ask Siri what to make for dinner. Search results in a heartbeat. So it makes sense that if you have a mental health issue like obsessive-compulsive disorder (OCD), you might want to turn to Dr. Google to treat your OCD. 

But let’s back up for a moment. You might know that the gold standard therapy for OCD is exposure and response prevention (ERP). But can you do it on your own, without the guidance of a therapist? After all, there can be some real barriers to therapy,   including cost, lack of insurance, or not having access to a specialized therapist in your area. Plus, people with OCD often feel ashamed of their obsessions and compulsions, and may have a hard time opening up even to a therapist.

“Therapists that specialize in OCD have the training needed to design ERP exercises that will be most successful,” says Dr. Patrick McGrath, Chief Clinical Officer at NOCD, an online therapy platform that specializes in ERP treatment for OCD. Let’s understand how ERP works, why the guidance of a therapist is your best option, and when practicing it on your own could actually be appropriate.

The OCD cycle

To understand why OCD is most effectively treated with the help of an ERP-trained therapist, it helps to know how OCD works. It can be best described as a cycle—one that’s so insidious it’s hard to break by yourself. The OCD cycle works like this:

1. You have a repetitive, unwanted intrusive thought, image or urge, such as: What if I’m wrong about my sexuality and end up blowing up my partner and our lives? Maybe I want to push that stranger off the train platform. I like hanging out at the park near the playground—does that mean I’m attracted to children?

2. You experience extreme distress—anxiety, worry, panic, fear, shame, guilt, embarrassment—over the intrusive thought. And you feel a desperate need to know right now, with certainty, whether or not it means something.

3. You engage in a mental or physical behavior (a compulsion) to try to relieve your distress. This can make you feel better for a short time. But here’s where the cycle comes back around: When you respond to your intrusive thoughts with compulsions, it reinforces the idea that you must do compulsions in order to be okay. It trains your brain to continue seeing intrusive thoughts as real threats that have to be taken seriously. Simply put, it teaches you that you can’t tolerate discomfort and uncertainty.

“Over time, performing compulsions reinforces the belief that obsessions pose a real danger, and that compulsions are necessary in order to be safe. This creates a vicious cycle that only gets stronger until it is interrupted,” says Stacy Quick, LPC, a therapist who specializes in OCD treatment.

The goal of ERP is to do the hard—but very possible—work of putting out the fire and breaking the OCD cycle, and a trained therapist knows how to do that effectively. A NOCD Therapist, based on their acute knowledge of OCD and experience working with others with the same disorder, can help you recognize what patterns are OCD-related that you may not even be aware of.

What is ERP and how does it work?

ERP for OCD consists of gradual exposures to the things that trigger your intrusive thoughts. That could be looking at a word, being around a certain person, or watching a piece of media that relates to your obsessions. And,most importantly, you learn how to not respond with compulsions—that’s the response-prevention part of ERP.

To kick off the process, you and your therapist work together to identify what your intrusive thoughts sound like and what compulsions you engage in. 

“If you try to do ERP on your own, you might only identify some of your compulsions. By not detecting all of them, you risk doing those other compulsions during your exposure exercises, which will prevent you from making progress,” explains Dr. McGrath.

After you’ve identified your obsessions and compulsions, you and your therapist will continue to collaborate on developing a hierarchy of exposures—meaning, you start with ones that cause the least amount of discomfort and work your way up. This model ensures that you don’t take on too much too fast, get overwhelmed, and quit. 

Can you start ERP on your own?

Here’s why it’s not the best idea. “By beginning ERP on your own, you risk starting an exposure exercise that you’re not ready for, which is sort of like lifting weights that are too heavy for you without proper form and a spotter,” says Dr. McGrath. As you tackle exposures, your therapist will encourage you to leave your comfort zone—while making sure you’re not doing anything you’re not ready for. They’ll also help you process through the distress that arises, and give you techniques that allow you to sit with discomfort and uncertainty. Over time, this teaches your brain that there wasn’t anything to be fearful of in the first place.

“Eventually, you should strive to become your own therapist, but conducting therapy on your own is not the best way to begin managing your OCD,” says Dr. McGrath. In fact, according to research, only 4% of people with OCD recover without professional help. “We NOCD clinicians have seen many times over how much more effectively and faster symptoms are reduced when you work with an ERP-trained, licensed therapist.”

Tracie Zinman-Ibrahim, CST, LMFT, another clinician at NOCD, says that she’s seen many clients who have tried to practice ERP on their own but don’t see results until they begin working with a therapist. “You have to fully apply ERP to your life, and it’s hard in the beginning sometimes,” she says. Starting this work with a clinician gives you an extra push of accountability and guidance.

How ERP can work without your therapist in the room

Again, the goal of ERP is to become your own therapist, eventually. Before then, you will typically practice ERP on your own between your therapy sessions as “homework.” Zinman-Ibrahim says this is important because you may only see your therapist for an hour a week, but you’re with yourself 24/7. 

While ERP is most effective when you do this “homework,” it’s key to have guidance from a professional before trying to do ERP on your own. They’ll be able to assign “homework” best suited for where you are in your OCD journey, and give you tips and tricks for how to practice at home. As Zinman-Ibrahim puts it, you’ll learn to “build ERP into your daily lifestyle.”

“Being proactive about practicing ERP every day is crucial to staying well,” says one NOCD member who entered recovery after working with their ERP therapist.

What if you can’t work with an ERP therapist right now?

Here are some other things you can do to work on you prepare to work on your mental health:

1. Learn about OCD from trusted sources. Education can give you insight into your own experience and help you recognize behaviors you didn’t realize were connected to OCD. Zinman-Ibrahim notes, “Just make sure you’re going to valid resources for information and support.” To begin, you can check out NOCD’s list of 12 OCD Advocates to Follow on Social Media, read the NOCD blog, and look through the International OCD Foundation (IOCDF) website.

2. Develop awareness of your compulsions. As you learn more about OCD and the many forms compulsions can take, reflect on your own (mental and physical) behaviors. From there, you can practice resisting them. Schuler says, “Start with small, manageable, specific goals. For example, reducing one specific compulsion by half for two days, and work up from there.”

3. Read up. There are some great, therapist-authored workbooks for OCD out there, specifically, Kimberley Quinlan, LMFT’s The Self-Compassion Workbook for OCD and Scott Granet, LCSW’s The Complete OCD Workbook. 

4. Attend livestreams and conferences. The IOCDF hosts a breadth of livestreams on various OCD-related topics where sufferers and experts gather for education and community. You can join live on Facebook, Twitter, YouTube, or LinkedIn, and you can also watch recordings in those places. They also have a robust conference series with both in-person and virtual attendance options. There are scholarship opportunities available for these events, too.

How it feels to start ERP with a therapist

Most people with OCD who begin ERP find enormous relief in finally getting the right help. Zinman-Ibrahim says she had one client who saw nine therapists before her, but none of them specialized in ERP. This person was about ready to give up. As they started working together, the client gave their all to ERP, and found that their symptoms quickly improved. Though they felt frustrated that they didn’t get this help sooner, they felt overwhelmingly grateful to be getting it then. 

You might also feel anxious about starting ERP with a therapist. It can be scary to open up to a stranger—especially if you feel shame around your intrusive thoughts. However, as you work together, you’ll learn that your ERP therapist is the last person who will judge you. They’ve heard just about every intrusive thought under the sun, and they want to teach you how to be as indifferent to those thoughts as they are.

As you think about (and hopefully move toward) therapy, here are some tips for OCD treatment to keep in mind:

• Let your therapist guide the session. You don’t have to know what to do or say all the time. Your therapist is there to walk you through it, so let them take the lead.
• If you’re feeling particularly nervous, let your therapist know. They can help you work through where the nerves are coming from and normalize them. It can be relieving to stop feeling like you have to hide them.
• Know that it might feel strange in the beginning. “Starting ERP feels unnatural because you’re supposed to allow thoughts, images, and urges that violate the most fundamental elements of your character in your head as opposed to resisting them,” says Dr. McGrath. But your therapist will help you understand why ERP works—even if it’s counterintuitive—and make it feel a little more natural.
• Because it makes you question core parts of your values, beliefs, and/or identity, OCD can change how you see yourself. Try to take note of how tackling exposures builds your confidence and self-esteem.
• Practice self-compassion—in other words, be kind and gentle with yourself. Experts stress that perfection is not the goal with ERP. The OCD cycle is hard to break for a reason. You can do it, but that doesn’t mean you’ll get it right all the time. Judging or berating yourself for slip-ups, like engaging in a compulsion you thought you kicked, won’t help.
• Curious about medication for OCD? Ask your therapist about it. They can help assess whether it might be a helpful thing to add to your treatment plan.

Every day, members at NOCD experience what it feels like to finally work with an ERP therapist. One member, Lisa, says, “If you need help, please get it as soon as possible because I truly believe the sooner you learn how to fight OCD, the better it is!”