Obsessive compulsive disorder - OCD treatment and therapy from NOCD

You’re afraid of ERP therapy, but do you really know what it’s like?

By Stephen Smith

Sep 06, 20225 minute read

If you have obsessive-compulsive disorder (OCD) and have done research about your best treatment options, chances are you’ve stumbled upon exposure and response prevention therapy, commonly known as ERP, EXRP, or sometimes even ERPT. It’s considered by the psychiatric research community as the gold-standard therapy for OCD, and about 80% of people on average see significant improvement in OCD symptoms through ERP. Hundreds of randomized control trials have demonstrated ERP’s clinical efficacy, and it’s proven to be just as effective in a telehealth setting

Yet, despite ERP’s often transformative impact, many people with OCD often feel nervous to start it. Some even decide to forgo treatment altogether rather than see an ERP specialist. From witnessing thousands of conversations about ERP in the OCD community, and going through ERP myself, I’ve observed that this nervousness is often rooted in a significant misunderstanding about what ERP entails. My objective is to alter these all-too-common misconceptions. 

What ERP therapy is like vs. how it’s perceived 

Imagine if you could learn how to respond to your OCD fears in a way that caused them to eventually stop bothering you, no matter their frequency or severity at the moment. How happy would you be? Unknown to many, that’s actually the goal of ERP therapy: to learn how to effectively respond to all OCD fears whenever they happen by not doing compulsive actions, so they eventually cause less distress. 

However, ERP therapy in the OCD community is often inaccurately discussed as only doing structured exposures—exercises to purposefully trigger OCD fears. Exposures represent the “E” in “ERP.” Licensed therapists who specialize in ERP do structured exposures, both in a practice and real-world setting, only as a way to teach their patients how to respond to OCD fears in both planned and unplanned settings, and how to resist engaging in compulsions that make OCD worse over time. 

The dangers of misunderstanding OCD

Since OCD is chronic and episodes can happen anywhere and at any time, people doing ERP therapy with an OCD specialist and people who are too afraid to start ERP therapy are essentially both forced to encounter unplanned exposures throughout the day. 

That’s right: people who avoid formal ERP therapy out of fear of doing exposures are still presented with unplanned exposures just by engaging in daily life with OCD, even if they don’t realize it. The difference is that people who haven’t done ERP therapy with a specialist have not received the personalized guidance needed to know how to respond to sudden, unplanned exposures by resisting all of their compulsions and mindfully accepting uncertainty—that type of response prevention is the “RP” in ERP. As a result, they continue to respond to these exposures with compulsions, and their OCD only gets worse over time. This is because the more people engage in compulsions, the more they become reliant on those compulsions—meaning they become more time-consuming, distressing, and cause more interference in their lives. That’s why the “RP” is critical: it helps breaks this cycle. 

Let’s say that Andrew is struggling with Relationship OCD, or ROCD, for instance. Intrusive thoughts and fears strike him daily: “What if I fall out of love with my wife?” He compulsively searches online for reassurance and certain answers, and he mentally analyzes every thought he has about his wife to try to confirm that he still feels love for her. 

Since Andrew fears that doing exposures with an ERP therapist could cause him to realize that he no longer loves his wife, he avoids starting ERP therapy. It is an extremely unfortunate decision, as the treatment would actually help him learn how to respond to his fears so they bother him less with time, allowing him to feel more secure in his love for his wife and giving him the freedom to feel confident in his relationship. 

Without knowing any better, Andrew keeps engaging in compulsions, causing him to retreat from his relationship and feel less and less secure about his own feelings. The relationship starts to spiral downward. If Andrew had recognized ERP for what it is—centered primarily on response prevention, rather than exposures—he may have been able to stop OCD’s vicious cycle and avoid the decline in his relationship.

Face your fears and start ERP with an OCD Specialist

Sadly, I’ve seen stories like Andrew’s dozens of times—the downfalls were all avoidable. That’s why it’s imperative to make it clear that ERP therapy is mainly focused on learning how to respond to OCD fears without compulsions, while both planned and unplanned exposures are vehicles used to master response prevention. To communicate this principle, exposure and response prevention should be represented with the acronym ERP, rather than the misnomer of “exposure therapy.”

If you are interested in starting Exposure and Response Prevention therapy with a licensed therapist who specializes in it, you have several options. You can find an ERP specialist in the NOCD network who can do live face-to-face virtual sessions with you, or you can seek one from the IOCDF network. Don’t hesitate to interview your provider before starting with them to make sure you find the right fit—here are a handful of questions you can ask

If you have any questions about starting ERP therapy or need more information about the treatment, please don’t hesitate to book a free 15-minute call with our care team. On the call, we’ll assist you in either getting started with a licensed therapist at NOCD who has specialty training in OCD and ERP, or connect you to other resources that might be helpful. 

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