OCD Exposure Therapy: How ERP Therapy Works for Treating Compulsions
Living with OCD can feel overwhelming, but there is hope. A mental health professional can discuss the benefits of ERP for treating OCD with you, including whether it’s a good fit for your needs. This page also works as a powerful guide for understanding OCD exposure therapy, walking you through how ERP works and why it might be the solution you’ve been looking for. It explores:
What OCD is- What OCD exposure therapy is
- How ERP can help when treating compulsions
- Benefits of ERP
- What to expect when starting ERP
- Where to find professional support
What Is OCD?
To put this definition as clearly as possible, someone with OCD will often have intrusive, repetitive thoughts (obsessions) that can cause significant distress. In attempts to alleviate this distress, the person might perform certain actions or “rituals.”
However, these rituals typically only bring temporary relief. Obsessions usually return, and the person will feel compelled to repeat their rituals to try to feel better again. This can become a never-ending cycle of obsessions and compulsions.
An example may help to better illustrate the OCD process.
For a moment, try to imagine a person who constantly fears contracting an illness. This fear could become an intrusive obsession, always at the back of their mind, causing distress. To try to reduce this unpleasant feeling, this person may wash their hands. Yet, washing their hands once may not feel enough – like they haven’t truly gotten rid of all the dirt or germs and are still susceptible to illness. Therefore, they continue washing their hands until they feel properly cleansed. Typically, this routine is much more extensive than a normal hand wash, because it’s not based on seeing dirt removed, it’s targeting a “feeling” of being clean enough.
Therefore, every time something triggers the obsession of being “clean,” fear makes the person believe that washing their hands is the only way to find relief. And they will only finish washing their hands when it feels “right.”
Impact of OCD
OCD symptoms can differ in severity and presentation, sometimes being mild, and other times becoming so intense that they significantly impact daily life.
Plus, without OCD anxiety treatment, symptoms can worsen over time, affecting work, relationships, and the ability to complete daily tasks. They can also affect how a person feels, for example, causing anxiety, avoidance of OCD triggers, and feelings of shame.
Often, someone with OCD knows that their obsessions or compulsions don’t necessarily make sense, yet they might feel powerless to stop them.
What Causes OCD?
The exact causes of OCD aren’t currently known. However, research tells us that there may be several factors that could contribute to its development. For example, factors such as genetics, life stress, and childhood experiences could all potentially contribute to a person being vulnerable to OCD. For more details on the causes of OCD, check out our resource on OCD Risk Factors.
Seeking support for OCD is essential for reducing the distressing symptoms it brings. ERP therapy for OCD is a first-line treatment that can bring effective relief from both obsessions and compulsions. The following sections look at ERP in more detail.
What Is ERP Therapy?
Exposure and response prevention (ERP) is a type of behavioural therapy used to treat obsessive-compulsive disorder. In a nutshell, it involves exposing someone to triggers of obsessions and then having this person attempt not to engage in their compulsive behaviours or rituals.
The aim of this process is for a person to face their fears and see that they are less threatening than they originally thought, and, consequently, find symptomatic relief.
Using the example of someone fearing infection from not being “clean enough,” ERP would challenge this fear by exposing the person to scenarios they consider “unclean” in a gradual way. Over time, and with repeated exposure to more challenging situations, this person would recognize that they won’t become seriously ill from not engaging in the compulsion of washing their hands. In turn, they find relief from their obsessions and compulsions.
We break the ERP process down in more detail in the following sections.
How Does ERP Therapy for OCD Work for Compulsions?
ERP works for compulsions by breaking the link between someone’s obsessions and the rituals they use to reduce distress. By exposing the person with OCD to situations that trigger their obsessions while resisting the urges to carry out their usual ritual, the desire to complete a compulsion is reduced.
This is done in sessions with a therapist through psychoeducation, exposure, and response prevention. Next, we consider what ERP sessions might look like in practice.
What Do ERP Sessions Look Like?
The first step in any OCD therapy plan is to assess and identify OCD symptoms with your therapist. By monitoring your symptoms (obsessions and compulsions), it is possible to see how much they affect you on a daily basis. By seeing how much of your time is taken up by OCD, you may become more motivated to engage fully with the ERP process.
Once symptoms have been identified, a list of triggers can be created and arranged in order from least anxiety-provoking to most distressing. After this, the following elements of sessions can be put in place:
Psychoeducation
An important part of the ERP process is understanding how OCD works. For many people, discovering how avoidance and rituals actually keep OCD going can bring a new perspective to their symptoms. It can allow them to see that a better way of coping with OCD is to safely face their fears.
Exposures
Exposures involve purposely being exposed to the triggers previously identified in the assessment. However, this is done in a gradual way. From the list of triggers, exposures begin with the least anxiety-provoking item. This process enables a person to face a more manageable fear first and work toward more distressing exposures later.
Each exposure will be anxiety-inducing to some degree in the beginning, but this anxiety should diminish with repeated exposures. Once one particular exposure no longer provokes as much anxiety, the next trigger on the exposure hierarchy can be targeted.
Response Prevention
Response prevention means that someone purposefully and consciously does not perform their usual rituals to reduce anxiety. The goal here is to completely stop performing the compulsion. However, if it feels too much to stop compulsions completely, the ritual may be delayed or changed in some way until they can resist the action altogether.
This part of the sessions is particularly important, as rituals bring a temporary relief from the anxiety caused by obsessions. However, these compulsions are also what keep OCD going. OCD is a cycle; each time an obsessive thought occurs, it provokes anxiety. When an action that relieves the anxiety is carried out, the brain learns to believe that compulsion is needed to cope. Instead, by facing fears and learning they are not as scary as initially believed, the mind can recalibrate itself so that the thoughts evoke a less emotional response.
ERP Therapy Benefits
While this concern is completely understandable, it’s important to keep the bigger picture in mind. Where OCD can bring struggles and overwhelm, OCD behavioral treatment can instead bring benefits and real relief. For example, ERP therapy benefits can include:5
Reductions in obsessions and compulsions- Feeling more able to manage anxiety
- Increasing confidence in managing OCD symptoms
- Long-term changes and relief
- Greater belief of control over obsessions and rituals
Along with these benefits, research shows that ERP can be just as effective, if not more so, than medication for OCD.6
In addition, exposure and response prevention is recognized as the first-line treatment for OCD by the Anxiety & Depression Association of America. The same stance is also taken by the American Psychological Association, the National Institute for Health and Care Excellence, and the International OCD Foundation.7-10
Therefore, if you’re considering whether ERP is the right approach for you, you can rest assured that its benefits are backed by professionals in the field.
What to Expect From ERP Therapy for OCD
We’ve already discussed how ERP sessions typically work. However, if you’re still curious about how an OCD treatment program operates, the following sections may give you more insight.
The following are some of the most common OCD myths and challenges to these misconceptions:
1. Homework
A large component of ERP is being given homework to do between sessions. These usually consist of OCD therapy techniques such as carrying out exposures and recording your responses. By practicing at home, as well as during therapy sessions, people often find they progress quickly through their hierarchy. The phrase “practice makes progress” really is true in this case.
2. Session Settings
3. Noticing Improvements From ERP Therapy for OCD
Participating in exposure and response prevention therapy for OCD may feel tough at times. After all, you’re triggering your obsessions and fears while consciously withholding your usual method of bringing relief. However, with the right professional support and a compassionate therapist, you can take the first steps to finding real, lasting relief from OCD.
ERP vs. Traditional Talking Therapies
You might be wondering how ERP differs from more traditional forms of talking therapy. In truth, exposure and response prevention varies greatly in its approach. It is very focused and action-oriented, with people actively confronting anxiety triggers to break the OCD cycle. It also often involves an element of homework so that a person can practice their skills between sessions.
Traditional talking therapy, on the other hand, can often be focused more on exploration of the roots of challenges and changing underlying beliefs through conversation. Therefore, it could complement ERP for many people.
Cognitive Behavioral Therapy OCD
Cognitive behavioral therapy, also known as CBT, is a traditional therapeutic approach that helps to change thinking and behavior to manage a variety of mental health challenges, such as depression. Interestingly, ERP is, in fact, a type of CBT.4
Like with CBT, ERP aims to identify and challenge a trigger before learning to habituate to it. Therefore, when trying to find ERP therapy, you may notice that someone trained in CBT can deliver it.
OCD Support and Counseling With Mission Connection
ERP therapy has helped many people to break free from the exhausting loop of compulsions and obsessions. Therefore, there’s no reason it can’t help you, too. Whether you are just beginning to explore OCD therapy or are looking to enhance your current OCD coping strategies, ERP offers a structured and effective path toward recovery.
At Mission Connection, we specialize in helping people overcome their mental health challenges – including OCD. We can tailor a treatment plan based on your unique symptoms and goals, and use evidence-based approaches, including CBT and ERP, to help you heal.
If you’re ready to take control of your OCD, reach out to us today for a free, confidential consultation. You don’t have to face this challenge alone – we can help you every step of the way.
References
- International OCD Foundation. (2025, May 16). Exposure and Response Prevention (ERP). https://iocdf.org/ocd-treatment-guide/erp/
- Anxiety and Depression Association of America, ADAA. (2025, August 21). Anxiety Disorders – Facts & Statistics https://adaa.org/understanding-anxiety/facts-statistics
- American Psychological Association (APA). (2023, November 15). Obsessive-Compulsive Disorder. APA Dictionary of Psychology. https://dictionary.apa.org/obsessive-compulsive-disorder
- McKay, D., Sookman, D., Neziroglu, F., Wilhelm, S., Stein, D. J., Kyrios, M., Matthews, K., & Veale, D. (2014). Efficacy of cognitive-behavioral therapy for obsessive–compulsive disorder. Psychiatry Research, 225(3), 236–246. https://doi.org/10.1016/j.psychres.2014.11.058
- Ferrando, C., & Selai, C. (2021). A systematic review and meta-analysis on the effectiveness of exposure and response prevention therapy in the treatment of Obsessive-Compulsive Disorder. Journal of Obsessive-Compulsive and Related Disorders, 31, 100684. https://doi.org/10.1016/j.jocrd.2021.100684
- Law, C., & Boisseau, C. L. (2019). Exposure and Response Prevention in the Treatment of Obsessive-Compulsive Disorder: Current Perspectives. Psychology Research and Behavior Management, Volume 12, 1167–1174. https://doi.org/10.2147/prbm.s211117
- Anxiety and Depression Association of America, ADAA. (n.d.). Treatments for OCD. Retrived September 4, 2025, from https://adaa.org/understanding-anxiety/obsessive-compulsive-disorder-ocd/treatments-for-ocd
- Lambert, M. (2008, July 1). APA releases Guidelines on Treating Obsessive-Compulsive Disorder. https://www.aafp.org/pubs/afp/issues/2008/0701/p131.html
- NICE. (2005, November 29). Obsessive-compulsive disorder and body dysmorphic disorder: treatment https://www.nice.org.uk/guidance/cg31/chapter/Recommendations
- International OCD Foundation. (2025, June 5). Treatment Guide: Best Evidence-Based Therapies, Medications, and New Advances. https://iocdf.org/ocd-treatment-guide/
- Pinciotti, C. M., Bulkes, N. Z., Horvath, G., & Riemann, B. C. (2021). Efficacy of intensive CBT telehealth for obsessive-compulsive disorder during the COVID-19 pandemic. Journal of Obsessive-Compulsive and Related Disorders, 32, 100705. https://doi.org/10.1016/j.jocrd.2021.100705
- National Health Service. (2025, July 8). Treatment – Obsessive compulsive disorder (OCD). https://www.nhs.uk/mental-health/conditions/obsessive-compulsive-disorder-ocd/treatment/